Intra-abdominal pregnancy complicated by uterine rupture: a case report

Intra-abdominal pregnancy is a rare and life-threatening form of ectopic gestation that poses significant diagnostic and management challenges, particularly in low-resource settings. Its occurrence alongside uterine rupture further increases maternal risk. We report the case of a 22-year-old gravida 4, para 1 + 2 Ugandan woman at 28 weeks + 3 days of gestation who presented with lower abdominal pain and vaginal bleeding. She had not attended antenatal care or undergone prior imaging. On examination, fetal heart sounds were absent, and the uterus was tender with smaller-than-expected fundal height. A provisional diagnosis of intra-abdominal pregnancy with possible uterine rupture was made. Emergency laparotomy revealed a ruptured uterine fundus with an intact gestational sac containing a macerated stillborn male fetus weighing 1.2 kg. The necrotic tissue was excised, and the uterine defect was repaired in layers. The postoperative course was uneventful, and the patient was discharged in stable condition. This case highlights the critical need for early antenatal attendance, access to basic obstetric ultrasound, and timely referral to avert complications associated with advanced extra-uterine pregnancies and uterine rupture. Strengthening maternal health systems and clinical suspicion remains vital to improving outcomes in similar low-resource settings.