2020-06-04 | Télécharger
BACKGROUND :
Abdominal implantation of a pregnancy is uncommon, accounting for 1.4% of all ectopic pregnancies and with a reported range of 1:10000 to 1:30000 pregnancies [1–3]. Abdominal pregnancies have been reported in several contexts in both high-income countries as well as lowand middle-income countries. A review of 163 cases of abdominal pregnancies from 13 countries emphasized how difficult it is to make the diagnosis [4]. Another series of
19 cases from Libreville, Gabon also highlighted the challenges of timely accurate diagnosis beyond the second trimester, especially in resource limited settings [5].
Severe complications associated with ectopic pregnancies are well known including maternal and fetal death, especially with increased gestational age. With abdominal pregnancies, fetal mortality rates range from 40 to 95%, while maternal mortality ranges from 1 to 18% [2]. Because diagnosis is typically made late, the fetus is often already dead when the abdominal pregnancy is recognized [2, 5]. With increasing gestational age, maternal complications can occur at any time in the antepartum, peripatum or poatpartum periods, these complications include spontaneous separation of the placenta leading to massive haemorrhage, shock, disseminated intravascular coagulation [3], organ failure, and death. Also, attempts to remove the placenta may causeuncontrollable, catastrophic bleeding leading to maternal
death. After delivery, an in-situ placenta may not resorb,
and infection may develop from its necrosis. However,good maternal and fetal outcomes have also beendocumented at a range of gestational ages from 31 weeks
[6–8] to 39 weeks [3, 5].
Existing literature around abdominal pregnancies is
mostly comprised of case reports and case series.
However, this case report is among the rare ones from
eastern Democratic Republic of Congo (DRC), a postconflict region. Despite a positive outcome for both the
mother and baby, neither the ultrasound nor the physical exam revealed the diagnosis of abdominal pregnancy
pre-operatively. This case report alerts clinicians to be
aware of the possibility of abdominal pregnancy in a patient with painful fetal movements and contributes to
existing data about good fetal and maternal outcomes.
Paluku, J.L. , Kalole, B.K., Furaha, C.M. et al. Late abdominal pregnancy in a post-conflict context: case of a mistaken acute abdomen - a case report. BMC Pregnancy Childbirth 20, 238 (2020).
https://doi.org/10.1186/s12884-020-02939-3