A rare case of secondary live advanced abdominal pregnancy

Abstract

A 25-year-old gravida 2 para one with a history of 8 months lactational amenorrhoea presented to labour room with pain in abdomen since, 20 days in shock. Fundal height of uterus corresponded to 34 weeks size with unstable lie and uterus was relaxed. Fetal parts were palpable more easily than usual. Fetal heart sound was good. Pelvic examination revealed uneffaced and undilated cervix. Antenatal ultrasonography showed a single, viable fetus with gestational age of 33 weeks 6 days with oblique lie with head in right lower quadrant. Placenta was located in lower uterine segment covering internal os with AFI – nil with normal fetal cardiac activity and fetal movement. On opening the abdomen there was a boggy mass in the lower pelvic cavity with fetus with intact membrane lying in the abdominal cavity. Baby was delivered by breech extraction Baby weighed 2.2kg with no congenital anomaly. Placenta with membrane was in the left non-communicating horn of uterus with feeding vessels from omentum which were clamped, cut and ligated. The non-communicating horn with placenta was resected and left salpingo oophorectomy was done. Examination of intraabdominal viscera confirmed no injury. There was no torrential haemorrhage intraoperatively and abdomen was closed in layers after achieving proper hemostasis.