Ovarian pregnancy: Report of four cases and review of the literature

Abstract

Ovarian ectopic pregnancy is rarely seen; it constitutes only 0.5-3% of all ectopic pregnancies and the incidence is only 1 for every 7000-40,000 deliveries. We herein report four cases of primary ovarian pregnancy encountered during the last 10 years in Miyazaki prefecture, Japan. The patients in all of these cases were admitted to their local hospitals with increased lower abdominal pain and intraperitoneal bleeding, and had surgery for total or partial oophorectomy. Grossly and microscopically, chorionic villi were exclusively found in the ovary but not in the fallopian tube, so that we diagnosed these cases as primary ovarian pregnancies. None of the patients were known to have used an intrauterine contraceptive device, which have been suggested as the cause of ovarian pregnancies in several studies. The incidence of ovarian pregnancy is recently increasing, and pathologists will have increased chances to diagnose this disease.

MR features of ectopic pregnancy

“…Ovarian pregnancy is the implantation of a fertilized ovum confined to the ovary, accounting for 0.5-3% of all EP [32][33][34]. Unlike tubal pregnancy, this condition is associated with neither pelvic inflammatory disease nor infertility.…”

Laparoscopic Conservative Management of Ovarian Ectopic Pregnancy

“…However, such clinical entities as ruptured ovarian cyst or corpus luteum may also yield similar impression (8) . Spielberg (4) specified the following 4 diagnostic criteria: (a) the fallopian tube on the affected side should be intact; (b) the gestational sac should definitely occupy the normal position of the ovary; (c) the sac should be connected to the uterus by means of proper ovarian ligament; (d) the ovarian tissues should be demonstrated in the wall of the sac. Our case met all the Spielberg criteria.…”

“…OEPs are more commonly composed of the rare cases associated with multiparity and IUD use (5,7) . The proposed etiologies, albeit yet to be elucidated (3) , can be specified as follows: (i) inhibition of release of the ovum from the ruptured follicle due to the inflammation (PID, perioophoritis, endometriosis) or low intrafollicular pressure; (ii) loss of tubal functions( ineffective ciliary movements, peristaltic dysfunction) for idiopathic reasons or secondary to the inflammation; (iii)parthenogenesis; (iv) prostoglandin use (4,5) . Either after fertilization of the ovum within the ovary (1) or after migration and implantation of the fertilized ovum to the ovary, a cascade leading to the development of the ectopic pregnancy is initiated (1,4) .…”

“…Moreover, that may possibly be confused with a bleeding ovarian cyst or corpus luteum during laparoscopy. According to the criteria specified by Spielberg et al (4) , such factors as high blood levels of B-hCG, absence of gestational sac in the TVUSG, absence of chorionic villi in the histological specimens and reversal of B-hCG to the normal levels sufficed for the definitive diagnosis of ectopic pregnancy. In the present case, laparoscopic diagnosis and conservative management of an ectopic pregnancy was aimed to be reported.…”

Primary ovarian pregnancy after the empty follicle syndrome: A case report

“…Primary ovarian pregnancy is a rare form of ectopic implantation with an incidence of 1 for every 7000-40 000 deliveries. 1 Approximately 6% of pregnancies achieved after in vitro fertilization (IVF) treatment are ectopic. 2 Despite the increased incidence after IVF treatment, the ovarian pregnancy is still a rare event.…”