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Reminder of important clinical lesson
CASE REPORT
Delayed diagnosis and management of second trimester abdominal pregnancy
  1. Katherine Tucker1,
  2. Neha Rani Bhardwaj2,3,
  3. Elizabeth Clark4,
  4. Eve Espey4
  1. 1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of North Carolina, Chapel Hill, North Carolina, USA
  2. 2Department of Obstetrics and Gynecology, Mount Sinai St. Luke’s and Mount Sinai West, New York, USA
  3. 3Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, USA
  4. 4Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
  1. Correspondence to Dr Katherine Tucker, ktucker77{at}gmail.com

Summary

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.

  • Medical Education
  • Abortion
  • Pregnancy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2017-221433

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    Footnotes

    • Contributors KT was the lead author for this manuscript. She was responsible for initial planning and conception of this case report, one of several authors of the first draft and has helped with numerous revisions of the paper. NRB and KT are immediate mentors for the project. They oversaw and contributed to the first draft of the paper as well as have been editors for its newer revisions. KT and NRB have both been in contact with the patient during the writing process. EC was involved in drafting the discussion for the initial draft and has been a contributor to newer revisions of the paper. EE was the lead mentor. She and KT initially conceived of the idea of writing this up as a case report. She has been instrumental in terms of her mentorship and editing of every iteration of the manuscript. All four authors were directly involved in this patient’s care.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.