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

Ultrasound Classification and Preoperative Ultrasound Diagnosis Analysis of Ovarian Ectopic Pregnancy

OBJECTIVES

A classification system of ovarian ectopic pregnancies (OEP) could aid in their management. This study aimed to investigate the ultrasound classification and preoperative ultrasound diagnosis of OEP.

METHODS

This retrospective case series study analyzed the clinical and ultrasound imaging data of 68 pregnant women diagnosed and confirmed with OEP at the Obstetrics and Gynecology Hospital affiliated with Tongji University between January 2015 and March 2023. The study focused on examining the ultrasound characteristics of different types of ovarian pregnancies and the accuracy of preoperative ultrasound diagnoses.

RESULTS

The study included 68 patients with a median age of 30 (22-47) years. There were 43 cases (63.2%) of ruptured OEP and 25 (36.8%) of unruptured OEP. The unruptured cases were subclassified as embryonic sac type (n = 16) and heterogeneous mass type (n = 9). Preoperative ultrasound accurately diagnosed 19 cases (27.9%) of OEP, including 10 (62.50%) of the embryonic sac type, 4 (44.44%) of the heterogeneous mass type, and 5 (11.63%) of the ruptured type. Preoperative ultrasonography showed that embryonic sac type OEP was characterized by an intra-ovarian cystic structure with a distinctive hyperechoic ring and, in some cases (8 out of 16), the presence of embryonic buds and/or yolk sacs. Ruptured OEP was characterized by mixed masses in the pelvic cavity with minimal or significant free pelvic fluid, an unclear boundary between the mass and the ovary, and limited or no vascularity.

CONCLUSIONS

Ultrasound may be used to determine the type of OEP preoperatively, with a higher diagnostic yield for the embryonic sac subtype. Preoperative ultrasonographic classification may enhance the preoperative diagnosis of OEP.

Ruptured primary ovarian pregnancy: A case report with a literature review

RATIONALE

Ovarian pregnancy is a rare form of ectopic pregnancy, accounting for 0.5% to 3% of the total number of ectopic pregnancies. Its diagnostic rate is very low and it can be easily misdiagnosed before laparoscopy, due to the clinical presentation being very similar to tubal pregnancy. The ovarian blood supply is abundant, and in case of rupture of ovarian pregnancy, intra-abdominal hemorrhage or even hemorrhagic shock may occur, endangering the patient's life. We report a case of ruptured primary ovarian pregnancy through natural conception.

PATIENT CONCERNS

This patient had a history of menopause with lower abdominal pain and tenderness. Ultrasound showed a thick-walled cystic echo in the left adnexal region, a dark area of fluid in the pelvis, and an irregular, slightly strong echo posterior to the uterus. Unclotted blood was punctured from the posterior fornix, and her hemoglobin was decreasing with a serum β-human chorionic gonadotropin of 1800.00 mIU/mL.

DIAGNOSES

Through early recognition of clinical manifestations, ultrasonography, laparoscopic exploration, and the final histopathologic examination, this patient was diagnosed with an ovarian pregnancy.

INTERVENTIONS

Then, removal of the left ovarian pregnancy lesion was performed, which was visible as villi. And Methotrexate 50 mg was administered locally.

OUTCOMES

Through conservative surgical treatment, she recovered well and was discharged with a satisfactory follow-up.

LESSONS

Gynecologists should be alert to patients with menopausal lower abdominal pain with or without vaginal bleeding and consider ectopic pregnancy in rare sites, such as ovarian pregnancy. Surgery is the mainstay of treatment, and early laparoscopic exploration may be beneficial in clarifying the diagnosis and performing the concurrent surgical treatment.

Ovarian ectopic pregnancy: clinical characteristics, ultrasound diagnosis and management

OBJECTIVE

To compare the clinical, ultrasound and biochemical characteristics of ovarian ectopic pregnancy (OEP) with those of tubal ectopic pregnancy (TEP).

METHODS

This was a retrospective case-control study of women with OEP and those with TEP seen at a single center between December 2010 and February 2021. OEP was defined as a pregnancy located completely or partially within the ovarian parenchyma, seen separately to a corpus luteum, if a corpus luteum was present within the ipsilateral ovary. We compared demographic features, risk factors, clinical presentation, ultrasound findings and outcomes, such as blood loss at surgery, need for blood transfusion, length of hospital stay, follow-up and future pregnancy outcome, between cases of OEP and TEP.

