title: Advanced abdominal ectopic pregnancy: lessons from three cases from Zimbabwe and a literature appraisal of diagnostic and management challenges.
abstract: We report three cases illustrating difficulties in diagnosis and challenges with management of the placenta in a low-resource country where ultrasound scanning, methotrexate, interventional radiology or blood products are often not accessible for the majority of patients. Even in situations where an ultrasound scan is available prenatally as in our three cases, the diagnosis is often missed. All the cases presented with vague abdominal symptoms, which are common in pregnancy anyway. Only one case was correctly diagnosed before surgery by ultrasound scan. For the two cases in the second trimester as expected the fetuses did not survive. The one advanced pregnancy had a good perinatal outcome. Maternal morbidity and mortality usually results from perioperative hemorrhage from the placental attachment site. The most important aspect of management is the management of the placenta. In the two cases with second trimester pregnancies, it was possible to remove the placentas, even though blood loss was significant, hemostasis was achieved at surgery. All three mothers recovered well and survived.
authors.affiliation: Academic Department of Obstetrics & Gynaecology, University of Zimbabwe College of Health Sciences, Parirenyatwa University Hospital, Mazowe Street, PO Box A178, Avondale Harare, Zimbabwe.
authors.forename: Muchabayiwa F
authors.initials: MF
authors.lastname: Gidiri
authors.affiliation: Mutare Provincial Hospital, Department of Obstetrics & Gynaecology, PO Box 30, Mutare, Zimbabwe.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kanyenze
mesh_terms: D000328:Adult; D003906:Developing Countries; D005260:Female; D006801:Humans; D011203:Poverty; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011269:Pregnancy, Abdominal / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D011295:Prenatal Care / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods; D015030:Zimbabwe
keywords: advanced abdominal pregnancy; diagnosis and management; ectopic pregnancy