Laparoscopic management of consecutive ovarian pregnancy in a patient with infertility

Subscribe to RSS DOI: 10.1055/s-2001-12528 J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG Laparoscopic management of consecutive ovarian pregnancy in a patient with infertility Laparoskopisches Management aufeinanderfolgender Ovarialgravidität bei einer Patientin mit FertilitätsstörungenPublication History Publication Date: 31 December 2001 (online) Summary The diagnosis of ovarian pregnancy is based on the improper rise of serum beta-hCG levels, sonographic findings of an empty uterus, highly characteristic ovarian formation with double hyperechogenic ring surrounding small hypoechogenic field, and the laparoscopic verification of Spiegelberg's criteria. We present a case of ovarian pregnancy in spontaneous cycle in 34-year-old woman following two unsuccessful IVF/ET procedures and ovarian pregnancy on contralateral side laparoscopically treated seven months ago, also achieved in non-stimulated, spontaneous cycle. On admission she had a serum hCG level of 596 mIU/mL on cycle day 46 and an empty uterus. Transvaginal sonography showed a 20 mm ring-like thick-walled hyperechogenic structure within the left ovary. The echogenic ring was surrounded by irregular, hypoechogenic structures suggestive of an ovarian pregnancy with periluteal hemorrhage and blood clots. The ruptured cystic ovarian pregnancy and the corpus luteum were removed by laparoscopy. During the procedure we have seen two clips on the right ovary placed laparoscopically to achieve hemostasis after rupture of the ovarian pregnancy seven months ago. Histopathology showed isolated chorionic villi within hemorrhagic areas in the vicinity of the corpus luteum. Laparoskopisches Management aufeinanderfolgender Ovarialgravidität bei einer Patientin mit Fertilitätsstörungen Zusammenfassung Wir berichten den Fall einer 34jährigen Patientin mit Ovarialgravidität nach nicht-erfolgreicher IVF-Behandlung. Sieben Monate vorher war bei der Patientin auf der kontralateralen Seite ebenfalls eine Ovarialgravidität laparoskopisch behandelt worden. MeSH C13.703 pregnancy complications Key words Laparoscopy - ovarian pregnancy - infertility - IVF/ET - transvaginal sonography Schlüsselwörter Laparoskopie - Ovarialgravidität - Fertilitätsstörung - transvaginale Sonographie References - 1 Dawood M Y. Laparoscopic surgery of the fallopian tubes and ovaries. Semin Laparosc Surg. 1999; 6 58-67 - 2 Ferro P L, Badawy S ZA, Berry C J, Rooney M. Laparoscopic resection of an ovarian pregnancy in a patient using the copper T intrauterine device. J Am Assoc Gynecol Laparosc. 1996; 3 329-332 - 3 Gaudoin M R, Coulter K L, Robins A M, Verghese A, Hanretty K P. Is the incidence of ovarian ectopic pregnancy increasing?. Eur J Obstet Gynecol Reprod Biol. 1996; 70 141-143 - 4 Hallatt J G. Primary ovarian pregnancy: a report of twenty-five cases. Am J Obstet Gynecol. 1982; 143 55-60 - 5 Koike H, Chuganji Y, Watanabe H, Kaneko M, Noda S, Mori N. Conservative treatment of ovarian pregnancy by local prostaglandin F2α injection. (Letter). Am J Obstet Gynecol. 1990; 163 696 - 6 Paulsson G, Kvint S, Labecker B M, Löfstrand T, Lindblom B. Laparoscopic prostaglandin injection in ectopic pregnancy: success rates according to endocrine activity. Fertil Steril. 1995; 63 473-477 - 7 Riethmuller D, Sautière J L, Benoit S, Roth P, Schaal J P, Maillet R. Ultrasonic diagnosis and laparoscopic treatment of an ovarian pregnancy. A case report and review of the literature. J Gynecol Obstet Biol Reprod (Paris). 1996; 25 378-383 - 8 Spiegelberg O. Casuistik der Ovarialschwangerschaft. Arch Gynaecol. 1878; 13 73-78 - 9 Studzinski Z, Branicka D, Filipczak A, Olinski K. Prolonged ovarian pregnancy: a case report. Ginekol Pol. 1999; 70 33-35 - 10 Yoshimura Y. The ovarian renin-angiotensin system in reproductive physiology. Front Neuroendocrinol. 1997; 18 247-291 Ass. Prof. Milan M. TerzićMD, MSc, PhD, Ob/Gyn Dept. of Ob/Gyn, School of Medicine University of Belgrade 11000 BelgradeYugoslavia Višegradska 26