Late abdominal pregnancy in a post-conflict context: A case
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Abdominal pregnancies have been frequently missed in routine antenatal care in resource-limited settings and delayed diagnosis is usually associated with poor fetal and maternal outcomes including death. This case report is among the rare ones. Despite a positive outcome for both the mother and baby, neither the ultrasound nor the physical exam revealed the diagnosis of abdominal pregnancy pre-operatively. This case report alerts clinicians to be aware of the possibility of abdominal pregnancy in a patient with painful fetal movements and contributes to existing data about good fetal and maternal outcomes.

A 25-year-old primigravida patient referred for management of acute abdomen at 33-weeks gestation. Her chief complaint was severe abdominal pain associated with each fetal movement for a period of 1 week prior to admission. A diagnosis of peritonitis was made. Emergency laparotomy revealed a normal live 2 kg baby with placental implantation on the greater omentum and small intestine mesentery. The placenta was not removed. Both maternal and fetal outcomes were good.

In conclusion, abdominal pregnancy with a normal live fetus at such an advanced gestational age is rare. diagnosing abdominal pregnancy remains a challenge, particularly in low-resource settings where ultrasound and/or MRI is less accessible. This case reminds clinicians that abdominal pregnancy remains a differential diagnosis for painful fetal movements.
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