A case report on a rare case of abdominal ectopic pregnancy

Abdominal pregnancy is a rare and potentially life-threatening form of ectopic pregnancy, accounting for approximately 1-2% of all ectopic gestations and associated with high maternal morbidity and mortality. Due to its variable presentation and diagnostic challenges, it is often misdiagnosed as an intrauterine pregnancy, leading to delayed management. We report a case of a 35-year-old sterilised woman, gravida 5 para 3, who presented at 26 weeks of gestation with three months of amenorrhea followed by irregular vaginal bleeding for 20 days. Initial evaluation suggested an intrauterine pregnancy with fetal demise; however, failure of induction and further ultrasonographic evaluation revealed an abdominal ectopic pregnancy with the fetal head located in the pouch of Douglas. The patient underwent exploratory laparotomy with en-masse removal of the fetus and placenta. Intraoperatively, the placenta was found adherent to the sigmoid mesentery without invasion of major pelvic organs. Postoperative recovery was largely uneventful, and the patient was discharged in stable condition. This case highlights the importance of maintaining a high index of suspicion for abdominal pregnancy, especially in patients with atypical clinical findings and poor response to induction. Early diagnosis, appropriate imaging, meticulous surgical planning, and a multidisciplinary team approach are crucial to reduce maternal morbidity and mortality associated with this rare condition.