Ovarian pregnancy; relationship to an intrauterine device

Postoperative reproductive outcomes in women with ovarian pregnancy: A retrospective analysis

OBJECTIVE

The reproductive outcomes of ovarian pregnancy are currently unknown. Therefore, the objective of our study was to report the pregnancy outcomes of women with laparoscopically treated ovarian pregnancy.

MATERIALS AND METHODS

In this retrospective case analysis, unpublished cases of ovarian pregnancy between 2009 and 2016 were reviewed. Women were followed up for 3 years to obtain subsequent pregnancy data.

RESULTS

A total of 21 women who intended to become pregnant were included in this study. Predisposing risk factors for ovarian pregnancy including previous pelvic surgery (23.81%), presentation of pelvic endometriosis (23.81%), and prior intrauterine device insertion (9.52%) were identified. The major symptom at presentation was abdominal pain (85.71%), and no preoperative sonographic diagnosis of ovarian pregnancy was identified. Laparoscopic wedge resection was performed in most women (90.48%). During the 3-year follow-up period, spontaneous intrauterine pregnancy was observed in 13 women (61.90%), 2 women (9.52%) became pregnant through artificial insemination treatment, and 6 women are not able to get pregnant (28.57%). None of the women experienced recurrent ectopic pregnancy.

CONCLUSION

The postoperative pregnancy outcomes of women with ovarian pregnancy were encouraging. In this study, the spontaneous intrauterine pregnancy rate was favorable, and no cases of recurrent ectopic pregnancy were reported.

A rare case of ovarian ectopic pregnancy with IUD in situ: A case report from Nepal

High index of suspicion of ectopic (much likely ovarian) pregnancy should be considered if a woman with IUD in situ presents with abdominal pain, vaginal bleeding, and positive urine pregnancy test.

Ovarian ectopic pregnancy: the role of complex morphopathological assay. Review and case presentation

Ovarian ectopic pregnancy (OEP) represents the rarest type of ectopic pregnancy, accounting for 1-3% of this pathology. The diagnosis of this pathology is challenging due to the non-specific clinical aspects and the ultrasound examination hampered by the lack of visible gestational sac in the presence of hematocele and hemoperitoneum. The purpose of the extended histopathological (HP) examination was to identify particular aspects of the OEP trophoblast and to highlight potential local ovarian modifications which can determine pregnancy fixation at this level. The patient presented local favorable conditions for intraovarian nidation, conditions confirmed by the HP classical examination and by the immunohistochemical evaluation. We identified, using classical Hematoxylin-Eosin, Masson's trichrome and Periodic Acid-Schiff (PAS)-Hematoxylin, necrotic hemorrhage, accentuated vascular thrombosis and high density lymphoplasmocytary infiltrate. These modifications increased local adhesivity and cell destruction through hypoperfusion. Anti-cluster of differentiation antibodies (CD34, CD38, tryptase) revealed the low number of intravillous vessels and the high number of macrophages and mastocytes involved in the local inflammatory process heighten. We identified the presence of trophoblast tissue in the ovarian structure using anti-cytokeratin AE1∕AE3 (CK AE1∕AE3)/anti-cytokeratin 7 (CK7) antibodies. The anti-alpha-smooth muscle actin (α-SMA) and anti-vimentin (VIM) antibodies displayed the density of myofibroblasts and intravillous stromal cells and with the aid of anti-progesterone receptor (PR) antibody, we identified the corpus luteum hormonal response in the OEP. The placental villosities present a blocked multiplication process at the anti-apoptotic B-cell lymphoma 2 (BCL2) protein, confirmed by the Ki67 cell proliferation and tumor protein 63 (p63) immunomarkers. Anti-neuron specific enolase (NSE), anti-calretinin and anti-inhibin A antibodies showed the particular aspects of the granulosa and internal theca cells, which may be involved in oocyte release blockage, intraluteal and extraluteal fecundation of the OEP.

