ABSTRACT
PURPOSE: The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality. METHODS: This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, ß-human chorionic gonadotropin (ß-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA). RESULTS: The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10- 5) that was diagnosed in the 7th gestational week. The only association found was between the ß-HCG level and LOS, with a linear regression ß coefficient of 0.01 and a P-value of 0.04. CONCLUSION: EP is a relatively common condition affecting approximately 1% of all pregnancies. ß-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.
Subject(s)
Abdominal Pain/physiopathology , Chorionic Gonadotropin, beta Subunit, Human/blood , Length of Stay/statistics & numerical data , Pregnancy, Ectopic/epidemiology , Abortifacient Agents, Nonsteroidal/therapeutic use , Adult , Cesarean Section/statistics & numerical data , Douglas' Pouch , Female , Humans , Incidence , Intrauterine Devices , Laparoscopy , Methotrexate/therapeutic use , Middle Aged , Pregnancy , Pregnancy, Ectopic/blood , Pregnancy, Ectopic/physiopathology , Pregnancy, Ectopic/therapy , Pregnancy, Heterotopic/blood , Pregnancy, Heterotopic/epidemiology , Pregnancy, Heterotopic/physiopathology , Pregnancy, Heterotopic/therapy , Pregnancy, Ovarian/blood , Pregnancy, Ovarian/epidemiology , Pregnancy, Ovarian/physiopathology , Pregnancy, Ovarian/therapy , Pregnancy, Tubal/blood , Pregnancy, Tubal/epidemiology , Pregnancy, Tubal/physiopathology , Pregnancy, Tubal/therapy , Reproductive Techniques, Assisted/statistics & numerical data , Retrospective Studies , Risk Factors , Salpingectomy , Salpingostomy , Smoking/epidemiology , Young AdultABSTRACT
We present a rare case of ovarian pregnancy that occurred in a woman who underwent in vitro fertilization (IVF) after bilateral salpingectomy. The patient presented with abdominal pain and a positive pregnancy test. Ovarian pregnancy was diagnosed owing to a suspicious mass detected on ultrasound. She underwent laparoscopy to confirm the diagnosis, which was subsequently verified by histopathological examination. The question that comes in mind is: How did the pregnancy get there? After a review of the literature, we have found a few possible explanations for the mechanism of this rare event. This case emphasizes the need for vigilance in suspecting ectopic pregnancy even in women who have undergone salpingectomy.
