Successful laparoscopic management of a rare complication after embryo transfer: ovarian pregnancy. A case report and up-to-date literature review

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.

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 β-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 β-hCG levels. The ultrasonic preoperative diagnosis is conductive to the early diagnosis of OP though the diagnosis accuracy is low.

Preoperative diagnostic clues to ovarian pregnancy: retrospective chart review of women with ovarian and tubal pregnancy

OBJECTIVE

To analyze the preoperative diagnostic clues to ovarian pregnancy (OP).

METHODS

This study conducted a retrospective chart review of 23 patients with OP and 46 patients with tubal pregnancy (TP) from October 1, 2003 to September 31, 2016 in Hanyang University Hospital.

RESULTS

There were no significant differences in demographic and clinical characteristics between the two groups. The presence of an ectopic gestational sac and hemoperitoneum was significantly higher in the TP group (13.0% vs. 95.7%, P=0.000; 13.0% vs. 54.3%, P=0.001, respectively) in preoperative ultrasonogram. The OP group had more ruptured ectopic gestational sacs than the TP group (73.9% vs. 45.7%, P=0.039) in surgical findings.

CONCLUSION

For the patients in whom a gestational sac is not detected in the uterus or the fallopian tubes, it is important to be aware of the possibility of OP and rupture of an ovarian gestational sac to promote early diagnosis and surgical intervention.

Improving the safety of the embryo and the patient during in vitro fertilization procedures

In vitro fertilization (IVF) is a method of treatment for infertility in selected indications. Recent years have brought dynamic development of technologies related to IVF. This article presents problems pertaining to the safety of technology with respect to the patient, as well as the embryo, based on an analysis of scientific reports and our own experience. Invasiveness of the IVF procedure for the woman and the embryo varies on an individual basis. Minimization of the invasiveness of IVF requires experience of the staff performing the procedure, especially with respect to the assessment of risk for an individual patient. Technologies related to IVF are constantly being improved, and the effectiveness of the selected individual treatment methods is not always scientifically confirmed.