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A 30-year review of advanced abdominal pregnancy at the Mater Misericordiae Hospital, Afikpo, southeastern Nigeria (1976–2006)

  • Materno-fetal Medicine
  • Published:
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Abstract

Purpose

This analysis attempts to highlight the varied presentations, diagnostic difficulties, management and subsequent obstetric performances of women managed for advanced abdominal pregnancy.

Methods

A retrospective analysis of all 20 cases of abdominal pregnancies between 1976 and 2006, at the Mater Misericordiae Hospital, Afikpo, southeastern Nigeria was performed.

Results

There were 20 cases of abdominal pregnancy out of 58,000 deliveries, giving an incidence of 0.34 per 1,000 deliveries. The diagnoses were missed in 10 cases and there was one maternal death. There were four live births, two early neonatal deaths and four cases of lithopedion. The placenta was removed in 11 cases. Though the duration of hospital stay was longer in women in whom the placenta was left in situ compared to those in whom the placenta was removed, the observed difference was, however, not statistically significant (p value, 0.538). The majority of the women were lost to follow-up over the years; however, of the five women successfully followed up, only two (40%) had subsequent childbirth.

Conclusion

The rate of 50% missed diagnosis in this study highlights the need for a high index of suspicion in the diagnosis of abdominal pregnancies as the clinical features are varied. It calls for vigilance on the part of the obstetrician. The maternal and fetal outcomes relate to early diagnosis and skilled management.

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References

  1. Ayinde OA, Aimakhu CO, Adeyanju OA, Omigbodun AO (2005) Abdominal pregnancy at the University College Hospital, Ibadan: a ten-year review. Afr J Reprod Health 9:123–127

    Article  CAS  PubMed  Google Scholar 

  2. Zeck W, Kelters I, Winter R, Lang U, Petru E (2007) Lessons learned from 4 advanced abdominal pregnancies at an East African health centre. J Perinat Med 35:278–281

    Article  PubMed  Google Scholar 

  3. Opare-Addo HS, Deganus S (2000) Advanced abdominal pregnancy: a study of 13 consecutive cases seen in 1993 and 1994 at the Konfo Anokye Teaching Hospital, Kumasi, Ghana. Afr J Reprod Health 4:28–39

    Article  CAS  PubMed  Google Scholar 

  4. Little KJ, Green MM (1995) Abdominal gestation. J Emerg Med 13:195–198

    Article  CAS  PubMed  Google Scholar 

  5. Sheikh MS, Misbha AM, Parvaiz AS, Omer SK (2009) Abdominal pregnancy as a cause of haemoperitoneum. J Emerg Trauma Shock 2:196–198

    Article  Google Scholar 

  6. Nkusu Nunyalulndho D, Eintrerz EM (2008) Advanced abdominal pregnancy: case report and review of 163 cases reported since 1946. Rural Remote Health 8(4):1087. Available from http://www.rrh.org.au. Accessed on 23 May 2009

  7. Clarke JF, Bourke J (1959) Advanced ectopic pregnancy. Am J Obstet Gynaecol 78:340–341

    Google Scholar 

  8. Worley KC, Hnat MD, Cuningham FG (2008) Advanced extrauterine pregnancy: diagnostic and therapeutic challenges. Am J Obstet Gynecol 198: 297.el–297.e7

  9. Mitra S (1942) Advanced extra-uterine pregnancy: report of 22 original cases with collective review of literature. Calcutta Med J 39(1):43–45

    Google Scholar 

  10. King G (1954) Advanced extrauterine pregnancy. Am J Obstet Gynaecol 6:712–740

    Google Scholar 

  11. Atrash HK, Friede A, Hogue CJR (1987) Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynaecol 69:333–337

    CAS  Google Scholar 

  12. Cross JB, Lester WM, McCain JR (1951) The diagnosis and management of abdominal pregnancy with a review of 19 cases. Am J Obstet Gynecol 62:303–311

    CAS  PubMed  Google Scholar 

  13. Delke I, Veridiano NP, Tancer LM (1982) Abdominal pregnancy: review of current management and addition of 10 cases. Obstet Gynecol 60:200–204

    CAS  PubMed  Google Scholar 

  14. Martin JN, Sessums JK, Martin RW, Pryor JA, Morrison JC (1988) Abdominal pregnancy: current concepts of management. Obstet Gynecol 71:549–557

    PubMed  Google Scholar 

  15. Breen JL (1970) A 21-year survey of 654 ectopic pregnancies. Am J Obstet Gynecol 106:1004–1019

    CAS  PubMed  Google Scholar 

  16. Westrom L (1975) Effect of acute pelvic inflammatory disease on infertility. Am J Obstet Gynecol 121:707–713

    CAS  PubMed  Google Scholar 

  17. Egwuatu VE, Ozumba BC (1987) Unexpectedly low ratio and falling incidence of ectopic pregnancy in Enugu, Nigeria. Int J Fertil 32:113–121

    CAS  PubMed  Google Scholar 

  18. Mbura JSI, Mgaya HN (1986) Advanced abdominal pregnancy in Muhimbili Medical centre, Tanzania. Int J Gynaecol Obstet 24:169–176

