Diagnostic dilemma in ovarian pregnancy: a case series

Begum J, Jasmina Begum, Pallavee P, P Pallavee, Samal S, Sunita Samal
Journal of clinical and diagnostic research : JCDR · 2015 · vol. 9(4) , pp. QR01–3 · doi:10.7860/jcdr/2015/11501.5772 · PMID:26023609 · PMC4437125
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This case series reports three primary ovarian ectopic pregnancies diagnosed via surgery and histopathology, highlighting the diagnostic challenge of distinguishing this condition from other causes of acute abdominal pain.

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This case series describes three instances of primary ovarian ectopic pregnancies that were initially misdiagnosed as ruptured tubal ectopic pregnancies or hemorrhagic corpus luteum. The authors utilized Spiegelberg’s criteria for diagnosis, with all cases confirmed via histopathology following emergency laparotomy. The paper highlights the diagnostic challenges posed by high-resolution transvaginal ultrasonography and notes potential links to intrauterine device use or ovulatory dysfunction in these rare events. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Ovarian pregnancy is a rare form of ectopic pregnancy but it is the most common type of nontubal ectopic pregnancy. Many times it is operated with a misdiagnosis of ruptured tubal ectopic pregnancy or hemorrhagic corpus luteum. The high resolution transvaginal ultrasonography is a valuable tool for diagnosis of ectopic pregnancy but ovarian pregnancy still remains a diagnostic problem and a continuous challenge to the gynecologist. The correct diagnosis is made at the time of surgery and confirmation is by histopathological report. Here we report three cases of primary ovarian ectopic pregnancies, consistent with the Spiegelberg's criteria. Out of this, two cases have corroboration of ovarian ectopic pregnancy with use of intrauterine contraceptive device and one case by chance without any preexisting risk factors, probably due to interference in the release of ovum from the follicle. In all the three cases, emergency laparotomy was done for ruptured tubal ectopic pregnancy and the diagnosis of ruptured primary ovarian pregnancy was made at the time of surgery, this was subsequently confirmed by histopathology report. In the era where wider usage of intrauterine devices, ovulatory drugs and assisted reproductive techniques are rife, there is a possibility of an increase in the incidence of this rare entity, so ovarian ectopic pregnancy should be kept in mind as a possibility. Thereby early diagnosis by high resolution transvaginal ultrasound and laparoscopy can decrease the risk of complications like rupture, secondary implantation, hemorrhagic shock and maternal mortality.
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Diagnostic Dilemma in Ovarian Pregnancy: A Case Series Correspondence Address : Dr. Jasmina Begum, Associate Professor, Department of Obstetrics and Gynecology, Mahatama Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry -607402, India. E-mail : [email protected] Ovarian pregnancy is a rare form of ectopic pregnancy but it is the most common type of nontubal ectopic pregnancy. Many times it is operated with a misdiagnosis of ruptured tubal ectopic pregnancy or hemorrhagic corpus luteum. The high resolution transvaginal ultrasonography is a valuable tool for diagnosis of ectopic pregnancy but ovarian pregnancy still remains a diagnostic problem and a continuous challenge to the gynecologist. The correct diagnosis is made at the time of surgery and confirmation is by histopathological report. Here we report three cases of primary ovarian ectopic pregnancies, consistent with the Spiegelberg’s criteria. Out of this, two cases have corroboration of ovarian ectopic pregnancy with use of intrauterine contraceptive device and one case by chance without any preexisting risk factors, probably due to interference in the release of ovum from the follicle. In all the three cases, emergency laparotomy was done for ruptured tubal ectopic pregnancy and the diagnosis of ruptured primary ovarian pregnancy was made at the time of surgery, this was subsequently confirmed by histopathology report. In the era where wider usage of intrauterine devices, ovulatory drugs and assisted reproductive techniques are rife, there is a possibility of an increase in the incidence of this rare entity, so ovarian ectopic pregnancy should be kept in mind as a possibility. Thereby early diagnosis by high resolution transvaginal ultrasound and laparoscopy can decrease the risk of complications like rupture, secondary implantation, hemorrhagic shock and maternal mortality. Contraceptive IUD, Ectopic pregnancy, Ovulatory dysfunction DOI: 10.7860/JCDR/2015/11501.5772 Date of Submission: Sep 29, 2014 Date of Peer Review: Dec 07, 2014 Date of Acceptance: Feb 05, 2015 Date of Publishing: Apr 01, 2015 Financial OR OTHER COMPETING INTERESTS: None. - Emerging Sources Citation Index (Web of Science, thomsonreuters) - Index Copernicus ICV 2017: 134.54 - Academic Search Complete Database - Directory of Open Access Journals (DOAJ) - Embase - EBSCOhost - Google Scholar - HINARI Access to Research in Health Programme - Indian Science Abstracts (ISA) - Journal seek Database - Popline (reproductive health literature) - www.omnimedicalsearch.com

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