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C~ TERM ABDOMINAL
ORT------------------------
PREGNANCY MIS-DIAGNOSED AS PLACENTA
BENIN - CITY: A CASE REPORT
PRAEVIA IN

*CA Okonkwo, FMCOG and ABA Ande, fWACS.

Departments of Obstetrics and Gynaecology, Uniuersity of Bening
Teaching Hospital, Benin - City, Nigeria.

SUMMARY
A 38-year old multiparous woman presented at the 37th week with a day history of
bleeding per vaglnum . Ultrasound scan made a diagnosis oj Placenta Praevla. She had a
laparatomy and was delivered oj a live female neonate, 2.7kg with Apgar scores oj 7 and 9 at
the first and fifth minute. The baby was lying within the peritoneal cavity with the placenta
attached to the ileum and Jejunum. Haemostasls was secured and the wound was closed with
the placenta and membranes left In-situ. She was transJused with Jour units oj blood and both
mother and baby did well.
This case highlights the Importance oj ultrasound scan In pregnancy by a competent
sonologlst and the possibility oj a viable abdominal pregnancy at term.

INTRODUCTION stained but there was no active bleeding per

Abdominal pregnancy is a formidable task for
an obstetrician and it is one of the most dreadful
calamities that can befall a woman'v'. This is
particularly more alarming when the pregnancy
survives till an advanced stage with antecedent
danger of the placenta invading delicate vascular
intra-abdominal structures". This case report is a
typical example.
Abdominal pregnancy is associated with
several complications including massive
haemorrhage (haemoperitoneum), acute abdomen,
intestinal obstruction, sepsis and death. 4
We report a ~case of abdominal pregnancy at
term, in a woman with previous ectopic gestation,
which was diagnosed at planned caesarean section
for placenta praevia with resultant delivery of a live
neonate.
CASE REPORT
Mrs av.a 38year old Para2+1 presented to
the Labour Ward on the 8th of June 2005 with a
days history of bleeding per vaginum at the 37th
week of pregnancy. She had a laparotomy and
right partial salpingectomy in November 2003 for a
ruptured ectopic gestation. There was no history of
pain or trauma, however she had been admitted at
13th week of the index pregnancy for severe lower
abdominal pain in a Private Hospital and was later
discharged when the pain subsided.
Examination revealed a pregnant woman who
was calm, not pale, afebrile with no pedal oedema.
Her pulse rate was 84beats per minute and blood
pressure 120/70mmHg.The abdomen was
uniformly enlarged, Uterus was 36 weeks size with
a single fetus in longitudinal lie, cephalic
presentation and the fetal heart rate was regular at
140 beats per minute. The vulva was slightly blood
*Correspondence: Dr CA Okonkwo
Department of Obstetrics and Gynaecology, University of
Benin Teachuu; Hospital, Benin - Citv, Ni.qeria.
Sahel Medical Journal Vol 9 No.4 October - December, 2006 (147 - 149)
vaginum. A clinical diagnosis of Antepartum
Haemorrhage due to Placenta praevia was made .
An ultrasound scan request made a diagnosis of
Type 3 Placenta praevia with a viable fetus at
36weeks. The cadre of the sonologist was
technician level in a private establishment. The
packed cell volume was 30%, and all other
investigations were normal.The patient was then
prepared for an elective caesarean section. Two
units of blood were made available for her.
The findings at laparotomy were a massive
haemoperitoneum with the fetus within its gestation
sac lying over the area of the ileum and jejunum.
The placenta was attached to the jejunum and
ileum up to its terminal part. A live female 2. 7kg
baby (Fig. 1) was delivered, and she had Apgar
scores of 7 and 9 in the first and fifth minute,
respectively. The cord was tied close to the
placenta with chromic catgut and severed with
haemostasis secured. The uterus was about
16weeks size. Two tube drains were put in the
peritoneal cavity since the placenta and
membranes were left in the peritoneal cavity (Fig.
2). The abdomen was closed appropriately in
layers.
Figure 1: The delivered live female neonate.
147
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Term Abdominal Pregnancy Mis-Diagnosed As Placenta Praevia
CA Okonkwo and ABA Ande
and keen assessment of many diagnostic clues,
none of which is conclusive''. The patient presented
late and the ultrasound report, which was later
discovered to have been done by a Radiographer,
further reduced the index of suspicion. This almost
led to a maternal mortality because the patient
already had a haemoperitoneum discovered on the
operating table, also she was booked for elective
Caeseran section instead of an emergency
laparotomy.
The placenta was left 'in-situ to undergo
autolysis because of its attachment to the small
intestine hence two tube drains were left in the
peritoneal cavity to facilitate drainage of autolysed
tissue. Management of the placenta remains the
most controversial issue in the management of
abdominal pregnancy. Most reports 1 ,2 have
emphasized that removal of the placenta where
considered safe is associated with the lowest
maternal morbidity and mortality. However where
Figure 2: Post operative laparotomy dressing its removal is judged risky, as in this case, it should
with tube drains. be left alone .
In conclusion advanced abdominal pregnancy
Post-operatively the patient was managed with has no classic symptoms and pathognomic
antibiotics, analgesics and intravenous fluids. She features. A high index of suspicion with good
had a total of 4 units of whole blood transfused . ultrasound scan services would help in making a
She had a good post-operative recovery. Her diagnosis.
haematochrit was 29% on third post operative day A limitation of this case report was the inability
and the tube drains were removed on the 14thpost of the surgeon to obtain photographs intra-
operative day. She was discharged home with her operatively, this was as a result of the massive
baby on the 16th post-operative day. Her baby was peritoneal haemorrhage encountered at surgery.
admitted into the Special Care Baby Unit for a However, post operative photographs were taken;
week for neonatal jaundice. She was thereafter (Figs 1 & 2).
seen at the Post Natal Clinic and she had no
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Term Abdominal Pregnancy Mis-Diagnosed As Placenta Praevia

CA Okonkwo and ABA Ande
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