Advanced abdominal pregnancy in Muhimbili Medical Centre, Tanzania.

A prospective study was conducted at Muhimbili Medical Centre (MMC) over a 2-year period on 16 patients with advanced abdominocyesis. The incidence of 1 in 3259 deliveries was higher than that of previous years. Infertility prior to index pregnancy was a significant antecedent factor (P less than 0.001). The most consistent symptom both in early and late pregnancy was abdominal pain. Difficulty in fetal palpation and abnormal lies were the most significant signs. The sensitivity of clinical suspicion was 68%, ultrasound 85% and X-ray diagnosis 93%. Sepsis was the leading maternal complication, especially when the placenta was left in situ. Perinatal mortality was 87.5% and maternal mortality was 6.4%. Abdominal pregnancy remains a diagnostic challenge and certain aspects of fetal mortality are ill-understood. Early diagnosis of abdominal pregnancy can be improved upon by more detailed history taking, a high index of suspicion and meticulous interpretation of sonographic and radiological signs. It is suggested that the placenta be removed except in the rarest trying cases and that pregnancy be terminated on diagnosis.