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BMJ Case Rep. 2017 Sep 1;2017. pii: bcr-2017-221433. doi: 10.1136/bcr-2017-221433.

Delayed diagnosis and management of second trimester abdominal pregnancy.

Author information

1
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of North Carolina, Chapel Hill, North Carolina, USA.
2
Department of Obstetrics and Gynecology, Mount Sinai St. Luke's and Mount Sinai West, New York, USA.
3
Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, USA.
4
Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.

Abstract

Second trimester abdominal ectopic pregnancies are rare and life threatening. Early diagnosis and treatment are paramount in reducing maternal morbidity and mortality. We describe an unusually late diagnosis of abdominal pregnancy despite multiple ultrasounds beginning in early pregnancy. A 28-year-old G2P1001 sought pregnancy termination at 22 weeks' gestation after fetal anomalies were noted on an 18-week ultrasound during evaluation for elevated maternal serum alfa-fetoprotein. Due to abortion restrictions in her home state, she travelled over 500 miles for abortion care. During dilation and evacuation, suspected uterine perforation led to the finding of a previously undiagnosed abdominal pregnancy. At laparotomy, she underwent left salpingo-oophorectomy and removal of abdominal pregnancy and placenta. A multidisciplinary team approach was paramount in optimising the patient's outcome. Abortion restrictions requiring travel away from the patient's home community interrupted her continuity of care and created additional hardships, complicating management of an unexpected, rare and life-threatening condition.

KEYWORDS:

Abortion; Medical Education; Pregnancy

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