Successful management of a patient with ovarian ectopic pregnancy by the end of the first trimester: a case report.

BACKGROUND: Among all ectopic pregnancies, between 0.5% and 3.5% are ovarian ectopic pregnancies, a potentially life-threatening condition when ruptured due to its serious potential for hemorrhaging. A majority of ovarian ectopic pregnancies are diagnosed by the 7th week of pregnancy when the patient becomes symptomatic, and ultrasound can be used to diagnose this condition. CASE PRESENTATION: We present the case of a 39-year-old Persian woman in the 12th week of gestation who presented with vaginal bleeding and abdominal pain and was diagnosed with ovarian ectopic pregnancy. Her notable laboratory finding was ß-human chorionic gonadotropin > 15,000, which indicates definite pregnancy. Transvaginal ultrasound (TVS) revealed no evidence of intrauterine pregnancy, but a well-circumscribed gestational sac in the left ovary. The patient was successfully treated with resection of the gestational sac and partial left salpingo-oophorectomy. Histopathological studies confirmed the diagnosis of ovarian ectopic pregnancy. CONCLUSION: The case emphasizes the ability of ovarian ectopic pregnancy to develop asymptomatically through the course of pregnancy and points to the necessity for high-quality prenatal care and the importance of determining the fetal site during pregnancy.

Dual extrauterine ectopic pregnancy: double management.

A 30-year-old nulliparous woman was referred with suspected left ovarian ectopic pregnancy. She had undergone laparoscopic left salpingectomy for ruptured tubal ectopic pregnancy 3 weeks earlier, following treatment with medications for ovulation induction. Sonological examination revealed a left ovarian ectopic pregnancy corresponding to 8 0/7 weeks with cardiac activity. She underwent ultrasound-guided intrasac therapy with intrasac instillation of 3 mEq of potassium chloride followed by 50 mg of methotrexate. She was followed with weekly measurements of serum beta human Chorionic Gonadotropin (hCG) which returned to baseline after 65 days of the intrasac therapy. This case not only highlights the need for continued follow-up of the serum beta hCG after definitive management of an ectopic pregnancy in cases with multiple ovulations, but also the option of medical management in cases of advanced ovarian ectopic pregnancy. It also accentuates the necessity for adequate counselling to avoid conception in a multiple ovulation cycle.

An investigation of the time trends, risk factors, role of ultrasonic preoperative diagnosis of 79 ovarian pregnancy.

BACKGROUND: Ovarian pregnancy (OP) is a rare form of ectopic pregnancy and is still a medical challenge. Therefore, more studies about the time trends, risk factors and diagnostic measurements are needed for the efficient treatment of OP. METHODS: The datum of OP patients who were treated at the Second Hospital of Hebei Medical University from 2003 to 2018 was collected and a retrospective cohort study was preformed between OP and tubal pregnancy. RESULTS: 79 of all 6943 ectopic pregnancy (1.14%) were OP. The prevalence of OP following assisted reproductive technology showed an increasing trend over time, from 8.33% to 15.22%. Previous abdominal surgery was one of the risk factors of OP (OR 0.41, 95% CI 0.18-0.95, p = 0.04). Merely 2 (2.53%) patients were sonographically diagnosed as OP accorded with their discharge diagnosis. However, 56 (80.0%) accumulation of blood in the pelvis formed echo free areas could be clearly found by ultrasonography. A significant difference was found in serum ß-hCG level among OP patients and tubal pregnancy patients (2762.73 ± 1915.24 mmol/L vs 1034.20 ± 915.32 mmol/L, p < 0.001). CONCLUSIONS: The prevalence of OP following assisted reproductive technology is on the rise. History of abdominal surgery may be a high risk factor for OP patients who have the tendency of high ß-hCG levels. The ultrasonic preoperative diagnosis is conductive to the early diagnosis of OP though the diagnosis accuracy is low.

Ultrasound classification and clinical analysis of ovarian pregnancy: A study of 12 cases.

