Search

Aim: To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center., Material and Methods: A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated., Results: In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96 mm vs. 17,34 ± 9,87 mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic ınflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05)., Conclusion: The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

The most common twin ectopic pregnancy is heterotopic (1/7000). We are reporting a rare case of twin tubo-ovarian ectopic pregnancy, which was presented in the emergency department of Ayub Teaching Hospital Abbottabad. A 30- year-old female arrived with worsening lower abdominal pain persisting for three weeks. She also had per-vaginal bleeding with passage of clots 1week ago. Clinical examination revealed a tense abdomen with tenderness in the left iliac fossa. Per-vaginally, there was cervical motion tenderness and fullness in the posterior fornix. Beta HCG level revealed a sub-optimal rise whereas Transabdominal ultrasound showed an echogenic shadow in the left ovary. The uterus appeared normal. On exploratory laparotomy a large left ovarian mass was seen with ruptured chronic right tubal pregnancy with adhesions. On cut-section of the ovary, a small foetus was evident. We have concluded that in case of subacute abdominal pain and an-echogenic mass on ultrasonography in reproductive age contralateral adnexa should be accessed to exclude contralateral ectopic pregnancy.

Ovarian pregnancy is rare but may occur with in vitro fertilization-embryo transfer in women who have undergone bilateral salpingectomy. We report a case of an approximately 30-year-old woman who had in vitro fertilization and a history of bilateral salpingectomy, and was diagnosed with an ovarian pregnancy. Laparoscopic enucleation of the gestational product in the ovary and ovarian remnant reconstruction were performed. The patient recovered well after surgery and was discharged home 5 days postoperatively. ß-human chorionic gonadotropin was undetectable 3 weeks after the surgery. Awareness of the possibility of ovarian pregnancy after in vitro fertilization-embryo transfer is the most important step in an early diagnosis and treatment. Salpingectomy should be carefully performed to eliminate the risk of heterotopic pregnancy, especially in cases where a subsequent gestation is desired.

Background: Among all ectopic pregnancies, between 0.5% and 3.5% are ovarian ectopic pregnancies, a potentially life-threatening condition when ruptured due to its serious potential for hemorrhaging. A majority of ovarian ectopic pregnancies are diagnosed by the 7th week of pregnancy when the patient becomes symptomatic, and ultrasound can be used to diagnose this condition., Case Presentation: We present the case of a 39-year-old Persian woman in the 12th week of gestation who presented with vaginal bleeding and abdominal pain and was diagnosed with ovarian ectopic pregnancy. Her notable laboratory finding was β-human chorionic gonadotropin > 15,000, which indicates definite pregnancy. Transvaginal ultrasound (TVS) revealed no evidence of intrauterine pregnancy, but a well-circumscribed gestational sac in the left ovary. The patient was successfully treated with resection of the gestational sac and partial left salpingo-oophorectomy. Histopathological studies confirmed the diagnosis of ovarian ectopic pregnancy., Conclusion: The case emphasizes the ability of ovarian ectopic pregnancy to develop asymptomatically through the course of pregnancy and points to the necessity for high-quality prenatal care and the importance of determining the fetal site during pregnancy., (© 2022. The Author(s).)

A 30-year-old nulliparous woman was referred with suspected left ovarian ectopic pregnancy. She had undergone laparoscopic left salpingectomy for ruptured tubal ectopic pregnancy 3 weeks earlier, following treatment with medications for ovulation induction. Sonological examination revealed a left ovarian ectopic pregnancy corresponding to 8 0/7 weeks with cardiac activity. She underwent ultrasound-guided intrasac therapy with intrasac instillation of 3 mEq of potassium chloride followed by 50 mg of methotrexate. She was followed with weekly measurements of serum beta human Chorionic Gonadotropin (hCG) which returned to baseline after 65 days of the intrasac therapy. This case not only highlights the need for continued follow-up of the serum beta hCG after definitive management of an ectopic pregnancy in cases with multiple ovulations, but also the option of medical management in cases of advanced ovarian ectopic pregnancy. It also accentuates the necessity for adequate counselling to avoid conception in a multiple ovulation cycle., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

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., Competing Interests: Declaration of competing interest The authors declare there are no conflict of interests., (Copyright © 2021. Published by Elsevier B.V.)