    Article  CAS  PubMed  Google Scholar 

  19. Astill AN (1980) Advanced abdominal pregnancies: two case reports. Aust IV J J Obstet Gynaecol 20:236–239

    Article  CAS  Google Scholar 

  20. Crabtree KE, Collet B, Kilpatrick SJ (1994) Puerperal presentation of a living abdominal pregnancy. Obstet Gynecol 84:646–647

    CAS  PubMed  Google Scholar 

  21. Tan KL, Goon SM, Wee JH (1969) The paediatric aspects of advanced abdominal pregnancy. J Obstet Gynaecol Brit Cwlth 76:1021–1028

    Article  CAS  Google Scholar 

  22. Moir JC Munro Kerr’s operative obstetrics (1964) Bailliere, Tindall and Cox, London, p 780

  23. D’Cunha APJ, Maroo SV (1971) Report on two cases of advanced abdominal pregnancy presenting as intestinal obstruction. E Afr Med J 48:116–171

    Google Scholar 

  24. Hall JM, Manning N, Moore NR, Tingey WR, Chamberlain P (1996) Antenatal diagnosis of late abdominal pregnancy using ultrasound and magnetic resonance imaging: a case report of successful outcome. Ultrasound Obstet Gynecol 7:289–292

    Article  CAS  PubMed  Google Scholar 

  25. Alexander MC, Horger OC (1983) Early diagnosis of abdominal pregnancy by ultrasound. J Clin Ultrasound 11:45–48

    Article  CAS  PubMed  Google Scholar 

  26. Kobayashi M, Hellman LM, Cromb E (1972) Atlas of Ultrasonography in Obstetrics and Gynaecology. Appleton-century Crafts, New York, p 137

  27. Alliborne GW, Fagan CJ, Porter SC (1981) The sonographic features of intra-abdominal pregnancy. J Clin Ultrasound 9:383–387

    Article  Google Scholar 

  28. Stanley JH, Horger EO, Fagan CJ, Andriole JG, Fleischer AC (1986) Sonographic findings in abdominal pregnancy. Am J Roetgenol 147:1043–1046

    CAS  Google Scholar 

  29. Grech P (1965) Radiological diagnosis of advanced extrauterine pregnancy. Br J Radiol 38:848–852

    Article  CAS  PubMed  Google Scholar 

  30. Soodeen T, Logley JD (1971) Plain film radiologic findings in abdominal pregnancy. J Can Assoc Radiol 22:163–167

    Google Scholar 

  31. Zvandasara P (1995) Advanced extrauterine pregnancy. Cent Afr J Med 41:28–34

    Google Scholar 

  32. Pelosi MA, Appuzio J (1988) Surgical management of abdominal pregnancy. Contemp Obstet Gynecol 31:144–156

    Google Scholar 

  33. Hreshchyshyn MM, Loghran GH (1965) What is the actual present day management of the placenta in late abdominal pregnancy? Am J Obstet Gynaecol 81:302–317

    Google Scholar 

  34. Rahman MS, Al-Suleiman AS, Rahman J, Al Sibai MH (1981) Advanced abdominal pregnancy: observation in 10 cases. Obstet Gynaecol 59:366–372

    Google Scholar 

  35. Eneli AC, Kuku SB (1975) Advanced abdominal pregnancy: two case reports. Nig Med J 5:170–171

    Google Scholar 

  36. Irwin HW (1960) Intraligamentous and abdominal pregnancy: report of four cases and review of the literature. Obstet Gynecol 16:327–333

    CAS  PubMed  Google Scholar 

  37. Strafford CJ, Ragan WD (1977) Abdominal pregnancy: review of current management. Obstet Gynecol 50:548–552

    CAS  PubMed  Google Scholar 

  38. Ware HH, Richmond V (1948) Observation on 13 cases of late extrauterine pregnancy. Am J Obstet Gynecol 55:561–582

    PubMed  Google Scholar 

  39. Schoffstall, Fackler EF (1965) Lithopaedion: report of two unusual cases. Obstet Gynecol 26:884–886

  40. Jongen VHWM, Van den Heuvel MM (1995) An abdominal pregnancy. Tropical Doctor 25:124

    Google Scholar 

  41. Twomey D (1994) Awareness of ectopic pregnancy. Niger J Surg Sci 4:48–49

    Google Scholar 

  42. Santos-Dias A (1971) Advanced abdominal pregnancy: three cases with a review of literature. S Afr Med J 45:62–66

    CAS  PubMed  Google Scholar 

  43. Cockshott WP, Lawson J (1972) Radiology of advanced abdominal pregnancy. Radiology 103:21–29

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the assistance of Prof W.I.B. Oniugbo, Professor of Pathology, National Orthopaedic Hospital, Enugu.

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Correspondence to Patrick I. Okonta.

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Sunday-Adeoye, I., Twomey, D., Egwuatu, E.V. et al. A 30-year review of advanced abdominal pregnancy at the Mater Misericordiae Hospital, Afikpo, southeastern Nigeria (1976–2006). Arch Gynecol Obstet 283, 19–24 (2011). https://doi.org/10.1007/s00404-009-1260-4

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  • DOI: https://doi.org/10.1007/s00404-009-1260-4

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