Background- Abdominal pregnancy remains a diagnostic and management challenge Objective- Highlighting diagnostic and management dilemmas in secondary abdominal pregnancy Search strategy- MEDLINE, EMBASE, PubMed and Web of Science searched from 1930-2021. Selection criteria- Articles on secondary abdominal pregnancies Data collection and analysis- An illustrative case report of a woman at 13 weeks gestation referred from a primary health centre with vague abdominal pain. Imaging confirmed secondary abdominal pregnancy with hemoperitoneum. Emergency laparotomy revealed significant hemoperitoneum, a live floating fetus in the abdominal cavity and placental attachment to the left cornu and fallopian tube which were removed and cornual repair performed. Recovery was uneventful. We reviewed the literature on secondary abdominal pregnancies, early and advanced from 1930-2021 and summarised management and outcomes of 314 such cases. Main Results- Among the 314 cases reviewed, 295 cases (93.9%) were surgically managed and 19 (6%) required hysterectomy. Post-surgery methotrexate was given in 9 cases (2.9%). Following primary methotrexate administration in 18 patients, 10 required surgery (55.5%). Complete placental removal was achieved in 264 cases (84%), partial in 27 (8.6%) and left in situ in 16 (5.1%). Seventy-four cases (23.6%) required blood transfusion. There were 15 maternal deaths (4.8%). Twenty-seven fetuses (8.6%) were live born, 6 (1.9%) were neonatal deaths and 46 (14.6%) were fetal demise. Conclusion- Maternal mortality and morbidity is of serious concern in abdominal pregnancies requiring a high index of suspicion and management expertise. Funding- None Keywords- abdominal pregnancy, primary peritoneal pregnancy, secondary abdominal pregnancy, hepatic pregnancy, omental pregnancy, diaphragmatic pregnancy.