A 42-year-old woman presented with lower abdominal pain and fainting episodes 36 days after in vitro fertilisation and embryo transfer. Transvaginal ultrasound revealed a large amount of free fluid in the pouch of Douglas and no evidence of an intrauterine gestational sac or adnexal mass suggestive of ectopic pregnancy. A presumed haemorrhagic corpus luteal cyst was seen in the left ovary. Laparoscopic exploration revealed a left ovarian haemorrhagic mass, which was excised with preservation of the ovary. Histopathological examination confirmed an ovarian ectopic pregnancy (OEP). OEP is rare but potentially life-threatening, as it can lead to internal haemorrhage. Its diagnosis is challenging as preoperative and intraoperative findings can be evocative of the far more frequent haemorrhagic corpus luteal cyst and histopathology is often necessary to confirm the diagnosis. Early recognition of OEP is crucial to reduce maternal morbidity and mortality, and allow treatment that preserves fertility as much as possible., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The estimated prevalence of the ectopic pregnancy (EP) is 1-2% of all pregnancies. Ovarian pregnancy is a rare finding with an incidence rate of 0.15% of all pregnancies and 1-3% of ectopic gestations. The use of intrauterine device (IUD) is a significant risk factor of ectopic pregnancy. Jaydess levonorgestrel intrauterine system (LNG-IUS) is considered as an extremely reliable method of contraception with the cumulative Pearl index of approx. 0.9% after a three-year period of use. This study presents a case of failure of the Jaydess intrauterine device in situ in a female patient with positive Beta Human Chorionic Gonadotropin (serum b-HCG) who was diagnosed with right-sided ovarian ectopic pregnancy. Although LNG-IUS represents the group of the most efficient contraception methods, the risks of failure still exist and should be taken into consideration. Before the insertion, every female patient should be fully informed on the potential adverse effects by a health practitioner.

Study Objective: To show a case of laparoscopic excision of an ovarian ectopic pregnancy and the technique used., Setting: A university hospital (Manchester University Foundation Trust)., Patient: A 23-year-old primigravida presentation at 6 weeks of gestation with an ectopic pregnancy., Intervention: A 23-year-old primigravida presentation at 6 weeks of gestation with a 7-day history of light bleeding and intermittent abdominal pain. The examination was unremarkable, and the serum human chorionic gonadotropin level was 7157 IU/L. An ultrasound scan showed an ectopic pregnancy in the right adnexa, and she underwent surgical management. At laparoscopy, both fallopian tubes were noted to be normal with an ectopic pregnancy within the right ovary; 20 IU argipressin diluted in 80 mL 0.9% sodium hypochlorite was injected between the normal ovarian tissue and the ectopic pregnancy to assist hemostasis and hydrodissection. An ultrasonic device was used to incise the ovarian cortex to identify a plane of dissection between the ectopic pregnancy tissue and the normal ovarian tissue. The ectopic pregnancy was excised with conservation of the ovary. The ovary was subsequently closed with absorbable sutures to ensure hemostasis. The ectopic pregnancy was removed in a bag through a 10-mm incision., Measurements and Main Results: The patient made an uneventful recovery. The serum human chorionic gonadotropin level in 7 days was <5, and no further medical management was indicated. Histology confirmed a primary ovarian ectopic pregnancy. Ovarian function was not assessed postoperatively; however, she conceived 6 weeks later with an intrauterine pregnancy., Conclusion: This case highlights the importance of considering nontubal ectopic pregnancies when making a diagnosis based on an ultrasound scan. Ovarian preservation with excision of ectopic pregnancy can be achieved using techniques commonly used for ovarian cystectomy. Recourse to oophorectomy should only be considered in the event of acute hemorrhage., (Copyright © 2019. Published by Elsevier Inc.)

Heterotopic pregnancy is a simultaneous intrauterine and ectopic pregnancy. We report a case of a spontaneous ovarian heterotopic pregnancy. A 36-year-old woman, gravida 7 para 4-1-1-5 at 4 weeks gestation (spontaneous conception), presented to the emergency department with vaginal spotting, lower abdominal cramps with human chorionic gonadotropin(hCG) 10 772 mIU/mL (hCG at T0). Abdominal and pelvic examinations were benign. Transvaginal sonogram (TVS) showed an intrauterine gestational sac and yolk sac, no fetal pole visualised. She was discharged home with a diagnosis of threatened abortion. The patient returned to the emergency department 3 weeks later (T1) at 7 weeks gestation with recurrent vaginal bleeding and lower abdominal pain. Her TVS showed an empty uterus with small amount of free fluid in the cul-de-sac. A small 2 cm round mass noted in the adnexa with hCG of 4663 mIU/mL (hCG at T1). Laparoscopy revealed normal fallopian tubes bilaterally and a ruptured right ovarian ectopic pregnancy. Pathology was consistent with ectopic pregnancy. Abnormal hCG patterns should raise suspicion for heterotopic pregnancy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Ovarian pregnancy is very rare, and contralateral tubal pregnancy coexisting with ovarian pregnancy must be even rarer., Case Presentation: A 33-year-old Korean nulliparous woman was referred to our hospital because she suffered lower abdominal pain and had missed her periods after controlled ovarian hyperstimulation and intrauterine insemination. We could not identify any normal gestational sac in the endometrium, or specific ectopic pregnancies, on an initial ultrasound scan. However, there was a large hematoma in the cul-de-sac and free fluid in the right paracolic gutter. We decided to perform emergent laparoscopic surgery. We found contralateral tubal and ovarian ectopic pregnancies., Conclusion: To the best of our knowledge, this is the first report of a case in which a patient underwent laparoscopic right salpingectomy and left ovarian ectopic mass excision due to contralateral tubal and ovarian ectopic pregnancies after assisted reproductive technology.

