Term AP Revealed by Amnioperitoneum in Rural Area
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Case Presentation
The patient was a 24-year-old, gravida 2, para 0, with a past surgical history of right salpingectomy indicated for ruptured ectopic pregnancy 2 years prior to admission. She was admitted with a pregnancy of 39 weeks and 4 days for diffuse abdominal pain of sudden onset with no history of abdominal trauma. She was HIV-positive under tritherapy (Tenofovir, Lamivudine, and Nevirapine) for the past 4 years with good clinical and biological improvement.

She had her menarche at 12, her first sexual intercourse at 16, and 03 sexual partners in her life, and, at 18 years of age, she used combined oral contraceptive drugs. She did two antenatal consultations (ANC) from the 5th month of pregnancy. Antianaemic prevention was done. The pregnancy was marked by recurrent abdominal pain and painful active foetal movements without bowel obstruction or vaginal bleeding. She had 05 documented ultrasounds done by two specialists: gynecologist and radiologist. The first was done at 17th week of gestation. All reported “a singleton viable intrauterine pregnancy with fundal placenta insertion.” Her main complaint on admission was severe diffuse abdominal pain aggravated by the change of position. The patient had reported no prior loss of liquor. On examination, she was conscious with a good general condition. Her blood pressure was 121/83?mmHg, pulse rate at 101 beats per minute, and temperature 37, 6°C. Her conjunctivae were pink, and the cardiovascular and pulmonary exams were unremarkable. The abdomen was distended, deflected to the right, and tender on palpation. There was no uterine contraction. Foetal parts were easily palpable beneath abdominal wall and foetal heart rate (FHR) was 138 beats per minute. On vaginal exam there was no bleeding and the cervix was posteriorly long and closed. The posterior pouch of Douglas was bulging and tender....

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