RESULTS

Overall, 20 women with OEP were identified and compared to 100 women with TEP. A total of 15/20 (75%) OEPs were diagnosed correctly on the first ultrasound scan. There was no difference between the groups in terms of maternal age, gestational age, gravidity, parity or risk factors. Compared with TEP, OEP was more likely to present with abdominal pain without vaginal bleeding (12/20 (60%) vs 13/100 (13%); odds ratio (OR), 10.0 (95% CI, 3.45-29.20); P < 0.01), contain an embryo with cardiac activity (3/20 (15%) vs 2/100 (2%); OR, 8.7 (95% CI, 1.34-55.65); P = 0.02) and have severe hemoperitoneum on ultrasound (9/20 (45%) vs 8/100 (8%); OR, 9.4 (95% CI, 3.01-29.40); P < 0.01), and had a higher volume of blood loss at surgery (median, 700 mL vs 100 mL; P < 0.01). All surgically managed OEPs had successful laparoscopic treatment (18 excisions, one wedge resection) with preservation of the ovary. Only one (5%) case of OEP required a blood transfusion.

CONCLUSIONS

OEP is more likely than TEP to contain an embryo and to present with severe hemoperitoneum. In a dedicated early pregnancy setting, the majority of OEPs were detected on an ultrasound scan at the initial visit, facilitating optimal minimally invasive surgical management, reducing the risk of blood transfusion and oophorectomy. Our findings can be used as a reference for clinicians who may not otherwise encounter this rare condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Case Report: Ovarian pregnancy, a rare but lethal condition: An analysis of 112 cases

Study Objective

To explore how to improve the treatment, and prognosis of ovarian pregnancy (OP).

Patients

A total of 111 OP patients, one of the patients suffered from OP twice.

Results

In this study, 112 OP cases confirmed by postoperative pathology were retrospectively analyzed. Common risk factors for OP were previous abdominal surgery (39.29%) and intrauterine device use (18.75%). We modified the ultrasonic classification into four types: gestational sac type, hematoma type I, hematoma type II, and intraperitoneal hemorrhage type. Among these four types, the proportion of patients who underwent emergency surgery as initial treatment after admission was 68.75%, 10.00%, 92.00%, and 81.36%, respectively. The treatment for hematoma type I patients was often delayed. The rate of OP rupture was 86.61%. All methotrexate therapy for OP patients failed. All these 112 cases underwent surgery treatment finally. The surgical procedures were pregnancy ectomy and ovarian reconstruction by laparoscopy or laparotomy. No significant differences were observed in the operation time or intraoperative blood loss between laparoscopy and laparotomy. Laparoscopy showed less influence on patients regarding length of hospital stay and postoperative fever than laparotomy. Further, 49 patients who desired fertility were followed up over 3 years. Among them, 24 (48.98%) experienced spontaneous intrauterine pregnancy.

Conclusion

Among the four modified ultrasonic classifications, hematoma type I was associated with more delays in surgical time. Laparoscopic surgery was a better choice for OP treatment. The reproductive prognosis of OP patients was promising.

Clinical analysis of women with ovarian pregnancy: a retrospective case-control study

Background

To address the clinical features and potential risk factors of ovarian pregnancy (OP).

Methods

In this retrospective case–control study performed in West China Second University Hospital from March 17, 2005 to December 8, 2018, 146 OP patients were selected as a case group, 292 patients with tubal pregnancy (TP) and 292 women with intrauterine pregnancy (IUP) were matched as controls at a ratio of 1:2:2.

Results

When compared with TP patients, OP patients tend to have worse clinical complications (hemorrhagic shock (7.41% vs 2.89%), rupture of pregnancy sac (54.07% vs 37.78%), hemoperitoneum (363.1 ± 35.46 ml vs 239.3 ± 27.61 ml) and increased need for emergency laparotomy (9.60% vs 3.97%) at an early gestational age. Assisted reproductive technology (ART) (adjusted OR1 2.08, 95%CI 1.04 to 4.18; adjusted OR2 2.59, 95%CI 1.25 to 5.37) and intrauterine contraceptive device (IUD) use (adjusted OR1 2.19, 95%CI 1.10 to 4.36; adjusted OR2 2.77, 95%CI 1.74 to 5.71) may be risk factors for ovarian ectopic pregnancy as compared to the control groups of TP and IUP patients.

