Full term abdominal pregnancy associated to a cornual uterine rupture and placenta percreta: a case report

Abstract

English Title: Grossesse abdominale à terme associée à une rupture utérine de la cornuae et un placenta percreta: un rapport de cas

Background: Abdominal pregnancy is an ectopic pregnancy in which the conceptus implants in the peritoneal cavity. It represents a very rare event with severe maternal and foetal morbidity and mortality. Abdominal pregnancy accounts for 1/10,000 live deliveries and the advanced forms 1/25,000. It is reported to represent 10/100,000 pregnancies in the USA and the diagnosis is usually missed during the antenatal period despite the routine use of ultrasound. Many authors recommend termination of abdominal pregnancy once it is diagnosed to avoid cataclysmic bleeding resulting from rupture and the associated maternal death.
Case presentation: the report is on a case of 29 year-old, G2P1 who presented at 36 weeks of gestation with ultrasonographic diagnosis of placenta praevia. An elective caesarean section was done at 37 weeks and an abdominal pregnancy with left cornual uterine rupture and placenta percreta discovered with live female baby of 3.300 g, Apgar score 8 and 10/10 at the First and fifth minutes respectively. An attempt to deliver the placenta led to massive bleeding and a subtotal hysterectomy was done. The post operativeperiod was uneventful and the patient discharged at day 5.
Conclusion: This case is presented because of its rarity and lessons learned which include: Abdominal pregnancy is a rare occurrence with the diagnosis often missed during antenatal period despite routine use of Ultrasonography. Abdominal pregnancy can result into good maternal and foetal outcomes. There is a need to review the recommendations on management of abdominal pregnancies.

Key words: Abdominal Pregnancy, Cornual Uterine Rupture, Placenta Percreta, Hysterectomy