Undiagnosed Advanced Abdominal Pregnancy Complicated by Fetal Death Following Failed Induction of Labour: A Case Report from Southwest Nigeria
IGE, Toluwalase Ebenezer *
Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital Ado Ekiti, Ekiti State, Nigeria.
OLADIPUPO, Olasoji Olamide
Maternity Complex, Northwick Park Hospital, London Northwest University Hospital, NHS Trust, Harrow, London.
BAMISAYE, Nifesimi Damilola
Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital Ado Ekiti, Ekiti State, Nigeria.
ATOKI, Modupe Omowumi
Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital Ado Ekiti, Ekiti State, Nigeria.
AKOMOLAFE, Shina Emmanuel
Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital Ado Ekiti, Ekiti State, Nigeria.
IGBOROODOWO, Wuraola Oluwabunmi
Department of Obstetrics and Gynaecology, Ekiti State University Teaching Hospital Ado Ekiti, Ekiti State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Abdominal ectopic pregnancy (AEP) is a rare and potentially life-threatening obstetric condition which complicates on average 1 in 10000 to 1 in 30000 pregnancies. Its diagnosis is challenging because the presenting symptoms are non-specific and some do not present with symptoms. AEP is associated with enormous complications, including perinatal and maternal morbidity and mortality. The purpose of this report is to highlight a clinically important but rare condition which can pose a diagnostic challenge, especially in regions with limited health resources and poor patient health-seeking behaviour, such as found in Nigeria and other sub-Saharan countries.
We present a 38-years old G7P3+3(3A) with post-dated pregnancy and incidental finding of intra-abdominal pregnancy complicated by fetal death during Caesarean section, following failed induction of labour. Intra-operative findings included a female macerated stillborn and a ball-shaped placenta found within the peritoneal cavity. The uterus was intact, about 20 weeks size, with grossly normal fallopian tubes and ovaries. Her post-operative recovery was unremarkable.
Despite multiple trans-abdominal scans done by this patient, the diagnosis of AEP was missed. This emphasises the need to have a high index of suspicion, coupled with the availability of high-frequency ultrasound and skilled sonologists. Following diagnosis, interventions should be prompt in order to avert complications that can ensue.
Keywords: Abdominal ectopic pregnancy, antepartum hemorrhage, fetal death, obstetric emergency, perinatal/maternal morbidity and mortality, studdiford’s criteria