Challenges and perspectives of abdominal pregnancy in a resource-limited setting: A case series

Kakanda Kaunda Christian-Bardol; Ekinda Mbula Patrick; Syrile Bwalya Chama; Kasereka Mwanamolo Noe; Maria Sumayi Musa; Lele Mutombo Fabrice

doi:10.1016/j.ijscr.2024.109282

Challenges and perspectives of abdominal pregnancy in a resource-limited setting: A case series

Int J Surg Case Rep. 2024 Feb:115:109282. doi: 10.1016/j.ijscr.2024.109282. Epub 2024 Jan 20.

Authors

Kakanda Kaunda Christian-Bardol¹, Ekinda Mbula Patrick¹, Syrile Bwalya Chama², Kasereka Mwanamolo Noe³, Maria Sumayi Musa⁴, Lele Mutombo Fabrice⁵

Affiliations

¹ General medicine, Saint Luc Reference Health Center, Lukafu, Haut katanga, the Democratic Republic of the Congo.
² General medicine, Saint Luc Reference Health Center, Lukafu, Haut katanga, the Democratic Republic of the Congo; Central Office of the Health Zone of Lukafu, Haut Katanga, the Democratic Republic of the Congo.
³ Department of Obstetrics and Gynecology, National University Hospital Hubert Koutoukou Maga, Cotonou, Benin.
⁴ Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania.
⁵ Department of General Surgery, Heal Africa Hospital, Goma, the Democratic Republic of the Congo. Electronic address: fabricelele@gmail.com.

Abstract

Introduction and importance: Abdominal pregnancies, although rare, present unique challenges in both diagnosis and management. This case series reports on four cases of abdominal pregnancies diagnosed in a remote and underserved region of the Democratic Republic of Congo, highlighting the difficulties encountered in an under-equipped environment.

Case presentation: The cases were documented in a remote village of DRC, which lacks specialized medical personnel and relies heavily on traditional healers. We report here 4 cases of abdominal pregnancies, their clinical presentations, diagnostic modalities, and surgical approaches. The cases varied in terms of clinical symptoms, gestational age, and placental implantation sites. Delayed diagnosis and presentation were common, resulting in significant hemoperitoneum and adverse fetal outcomes. All cases required laparotomy for both diagnosis and intervention.

Clinical discussion: Abdominal pregnancies can go undetected until advanced gestational age, with common physical findings including abdominal tenderness, abnormal fetal lie, fetal body parts readily palpable, and a displaced cervix. Laboratory tests may raise suspicion, but treatment options depend on intraoperative findings and gestational age. Advanced abdominal pregnancies are associated with high mortality rates for both the mother and the fetus. Laparotomy is typically required for diagnosis and intervention, with variations in placental implantation sites. Management of the placenta remains a debated topic, with partial or complete removal both viable options.

Conclusion: Abdominal pregnancies pose significant challenges in resource-poor settings, where limited healthcare resources and a shortage of specialized medical personnel can impede early diagnosis and appropriate management. Enhancing prenatal care, improving diagnostic capabilities, and increasing awareness among healthcare providers and communities are essential for optimizing outcomes in these complex obstetric cases.

Keywords: Abdominal pregnancy; Case series; Diagnosis; Management; Resource-limited settings.