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.

Successful outcome in a rare case of live post-term ovarian pregnancy

Ovarian ectopic is a rare form of ectopic pregnancy and reaching up to term is an extreme rarity. It is usually diagnosed incidentally when a cesarean section is done for other obstetric causes. Being highly vascular, it may result in obstetric catastrophes. We report first live post-term ovarian pregnancy well managed with multidisciplinary approach. A 35-year multigravida at 44 weeks presented with a diagnosis of placenta percreta. Magnetic resonance imaging suggested abdominal pregnancy with a live fetus. On laparotomy, it was live ovarian ectopic with placenta attached to left infundibulopelvic vessels and later confirmed on histological examination. Ovarian ectopic is best diagnosed in the first trimester by ultrasound and managed by laparoscopy or laparotomy. It is usually misdiagnosed as an abdominal pregnancy at term even with the use of high-end technology. It always poses a dilemma for clinicians. Preoperative magnetic resonance imaging helps in the planning of surgery with all precautionary measures and counseling of patients.