Tubo-Ovarian ectopic pregnancy: A rare twin ectopic pregnancy.

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.

Ruptured primary ovarian pregnancy: A case report with a literature review.

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 ß-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.

Non-tubal ectopic pregnancy treatment experiences of a tertiary care center.

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 inflammatory 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.

Ovarian pregnancy after bilateral salpingectomy in a patient with in vitro fertilization: a case report.

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.

Successful management of a patient with ovarian ectopic pregnancy by the end of the first trimester: a case report.

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 ß-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.

Dual extrauterine ectopic pregnancy: double management.

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.

Postoperative reproductive outcomes in women with ovarian pregnancy: A retrospective analysis.

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.

Ovarian ectopic pregnancy after in vitro fertilisation treated by laparoscopic excision with ovarian preservation.

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.

Right-sided ovarian ectopic pregnancy with Jaydess in situ.

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.

Ectopic pregnancy in left ovary and contralateral uterine tube diagnosed one week apart in In Vitro Fertilization with donor eggs: Case report.

Bilateral ectopic pregnancy is a rare clinical condition with an estimated prevalence of 1/200 000 in spontaneous pregnancies. Studies have found that In Vitro Fertilization (IVF) is related to ectopic pregnancy independently, but the incidence of tubal disease in the donor egg recipient population is thought to be significantly lower than in the standard IVF population. We report the case of a patient participating in the egg-sharing program, who was diagnosed with ovarian ectopic pregnancy, treated with surgery. After one week, she was diagnosed with tubal ectopic pregnancy in the contralateral tube. The clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operatory inspection of both side fallopian tubes in any ectopic pregnancy case. Routine ultrasound after ectopic pregnancy treatment may be reasonable, especially in high risk patients.

Ovarian Ectopic Pregnancy: Laparoscopic Excision and Ovarian Conservation.

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.

Spontaneous ovarian heterotopic pregnancy.

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.

Coexisting ovarian and tubal pregnancies on opposite sides after intrauterine insemination: a case report.

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.

Ovarian apoplexy resulting from ruptured heterotopic pregnancy following intrauterine insemination.

Heterotopic pregnancy is on the rise with the use of assisted conception and commonly involves the fallopian tube. Ovarian heterotopic pregnancy is rare, with fewer than 40 reported cases in PubMed/Medline; cases of ovarian ectopic pregnancy after intrauterine insemination are even rarer, with only seven published reports. We report here a case of ovarian heterotopic pregnancy following intrauterine insemination; this could possibly be the first such report. Our patient presented with circulatory collapse in the first trimester and laparoscopy disclosed an ovarian pregnancy with hemoperitoneum. Following resection of the ovarian pregnancy, the intrauterine gestation continued undisturbed and the patient delivered at term. Heterotopic pregnancy and unusual ectopic locations should be considered a possibility in pregnant women with pelvic pain, particularly following fertility treatment, including ovarian stimulation and intrauterine insemination.

Ectopic ovarian pregnancy after intracytoplasmic sperm injection with testicular spermatozoa - a case report.

Ovarian ectopic pregnancy is a rare event in both natural and assisted human reproduction settings. There are few reports of this event after in vitro fertilization. Diagnosis can be challenging, since it requires specific medical expertise. Patients with this condition call for careful management during treatment so as to not affect their fertility potential. This paper describes the case of a woman submitted to ICSI and embryo transfer who subsequently had an ovarian ectopic pregnancy and underwent a laparoscopic partial right oophorectomy.

Presentación de una paciente con embarazo ectópico ovárico / Presentation of a Patient with Ovarian Ectopic Pregnancy

El embarazo ectópico es en la actualidad un problema de salud a nivel mundial, atribuido el aumento de su incidencia, a las inflamaciones pélvicas provocadas por enfermedades de transmisión sexual, el aborto, uso de dispositivos intrauterinos, la aplicación de técnicas de reproducción asistida, uso de inductores de la ovulación, entre otros. Se presentó un caso de embarazo ectópico ovárico en una mujer de la raza negra de 38 años de edad, que acudió con cuadro clínico de vómitos, escalofríos y dolor abdominal al Cuerpo de Guardia del Margret Marquart Catholic Hospital en Kpando, región Volta, Ghana. Al examen físico se palpó una tumoración que ocupaba gran parte del hipogastrio, fondo de saco de Douglas abombado y doloroso. Con antecedentes patológicos personales de anemia crónica y portadora de virus de inmunodeficiencia humana (VIH). Se ingresó, se realizó laparotomía y se egresó luego de evolución satisfactoria(AU)

Ectopic pregnancy is nowadays a worldwide health problem due to the incidence of pelvic inflammatory diseases caused by abortion, sexually transmitted diseases, the use of intrauterine devices and assisted reproductive techniques among others. A 38- year- old black woman came to the emergency room at the Margret Marquart Catholic Hospital of Kpando, Volta Region in Ghana with a history of vomiting, chills and abdominal pain. On physical examination, a tumor mass was found, that occupied a large part of the epigastrium, Douglas sack fundus, which was convex and painful. She has a personal pathological history of chronic anaemia and she was a carrier of HIV. She was admitted in the hospital and a laparotomy was performed. She was discharged after her satisfactory evolution(AU)

Primary Ovarian Ectopic Pregnancy: Still a Medical Challenge.

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.

Heterotopic Pregnancy After In Vitro Fertilization and Embryo Transfer After Bilateral Total Salpingectomy/Tubal Ligation: Case Report and Literature Review.

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.