Advanced abdominal pregnancy: a case report.

ABSTRACT

A 37-year-old, gravida 5 with 41 weeks of gestation was admitted because of slight vaginal bleeding, abdominal pain, and absence of fetal movements for a few days. Previously she had been admitted to a provincial hospital with sudden severe abdominal pain and fainting at the second month of her pregnancy and ectopic pregnancy was suspected. She was discharged the following morning, after all signs and symptoms had completely disappeared without any special investigation. On her last admission all clinical examinations were normal but fetal heart sound was absent. The cervix was closed and uneffaced. Abdominal X-ray showed signs of fetal death. Sonography confirmed a dead fetus in utero but with placenta previa totalis. A laparotomy was performed. A macerated female fetus, weighting 3,800 g was found in the amniotic sac lying in the abdominal cavity. The placenta was attached to the dorsal surface of her abdomen close to the large intestine and the omentum; the entire placenta was untouched and left in the peritoneal cavity. There were no postoperative complications. She recovered well and was discharged after 7 days.