Advanced Abdominal Pregnancy As a Cause of Symptomatic Hemoperitoneum

Background: Abdominal pregnancy is an ectopic pregnancy in which a fetus develops in the peritoneal cavity. Rates of maternal mortality and morbidity are high and are largely the result of hemorrhage because of separation of the placenta. Abdominal pregnancies are rare and are often misdiagnosed. Case: A 31-year-old multipara with an abdominal pregnancy that was initially misdiagnosed as a missed abortion was referred to the Obafemi Awolowo University Teaching Hospitals Complex, in Ile Ife, Osun State, Nigeria, from a peripheral hospital because of failed attempts at medical evacuation of uterine contents at the peripheral hospital. This patient later had an emergency exploratory laparotomy and evacuation of the products of conception from the peritoneal cavity at a gestational age of 24 weeks. Hemostatic stitches were applied to the sites of placental attachment on the anterior abdominal wall, sigmoid colon, and small bowel. The patient was discharged from the hospital on the 14th postoperative day in stable condition. Results: The patient had a remarkable improvement on follow-up. She expressed her desire for contraception and later opted for hormonal implant (Implanon). Conclusions: Diagnosis of abdominal pregnancy continues to be a challenge, resulting in delays in diagnosis and decision making. A high index of suspicion is needed with an appropriate management approach to limit morbidity and prevent mortality.