Viable Advanced Abdominal Pregnancy Following Prior Cesarean Sections: A Case Report And Surgical Insight

Abdominal pregnancy is a rare and potentially life-threatening form of ectopic pregnancy, where implantation occurs within the peritoneal cavity. Advanced abdominal pregnancy (AAP), defined as gestation beyond 20 weeks, poses significant diagnostic and surgical challenges, especially in resource-limited settings. Case Presentation: We report a case of a 31-year-old multiparous woman (para 3, all via cesarean section) who presented at 31 weeks gestation with mild abdominal pain. Initial ultrasound revealed an empty uterus and a viable extrauterine fetus. Transvaginal scan and abdominal X-ray confirmed abdominal pregnancy. She was referred to a tertiary center, where elective laparotomy was performed. Intraoperatively, the fetus was found free in the abdominal cavity and delivered successfully. The placenta was densely adherent to the bladder, uterine fundus, and pelvic walls. It was left in situ due to high risk of hemorrhage. Management and Outcome: Postoperative care included antibiotics and anticoagulants. The patient was followed with serial ultrasound and β-hCG monitoring. Initially, methotrexate was withheld, but later administered after the patient sought external consultation. Placental tissue regressed over two months, and the patient remained stable. The neonate was healthy with no congenital anomalies. Conclusion: Advanced abdominal pregnancy can result in favorable maternal and fetal outcomes if diagnosed and managed appropriately. Placental management remains the cornerstone of surgical decision-making. Expectant management with delayed methotrexate may be considered when placental removal is contraindicated.