Introduction: Extrauterine abdominal pregnancy is extremely rare, reported as 1% out of ectopic pregnancy and it is frequently missed during antenatal screening and late antenatal booking. This is a report of an abdominal pregnancy of a multipara who had a fetal demise at 2nd trimester.
Case Presentation: A 41 years old Malaysian, Gravida 5 Para 4 at 24 weeks gestation, was referred for uterine fibroid complicating pregnancy with reduce fetal movement. A transabdominal ultrasound shows an anteverted, empty uterus and a single non viable fetus in an intact sac in the abdominal cavity with the placenta implanted at the posterior wall of uterus with highly vascularity showed on the color doppler. CT abdominal-pelvis finding showed that the placenta blood supply was derived from extrauterine vessels. She was planned for conservative management for 3 to 4 weeks expecting the placenta to degenerate to reduce the vascularity of the placenta. She had been followed up as an outpatient weekly under closed monitoring with full blood count and coagulation profile during each visit. However she developed acute abdomen symptoms at her 3rd week, and had an emergency laparotomy with suspicion of ruptured abdominal pregnancy. Intraoperative, there was massive bleeding from the feeding vessel from the omentum to placenta which was ligated two times thus hemostatic was secured. The fetus was extracted and the placenta was left in situ. Post operatively, she was sent immediately to tertiary center for embolization of placenta vessels. The embolization was a success and patient was discharged home on day four postoperative. The first follow up was after 2 week shows that placenta mass was 12 cm x 12 cm and still vascularized. Two months post embolization, placental mass reduce to 8 cm x 8 cm with no color flow on Doppler ultrasound.
Conclusion: An extra-uterine abdominal pregnancy could be missed on late antenatal booking. Conservative management following fetal demise aimed to reduce blood supply to the placenta did not seem to be successful in this case.