OBJECTIVE: To evaluate the clinical significance of preoperative ultrasound diagnosis and classification of ovarian pregnancy (OP). METHODS: The ultrasonographic reports, medical records, and operative summaries were reviewed for twelve women with a confirmed diagnosis of OP. According to the ultrasonographic appearance, OP was classified into two types. For every type, we analyzed the possibility and clinical significance of preoperative ultrasound diagnosis, combining with its clinical manifestations and treatments. RESULTS: According to sonographic features, twelve cases of OP can be classified into ruptured type (n = 6) and unruptured type (n = 6), the latter was subclassified into embryo sac type (n = 2) and non-homogeneous mass type (n = 4). All the unruptured OP have the characteristic solid hyperechoic rings or masses, and 66.7% (4/6) were correctvly diagnosed by preoperative ultrasound. No characteristic ultrasonogram was detected in ruptured OP which were all diagnosed as ruptured ectopic pregnancy (EP) or corpus luteum by preoperative ultrasound. The diagnostic and surgical procedures of four cases diagnosed by preoperative ultrasound were all laparoscopy and removal of the gestational products, and their average hemoperitoneum, operation time, hospital days was 313 ± 278 ml, 57 ± 9 min, and 4.25 ± 0.5days, respectively. While ruptured OP cases (6 cases diagnosed at first visit and 1 underdiagnosed but ruptured after 6 days), the diagnostic procedures was laparoscopy(3/7) or laparotomy(4/7), the surgical procedure was removal of the gestational products(2/7), wedge resection(3/7), or adenexectomy(2/7), and their average hemoperitoneum, operation time, and hospital days was 1914 ± 1059 ml, 93 ± 17 min, and 5.9 ± 1.3days, respectively. CONCLUSIONS: Ultrasound plays a significant role in diagnosis of OP, and part of the unruptured OP based on the typical sonographic characteristics could be correctly diagnosed by an experienced sonographer, this is beneficial and effective in terms of the risk of patient's operation and life. Whereas ruptured OP were generally diagnosed as ruptured EP or corpus luteum because there were no characteristic ultrasound manifestations.

Embarazo ectópico ovárico / Ovarian Ectopic Pregnancy

El embarazo ectópico es en la actualidad un problema de salud a nivel mundial atribuido al aumento de su incidencia y la morbimortalidad que crea. La localización ovárica del embarazo ectópico es un evento raro pero posible y también en ascenso. Presentamos el caso de una paciente que acude al cuerpo de guardia con escasa sintomatología. Se le realizó el diagnóstico ultrasonográfico de la entidad y apoyado en una prueba de embarazo positiva. Luego le practicaron laparotomía de urgencia en la que se comprobó el embarazo ovárico derecho no complicado. También se efectuó una salpingooforectomía y la paciente tiene una evolución satisfactoria trans-posoperatoria(AU)

Ectopic pregnancy is currently a global health problem due to the increase in its incidence and morbidity and mortality. The ovarian location of ectopic pregnancy is a rare but possible event and on the rise. We present the case of a patient who comes in with little symptoms. The ultrasound diagnosis of the entity was made and supported by a positive pregnancy test. Then emergency laparotomy was performed, which proved that the right ovarian pregnancy was not complicated. Salpingo-oophorectomy was also performed and the patient has a satisfactory trans and postoperative evolution(AU)

Primary Ovarian Pregnancy: A Case Series and Analysis.

The preoperative diagnosis of primary ovarian pregnancy (POP) remains elusive and the final diagnosis relies heavily on histologic findings. The diagnostic criteria for POP, established in 1878 by Spiegelberg, are based primarily on the identification of an embryonic sac within the ovary and the localization of conception products therein. However, these diagnostic criteria may be overly strict, which may not only significantly underestimate the prevalence of POP, but also potentially mislead patient management. In this series, we present 7 cases that showed no embryonic sac within the ovary (thus not meeting the Spiegelberg criteria for POP), but were nonetheless classified by the authors as POP based on the unequivocal presence of chorionic villi and implantation sites within the ovary. Immmunohistochemical studies for beta-human chorionic gonadotropin, human placental lactogen, and inhibin highlighted the trophoblastic populations. These findings indicate that POP may occur even if no embryonic sac is pathologically demonstrable. Accordingly, we propose the following modified diagnostic criteria for POP: (1) no pathologic evidence of ipsilateral fallopian tube involvement is present; and (2) evidences of gestation, including presence of chorionic villi and/or implantation site are present within the ovary. If both criteria are met, the diagnosis of POP should be rendered. These proposed diagnostic criteria should lead to more accurate diagnoses of POP, provide more contemporary insights into its true prevalence, heighten clinical awareness of the disease, and ultimately, optimize its clinical management.

Heterotopic Pregnancy After In Vitro Fertilization and Embryo Transfer After Bilateral Total Salpingectomy/Tubal Ligation: Case Report and Literature Review.

