PT  - JOURNAL ARTICLE
AU  - Katherine Tucker
AU  - Neha Rani Bhardwaj
AU  - Elizabeth Clark
AU  - Eve Espey
TI  - Delayed diagnosis and management of second trimester abdominal pregnancy
AID  - 10.1136/bcr-2017-221433
DP  - 2017 Sep 01
TA  - BMJ Case Reports
PG  - bcr-2017-221433
VI  - 2017
4099  - http://casereports.bmj.com/content/2017/bcr-2017-221433.short
4100  - http://casereports.bmj.com/content/2017/bcr-2017-221433.full
AB  - 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.