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

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.