Heterotopic pregnancy is defined as the simultaneous occurrence of intrauterine and ectopic pregnancy, either of which may be single or multiple. It occurs in up to 1% of pregnancies after in vitro fertilization and embryo transfer. This article reports 2 rare cases of heterotopic pregnancy after in vitro fertilization and presents a literature review. In the first case, a 28-year-old woman had previous laparoscopic bilateral total salpingectomy for a right tubal pregnancy and a left hydrosalpinx. However, she had ovarian heterotopic pregnancy after a third in vitro fertilization cycle. Emergency laparotomy was performed. The synchronous intrauterine pregnancy continued with no further complications and ended in the delivery of a singleton term pregnancy. The second case combined interstitial and intrauterine pregnancies after bilateral tubal ligation for hydrosalpinges followed by in vitro fertilization and frozen embryo transfer. The possibility of heterotopic pregnancy after bilateral total salpingectomy/tubal ligation, although extremely rare, should also be considered by gynecologists when they treat an in vitro fertilization patient even though an intrauterine pregnancy has been confirmed.

[Ovarian pregnancy: a case report]. / A propos d'un cas de grossesse ovarienne.

We here report a case of left ovarian pregnancy passively detected in the General Reference Hospital outpatient clinic in Dilolo, Democratic Republic of Congo. The diagnosis was confirmed by ultrasound; the patient underwent surgery with uneventful postoperative course. Pregnant women and healthcare personnel should be aware of the importance of proper clinical and echographic monitoring in pregnancy for early diagnosis of abnormal implantations.

Clinical analysis of 95 cases with ovarian pregnancy.

BACKGROUND: Ovarian pregnancy (OP) is a rare ectopic pregnancy, in which it is very difficult to achieve preoperative diagnosis. Ovarian blood supply in OP increases which will lead to intra-abdominal bleeding, hazarding women's lives. Surgical exploration should be conducted once cases of OP are suspected. OBJECTIVE: To investigate clinical characteristics, diagnosis, and therapy of OP. MATERIALS AND METHODS: A retrospective study was conducted in 95 patients with OP admitted to the present hospital from January 2005 to June 2014. RESULTS: OP accounted for 1.79% of ectopic pregnancy over the same period, of which 68.4% had a history of artificial abortion, 6.3% was treated with intrauterine contraceptive device (IUD), 87.4% had abdominal pain, 84.2% had a history of menopause, and 51.6% had vaginal bleeding. All patients had no preoperative diagnosis and underwent laparoscopic wedge resection of ovary or lesionectomy and were all were cured. CONCLUSION: Since the cause of OP is still unknown and it has no typical clinical manifestations, the present authors adopt blood P-hCG combined with B-ultrasound to improve the preoperative diagnosis. They prefer laparoscopic wedge resection of ovary or lesionectomy, which induce higher rate of intrauterine pregnancy and lower rates of ectopic pregnancy and infertility in re-pregnancy after surgery.

Ovarian pregnancy associated with a fresh blastocyst transfer following in vitro fertilization.

Ovarian pregnancy is a rare subtype of ectopic pregnancy, and its mechanisms have not been clarified. We report a case of ovarian pregnancy that supports a blastocyst migration mechanism. An infertile woman became pregnant after a single blastocyst transfer following in vitro fertilization during a fresh non-donor cycle. Transvaginal ultrasound revealed a gestational sac-like structure containing an active fetus that was located adjacent to the corpus luteum of the right ovary. Laparoscopy identified a red, swollen implantation site in the ovary, which was completely removed by wedge resection without damaging the remaining parenchyma. This case demonstrated that a fresh blastocyst transferred into the endometrial cavity migrated through the fallopian tube, implanted on an ovarian surface, and formed an ovarian pregnancy.

Unruptured second-trimester ovarian pregnancy.

Ovarian ectopic pregnancies are rare, with the majority diagnosed in the first trimester and often treated due to symptoms related to ovarian rupture. We report our experience with the diagnosis, management, and histologic evaluation of an unruptured second-trimester ovarian ectopic pregnancy. A 37-year-old woman presented with vague abdominal discomfort and irregular menses. Ultrasound detected a 16-week 4-day gestation with cardiac motion in the right adnexa and no evidence of an intrauterine pregnancy. Laparotomy with right salpingo-oophorectomy was performed, with removal of an unruptured pregnancy from the ovary. Although intraoperative examination and postoperative histopathologic evaluation demonstrated the classic Speigelberg criteria, it did not assist in the preoperative diagnosis, nor impact the treatment of the ovarian ectopic pregnancy in this case.