Intraoperative Encounter of a Live Term Abdominal Pregnancy: A Rare Case Report from Rwanda.

Background: Abdominal ectopic pregnancy is a rare and serious form of ectopic pregnancy associated with significant fetomaternal complications. This case highlights the importance of a high index of suspicion for diagnosis, especially in low-resource settings. Case Presentation: A 28-year-old gravida 3, para 2 woman with an unknown gestational age presented to our hospital. She was diagnosed with abdominal ectopic pregnancy intraoperatively, which was missed on multiple ultrasounds performed after 28 weeks. The diagnosis was made intraoperatively during an elective cesarean section performed for presumed placenta previa at term. The pregnancy was implanted on the left fundus, with extension into the adnexal structures, the broad ligament, and part of the left posterior uterine wall, then a hysterectomy was done due to extensive hemorrhage and damage to body of uterus. The pregnancy resulted in a healthy mother and a live term fetus, showcasing a rare positive outcome for such a complicated case. Conclusion: This case underscores the critical need for early ultrasound examination by trained professionals and the need for clinical vigilance in diagnosing abdominal ectopic pregnancies, particularly in settings where resources are limited. It serves as a reminder to clinicians to remain vigilant and cautious during similar cases to avoid missing such rare but significant diagnoses.