We here report a case of left ovarian pregnancy passively detected in the General Reference Hospital outpatient clinic in Dilolo, Democratic Republic of Congo. The diagnosis was confirmed by ultrasound; the patient underwent surgery with uneventful postoperative course. Pregnant women and healthcare personnel should be aware of the importance of proper clinical and echographic monitoring in pregnancy for early diagnosis of abnormal implantations., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Backround: Primary ovarian pregnancy is a rare form of ectopic gestation and one that is often diagnosed only at the time of surgery., Case: A 17-year-old primi- gravid woman presented to our clinic with lower abdom- inal pain, vaginal bleeding, and missed period. Trans- vaginal sonography revealed an empty uterus, normal- looking right fallopian tubes, and the presence of a gestational sac containing 2 yolk sacs and 2 embryos with cardiac activity on the right ovary. Methotrexate therapy failed and the patient was successfully treated with laparoscopic enucleation of the ectopic pregnancy mass., Conclusion: Surgery is the primary treatment modality of choice in twin ovarian pregnancy. Therefore, the differential diagnosis of ovarian pregnancy is of great importance in order to plan immediate surgery and save the patient from unnecessary medical treatment, and thus preserving future fertility.

Heterotopic pregnancy is defined as the simultaneous occurrence of intrauterine and ectopic pregnancy, either of which may be single or multiple. It occurs in up to 1% of pregnancies after in vitro fertilization and embryo transfer. This article reports 2 rare cases of heterotopic pregnancy after in vitro fertilization and presents a literature review. In the first case, a 28-year-old woman had previous laparoscopic bilateral total salpingectomy for a right tubal pregnancy and a left hydrosalpinx. However, she had ovarian heterotopic pregnancy after a third in vitro fertilization cycle. Emergency laparotomy was performed. The synchronous intrauterine pregnancy continued with no further complications and ended in the delivery of a singleton term pregnancy. The second case combined interstitial and intrauterine pregnancies after bilateral tubal ligation for hydrosalpinges followed by in vitro fertilization and frozen embryo transfer. The possibility of heterotopic pregnancy after bilateral total salpingectomy/tubal ligation, although extremely rare, should also be considered by gynecologists when they treat an in vitro fertilization patient even though an intrauterine pregnancy has been confirmed., (Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Ovarian pregnancy (OP) is a rare ectopic pregnancy, in which it is very difficult to achieve preoperative diagnosis. Ovarian blood supply in OP increases which will lead to intra-abdominal bleeding, hazarding women's lives. Surgical exploration should be conducted once cases of OP are suspected., Objective: To investigate clinical characteristics, diagnosis, and therapy of OP., Materials and Methods: A retrospective study was conducted in 95 patients with OP admitted to the present hospital from January 2005 to June 2014., Results: OP accounted for 1.79% of ectopic pregnancy over the same period, of which 68.4% had a history of artificial abortion, 6.3% was treated with intrauterine contraceptive device (IUD), 87.4% had abdominal pain, 84.2% had a history of menopause, and 51.6% had vaginal bleeding. All patients had no preoperative diagnosis and underwent laparoscopic wedge resection of ovary or lesionectomy and were all were cured., Conclusion: Since the cause of OP is still unknown and it has no typical clinical manifestations, the present authors adopt blood P-hCG combined with B-ultrasound to improve the preoperative diagnosis. They prefer laparoscopic wedge resection of ovary or lesionectomy, which induce higher rate of intrauterine pregnancy and lower rates of ectopic pregnancy and infertility in re-pregnancy after surgery.

