title: Hemoperitoneum in advanced abdominal pregnancy with a live baby: a case report.
abstract: BACKGROUND
  Abdominal pregnancy is a rare condition which is usually missed during prenatal assessment particularly in settings lacking routine ultrasound surveillance. We report a case of abdominal pregnancy at 32 weeks, which is most likely to have been a tubal abortion with secondary implantation, leading to delivery of a healthy baby girl weighing 1.7 kg.
  
  
  METHODS
  A 22-year-old woman, gravid 3 para 2 was referred to our centre from a district hospital with complaint of generalized abdominal pain and reduced fetal movements. Although the initial abdomino-pelvic ultrasound done at our centre was read as normal, there was subsequently a strong clinical suspicion of abdominal pregnancy, which was confirmed by a second ultrasound. The patient underwent laparotomy and was found to have an intact uterus with a viable fetus floating in the abdominal cavity without its amniotic sac and with hemoperitoneum of 1litre. The baby was extracted successfully; the placenta was found to be deeply implanted on the right cornual side extending to the fundus superiorly. Wedge resection of the cornual area and fundus was performed to remove the placenta. Intraoperatively, one unit of blood was transfused due to severe anemia prior to surgery. Both the mother and the baby were discharged home in good condition.
  
  
  CONCLUSIONS
  Abdominal pregnancy can be missed prenatally even when an imaging (ultrasound) facility is available. Emphasis should be placed on clinical assessment and thorough evaluation of patients.
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of Health and Allied sciences, P,O, BOX 1464, Mwanza, Tanzania. magonza77@yahoo.co.uk.
authors.forename: Dismas
authors.initials: D
authors.lastname: Matovelo
authors.forename: Nhandi
authors.initials: N
authors.lastname: Ng'walida
mesh_terms: D015746:Abdominal Pain / Q000150:complications; D005260:Female; D005865:Gestational Age; D006465:Hemoperitoneum / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007813:Laparotomy; D010920:Placenta / Q000000981:diagnostic imaging* / Q000196:embryology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011269:Pregnancy, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055815:Young Adult