Conclusions

OP patients tend to have more severe clinical complications and this study has identified ART and IUD use as potential risk factors for OP. Results of this study may contribute to improve the understanding of OP and promote early surgical intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05099-8.

Rupture of Ectopic Ovarian Pregnancy Accompanied by Massive Intra-abdominal Bleeding and Disorder of the Coagulation Mechanism: A Rare and Life-Threatening Obstetric Complication

The rupture of ectopic ovarian pregnancy accompanied by massive intra-abdominal bleeding is a rare obstetric complication, occurs predominantly in the first trimester of pregnancy, and can be dangerous and life-threatening for the pregnant woman. Our case describes a 37yr old woman with a history of 4 lower segment Cesarian sections (LSCS) (Caesarean sections) and multiple surgical abortions, presenting at the ER with acute abdomen symptoms. The patient's hemodynamic status was unstable. The positive urine pregnancy test combined with the clinical and ultrasound findings established the diagnosis of the ruptured ectopic pregnancy, and immediate surgical treatment was decided. During surgery, a large amount of blood was found in the peritoneal cavity, resulting from a rupture of the right ovary and accompanied by hemorrhagic infiltration of adjacent tissues, without participation in the damage of the ipsilateral fallopian tube. It was deemed necessary to remove the ipsilateral adnexa and whole blood transfusion. The patient was discharged from our department on the fourth postoperative day. The price of beta-chorionic gonadotropic hormone was on a downward trend. Three weeks later, the level of beta-chorionic gonadotropic hormone was zero. In the present paper, a brief review is attempted regarding the diagnostic and therapeutic approach for patients with ruptured ectopic ovarian pregnancy after describing the case.

Surgical Treatment of Ovarian Pregnancy

The description of this case concerns the early diagnosis and the surgical treatment of a patient diagnosed with an ectopic ovarian pregnancy. A gravida 2, para 0 woman with a history of termination of pregnancy in the second trimester, was referred to the outpatients of the Gynecologic Department of the General Hospital of Trikala, reporting vaginal bleeding, accompanied by a deep, mild pain in the abdomen for a few days. The urine pregnancy test was positive. The transvaginal ultrasound in combination with the β-chorionic gonadotropin level was indicative of an ectopic pregnancy, and the surgical treatment of the patient was decided. Intraoperatively, the presence of an ovarian ectopic pregnancy was detected, and a wedge resection of the affected ovary was performed. The patient was discharged from our clinic on the third postoperative day, with instructions for weekly follow-up of the β-chorionic gonadotropin level until it returns to normal values.

Abdominal Ectopic Pregnancy and Impaired Postnatal Mammary Gland Development, Consistent With Physiologic Agalactia, in a Wild European Rabbit, Oryctolagus cuniculus

A wild European rabbit, Oryctolagus cuniculus, was diagnosed with an abdominal pregnancy due to the presence of a single abdominal lithopedion attached by a thin fibrovascular stalk to the left uterine horn, which was distorted by the tension of the adhesion. Evidence of mineralized remnants, chronic inflammation, and fibrosis in the left uterine endometrium and myometrium suggested that the lithopedion had arisen as a secondary abdominal pregnancy. The right uterine horn contained two macroscopically normal fetuses. The mammary gland exhibited notably retarded development in relation to the size of the fetuses. Histologically, mammary alveoli lacked evidence of intraluminal secretory product, and ducts lacked prominence and contained clusters of small numbers of macrophages. The doe also exhibited mild granulomatous and heterophilic pneumonia with rare intralesional adiaspores, suggesting infection with Emmonsia spp. as an incidental finding. This case documents secondary abdominal pregnancy in a wild lagomorph not subjected to artificial insemination procedures suggested to increase the occurrence of this condition in farmed rabbits. An abdominal pregnancy is one of a number of factors that should be considered as a potential factor in the etiology of impaired postnatal mammary development or reduced milk yield in a breeding doe, although no causative association is demonstrated in this case. Abdominal ectopic pregnancy is one possible differential diagnosis in the investigation of the presence of a palpable abdominal mass or masses in O. cuniculus.