[Ovarian pregnancy: about 3 cases and review of the literature]

Ovarian pregnancy is a rare event among women with ectopic pregnancy in whom the ovary is the site of implantation. Its diagnosis requires a well codified approach. The peculiarities of the determining factors, of the histopathological and evolutionary features typical of ovarian pregnancies led us to focus on this form of ectopic pregnancy. We report 3 cases of ovarian pregnancy diagnosed in our Department. The three women were between 30 and 42 years, at 13 to 37 weeks of amenorrhea. All women had abdominal pain of varying intensity associated with shock. Anatomopathological examination of the right annex, normal site of implantation of ovarian pregnancies, confirmed the diagnosis. All women had juxtaposition ovarian cortical pregnancy. Ovarian pregnancy is a rare event among women with ectopic pregnancy, having specific peculiarities. Its diagnosis is difficult and is based on preoperative findings. The identification of the ovarian implantation on histopathological examination is ideal for confirming the diagnosis. Currently, it is assumed that ovarian pregnancy is the form of ectopic pregnancy which can develop to term or even result in a live birth.

Ovarian pregnancy: uncommon mode of presentation

Ovarian pregnancy is very rare, and its incidence is 1 in 3000 live births. In this condition, common risk factors for ectopic pregnancy not usually found. It usually occurs in fertile women and more commonly with in-situ intrauterine device (IUD). Preoperative diagnosis is always not possible although the patient commonly presents with abdomen-pelvic pain, per vaginal bleeding and hypovolemic shock. High degree of suspicion with estimation of serum beta HCG, transvaginal ultrasonography by an experienced sonologist and laparoscopy is required for confirming the diagnosis. Though, the usual treatment is surgery, it can be managed by medical methods only in hemodynamically stable patients. In this case report, we describe the unusual mode of clinical presentation in an elderly woman with ovarian pregnancy.

Laparoscopic Surgery for Ovarian Pregnancy using Diathermy Hook with Conservation of Ovary: A Case Report and Literature Review

A 31-year-old woman presented with a 7-week history of irregular vaginal bleeding without abdominal pain. She had been using the intrauterine contraceptive device (IUD) for the last 3 years. A pregnancy test was positive and subsequent serum beta human chorionic gonadotropin (β-HCG) was 4992 mIU/mL. A transvaginal ultrasound scan demonstrated an empty uterus with an associated adnexal mass but no free fluid. A right primary ovarian ectopic pregnancy was diagnosed a laparoscopy. This was managed laparoscopically using monopolar diathermy hook with conservation of the ovary and minimal blood loss. Ovarian pregnancy is rare, especially in women without the classical risk factors for tubal pregnancy, and efforts should be made to exclude ectopic pregnancy in the absence of abdominal pain in a woman of reproductive age presenting with prolonged and irregular vaginal bleeding. Methods to conserve the ovary are also encouraged in cases of ovarian pregnancy.

Primary ovarian pregnancy and its management

The authors suggest that with ultrasonographic advances, the diagnosis of primary ovarian pregnancy can be made earlier enough for conservative treatment and preservative surgery.

Primary ovarian ectopic pregnancy, i.e., the implantation of the gestational sac in the ovary, is one of the rarest forms of ectopic pregnancy. Its incidence after natural conception ranges from 1 in 2000 to 1 in 60 000 deliveries and accounts for 3% of all ectopic pregnancies. The diagnosis is intricate and based on surgical and histopathological observations. The management is, in spite of medical improvement, based on surgery.

We present a case of a 10-wk ectopic ovarian pregnancy managed laparoscopically, and we describe, through a review of the literature, the specific symptomatology, diagnostic criteria, and treatment of this particular pathology.

Complex ovarian pregnancy

BACKGROUND

Ovarian pregnancy is a rare occurrence. Normally it ends spontaneously in the first trimester. However, it can turn into a life-threatening condition if it ruptures, leading to hemoperitoneum and hypovolemic shock. Diagnosis usually is made with high-resolution transvaginal ultrasonography, and laparoscopic treatment follows.

CASE

We report on a case of ovarian pregnancy seen in the southeast of Madagascar. Laparotomy revealed the presence of a fully developed, mummified fetus in the right ovary. Surprisingly, the ovary capsule had not ruptured and the patient had no complaints or signs of intra-abdominal bleeding.

CONCLUSION

In rare cases, an aborted ovarian pregnancy can persist for years, producing no symptoms except abdominal swelling.