Objective: To investigate the clinical presentation of women with primary ovarian pregnancy diagnosed in recent years and to compare it to tubal pregnancy., Study Design: Seven women treated for primary ovarian pregnancy from 2002-2013 were retrospectively identified and compared to 42 women with tubal pregnancies (involving either tubal rupture or tubal abortion) operated on during the same period. In the ovarian pregnancy group the pathology examination confirmed primary ovarian pregnancy according to the Spiegelberg criteria., Results: Seven women underwent surgery for primary ovarian pregnancy during the study period. Five women presented with hemodynamic shock. A ruptured ovarian pregnancy was identified in all cases. Wedge resection was performed by laparotomy in 1 case and by laparoscopy in 6 cases. The mean estimated blood loss was significantly higher in those women with ovarian versus tubal pregnancy (1057.1 ± 472.1 mL vs. 250.2 ± 241.5 mL, respectively, p<0.001). Moreover, a statistically significant difference was found when we compared postoperative hospitalization days (2 ± 0.6 vs. 1.3 ± 0.7, respectively; p=0.01) in the ovarian pregnancy group as compared with the tubal pregnancy group., Conclusion: Primary ovarian ectopic pregnancy is still a major challenge for early diagnosis and treatment; it is associated with rupture and massive intraabdominal bleeding.

Ovarian pregnancy is a rare subtype of ectopic pregnancy, and its mechanisms have not been clarified. We report a case of ovarian pregnancy that supports a blastocyst migration mechanism. An infertile woman became pregnant after a single blastocyst transfer following in vitro fertilization during a fresh non-donor cycle. Transvaginal ultrasound revealed a gestational sac-like structure containing an active fetus that was located adjacent to the corpus luteum of the right ovary. Laparoscopy identified a red, swollen implantation site in the ovary, which was completely removed by wedge resection without damaging the remaining parenchyma. This case demonstrated that a fresh blastocyst transferred into the endometrial cavity migrated through the fallopian tube, implanted on an ovarian surface, and formed an ovarian pregnancy., (© 2015 Japan Society of Obstetrics and Gynecology.)

Background: Ovarian pregnancy (OP) is a low-frequency pathology but with devastating effects on women reproductive health. It is often difficult to distinguish from tubal or abdominal pregnancy. Diagnostic procedures and actual medical approaches to the treatment of OP are still a challenge., Clinical Case: In this paper we present a 21 years old woman, seen at the Hospital as emergency abdominal pain and hypovolemic shock, with a pregnancy of 14 weeks of gestational age. Emergency laparotomy was performed and right salpingo-oophorectomy was made. The findings were massive hemoperitoneum with a live fetus implanted on the surface of the right ovary. H istopathology report fulfilled Spiegelberg's criteria of primary ovarian pregnancy. The association of IUDs and ectopic pregnancy are discussed as well as some basic aspects of trophoblast biology., Conclusion: Ectopic pregnancy is an obstetric problems including poorly understood pathophysiology, clinical diagnostic dilemma and a very poor arsenal of therapeutic options.

Ovarian ectopic pregnancies are rare, with the majority diagnosed in the first trimester and often treated due to symptoms related to ovarian rupture. We report our experience with the diagnosis, management, and histologic evaluation of an unruptured second-trimester ovarian ectopic pregnancy. A 37-year-old woman presented with vague abdominal discomfort and irregular menses. Ultrasound detected a 16-week 4-day gestation with cardiac motion in the right adnexa and no evidence of an intrauterine pregnancy. Laparotomy with right salpingo-oophorectomy was performed, with removal of an unruptured pregnancy from the ovary. Although intraoperative examination and postoperative histopathologic evaluation demonstrated the classic Speigelberg criteria, it did not assist in the preoperative diagnosis, nor impact the treatment of the ovarian ectopic pregnancy in this case., (© 2015 Japan Society of Obstetrics and Gynecology.)

Background: Ectopic pregnancy is one of the ginecobstetric conditions that contribute to increased maternal mortality by 10 to 15% of cases. Ovarian ectopic pregnancy is one of the rare cases and represents up to 3% of ectopic pregnancies., Case: Female with 33 years old with lower abdominal pain, and pallor. Transvaginal ultrasound showed a live product with 15.3 weeks in left ovary and moderate hemoperitoneum. Exploratory laparotomy was performed with left salpingo-oophorectomy; postoperative course was satisfactory, discharged on the fourth day., Conclusion: Ovarian pregnancy is a rare form of presentation. Preoperative diagnosis is difficult and must have a high level of diagnostic suspicion with physical examination and imaging studies. Treatment will vary according to clinical and diagnostic precocity.

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., (Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.)