Delayed Diagnosis of Advanced Abdominal Pregnancy Complicated by Massive Hemorrhage, Cardiac Arrest, and Surgical Challenges Managed with Flipped Peritoneal Suture: A Case Report

Background: Abdominal pregnancy is a rare and potentially fatal form of ectopic gestation that poses significant diagnostic and surgical challenges.Delayed recognition may lead to life-threatening complications such as massive hemorrhage and cardiac arrest.Case presentation: We report a case of a 34-year-old woman who presented with worsening abdominal pain and hypovolemic shock.Initial antenatal ultrasound suggested an intrauterine pregnancy, contributing to diagnostic delay.Upon presentation, transvaginal ultrasound revealed an 11-week extrauterine gestation with suspected hemoperitoneum.During surgical preparation, the patient experienced cardiac arrest requiring advanced cardiac life support (ACLS).Emergency laparotomy revealed approximately 3 L of intra-abdominal blood loss and placental implantation on the peritoneal surface near the pouch of Douglas.Conventional hemostatic techniques failed; thus, a flipped peritoneal suture technique was employed, effectively controlling bleeding.Outcome: The patient was admitted to the ICU and showed rapid postoperative recovery, being discharged in stable condition on postoperative day four.Conclusion: This case emphasizes the importance of early recognition, accurate imaging, and surgical innovation in managing abdominal pregnancies.The flipped peritoneal suture technique may serve as a valuable strategy in complex obstetric hemorrhages, particularly when standard interventions are insufficient.Timely multidisciplinary collaboration is crucial in optimizing maternal outcomes in rare and high-risk pregnancies.