Ovarian ectopic pregnancy

The authors report the rare case of a 25-year-old female who suffered from an ovarian ectopic pregnancy. She presented at 10 weeks gestation with a 1-day history of vaginal bleeding and lower abdominal discomfort. β-human chorionic gonadotropin concentration was 8538 IU/ml. Ultrasound showed a right adnexal mass 4.0 × 3.8 × 5.5 cm with a 16 mm cystic area suggesting right ovarian ectopic pregnancy. Diagnostic laparoscopy confirmed a ruptured right ovarian ectopic pregnancy with haemoperitoneum. This was excised laparoscopically. She made a good postoperative recovery and was discharged on the second postoperative day. Histology confirmed a ruptured ovarian ectopic pregnancy. Ovarian ectopic pregnancy is a rare condition. There are two features that make this an unusual case; the relatively late gestation at which she presented and her mild presenting features. Unlike tubal ectopic pregnancies, which usually present at earlier gestations, this patient presented relatively late. She also presented with mild symptoms and signs.

Ovarian pregnancy-a 12-year experience of 19 cases in one institution

OBJECTIVES

To report the prevalence, presentation, diagnostic modalities, and treatment of ovarian pregnancy in one institution.

STUDY DESIGN

Retrospective case control study of 19 cases of ovarian pregnancy treated between 1990 and 2001 at Assaf Harofeh Medical Center, Zerifin, Israel.

MAIN OUTCOME MEASURES

Prevalence, presentation, diagnostic modalities, surgical treatment, and relation to intrauterine device (IUD) use.

RESULTS

Nineteen ovarian pregnancies, diagnosed between 1990 and 2001, comprised (19/694) 2.7% of all ectopic pregnancies, 1:3000 of all live births leading to a mean ovarian pregnancy per year of 1.6. Presenting symptoms were similar to those of tubal pregnancies including circulatory collapse which was present in 4/19 (21%) of patients. Culdocentesis for diagnostic purposes, has become an unnecessary procedure. Wedge resection by laparotomy was the treatment of choice in the past, and from 1994, it was performed exclusively by laparoscopy. When an ovarian pregnancy was diagnosed, intrauterine device was present in 68% of the patients and in 76% of the fertile women.

CONCLUSIONS

The absolute number of ovarian pregnancies between 1900 and 2001 increased but the prevalence rate per delivery was stable. Despite modern diagnostic modalities patients still present in circulatory collapse-conservative approach may underestimate the potential risk of bleeding. Culdocentesis has no clinical diagnostic benefits. Laparoscopy is invaluable, as diagnosis and treatment can be carried out as a single treatment. Laparoscopic wedge resection is the treatment of choice. The relation between IUD use and ovarian pregnancies is still strong.

A Comparison of the Incidence, Presentation, and Management of Ovarian Pregnancies between Two Periods of Time

STUDY OBJECTIVE

To compare the prevalence, presentation diagnostic modalities, and management of 37 ovarian pregnancies in one institution during two time periods.

DESIGN

A retrospective study (Canadian Task Force classification II-2).

SETTING

Department of Gynecology in a university-affiliated hospital.

PATIENTS

Twenty patients with ovarian pregnancy between 1971-1989 compared with 17 patients with ovarian pregnancy between 1990-2000.

MEASUREMENTS AND MAIN RESULTS

Seventeen ovarian pregnancies, diagnosed between 1990-2000, comprised 2.6% (17/634) of all ectopic pregnancies, 1:3500 of all live births leading to a mean ovarian pregnancy rate per year of 1.5, as opposed to 3.1% (20/647) of all ectopic pregnancies, 1:3600 of all live births, and a mean ovarian pregnancy rate per year of 1.1 in the previous period. Circulatory collapse was present in 4/17 (23%) patients in the 1990-2000 time period and in 6/20 (30%) in the previous period. Culdocentesis for diagnostic purposes was practically abandoned in the recent decade. Wedge resection by laparotomy was the treatment of choice in the past, and after 1997, it was performed exclusively by laparoscopy. When an ovarian pregnancy was diagnosed, an intrauterine device (IUD) was present in 65% of all patients and in 73% of women who had previously conceived in the 1999-2000 time period, compared with higher rates in the previous period (90% and 100%, respectively).

CONCLUSION

The absolute number of ovarian pregnancies in the last 11 years increased when compared with the previous 19 years; however, the prevalence rate per delivery was stable. Patients still experienced circulatory collapse despite modern diagnostic modalities. Culdocentesis for diagnostic purposes has become an unnecessary procedure. Laparoscopic wedge resection was the treatment of choice. The relationship between IUD use and ovarian pregnancies was still strong.