부산대학교 도서관

Introduction: Secondary abdominal pregnancies usually develop as a result of a tubal abortion, tubal rupture or uterine rupture with intraabdominal implantation. Case Report: We report a 40-year-old patient gravida IV, para III suffering from abdominal pain. She was in the 29th week of gestation according to a 14th-week normal sonogram. She had unsuccessfully attempted to induce abortion with the assistance of a home midwife in the 14th week. This caused severe abdominal pain, but she chose not to be hospitalized because of fear of prosecution. Ultrasound demonstrated that the fetus was out of the uterus and revealed a heterogeneous mass in the left lower quadrant. Laparotomy revealed an area of thin fibrotic scar behind the uterus with normal tubes and ovaries. The fetus in the amniotic sac was surrounded by intestinal loops. The placenta, implanted behind the left broad ligament at the edge of the scar area was removed with a brisk bleeding, which was controlled. No postoperative complications were observed. Conclusion: Presence of little free fluid and a uterine scar with normal fallopian tubes against a history of an unsuccessful induced abortion and severe illness are highly suggestive of a uterine rupture resulting in secondary implantation on the broad ligament. This is probably the first case that shows an abdominal pregnancy can result from unsuccessful induced abortion. In the countries where abortion is not permitted, patients with low socioeconomic status are prone to the dangerous consequences of illegal attempts to induce abortion. Close observation and special follow-up care are necessary in such cases.