Abstract
Background: Advanced abdominal pregnancy is a rare form of ectopic pregnancy. It is is rarely diagnosed mainly in low-income countries and associated with a very high foetal and maternal morbidity and mortality. The management of advanced abdominal pregnancy is based on surgery procedure. Laparotomy was chosen to be better than laparoscopic surgery because of the risk of perioperative haemorrhage, which can be uncontrollable from the implantation site. Uterine prolapse during pregnancy is rare. the aetiology is multifactorial. We report this association to discuss difficulties of management of these two pathologies in areas where health services are unavailable or utilized poorly.
Case presentation A 25-year-old woman is referred in our maternity for uterine prolapse and pregnancy. On examination, the cervix was protruding and oedematous beyond the introitus (Stade IV of POP-Q classification). She has no prenatal consultation and no history of surgery or vaginal delivery complications. The obstetric ultrasound showed an empty uterus and the abdominal pregnancy at 32 weeks, the placenta localisation was unclear. An urgent laparotomy was done, and we discovered the foetus in the abdominal cavity and the placenta is attached on the right ovary and large ligament. We proceeded to the extraction of foetus and placenta successful. The newborn presented an ectodactylia and club foot varus equinus. He developed respiratory distress after 12 hours and died. before her discharged from hospital, she requests sterilization and total hysterectomy was scheluded after 3 months.
Conclusion the association of advanced abdominal pregnancy ant uterine prolapse is exceptional. It can be seen in developing countries because of poor prenatal follow up. The management is based on urgent laparotomy for abdominal pregnancy and hysterectomy for uterine prolapse for women who have completed their family’s life.