Advanced Abdominal Pregnancy: Insights and Outcomes from a Two-Year Case Report and Literature Review at a Tertiary Hospital in South Africa

Advanced abdominal pregnancy (AAP) is a rare condition posing significant challenges to mothers, babies, and clinicians, especially in low-resource settings. Despite its association with high morbidity and mortality, there is limited data on its diagnosis and management. This retrospective study aimed to review the demographic characteristics, clinical presentation, imaging findings, treatment approaches, and outcomes for mothers and fetuses affected by AAP at Universitas Academic Hospital (UAH) from May 1, 2020, to May 1, 2022. A secondary objective was to enhance diagnostic and management guidelines at the institution. Out of 1129 deliveries during the study period, 11 patients were diagnosed with AAP. The mean age of the patients was 23 years, with 54% being unemployed, 45% using alcohol, and 27% smoking. Notably, 72% of the patients were HIV-positive, with 50% not virally suppressed and half having CD4 counts below 200 cells/µL. Additionally, 63% had undergone at least one ultrasound where AAP was missed. The most common symptom was abdominal pain, reported by 72% of patients. The study revealed that only 2 neonates survived, and 1 patient required ICU admission. The findings highlight critical gaps in AAP diagnosis and management, particularly missed diagnoses on ultrasound, and underscore the need for heightened clinical awareness, improved skills, and further research to enhance outcomes.