Abstract
A 31-year-old woman presented with a 7-week history of irregular vaginal bleeding without abdominal pain. She had been using the intrauterine contraceptive device (IUD) for the last 3 years. A pregnancy test was positive and subsequent serum beta human chorionic gonadotropin (β-HCG) was 4992 mIU/mL. A transvaginal ultrasound scan demonstrated an empty uterus with an associated adnexal mass but no free fluid. A right primary ovarian ectopic pregnancy was diagnosed a laparoscopy. This was managed laparoscopically using monopolar diathermy hook with conservation of the ovary and minimal blood loss. Ovarian pregnancy is rare, especially in women without the classical risk factors for tubal pregnancy, and efforts should be made to exclude ectopic pregnancy in the absence of abdominal pain in a woman of reproductive age presenting with prolonged and irregular vaginal bleeding. Methods to conserve the ovary are also encouraged in cases of ovarian pregnancy.
Highlights
Ovarian pregnancy is rare and remains a diagnostic and management challenge, especially in settings where health resources are stretched [1]
Primary ovarian pregnancy is when the primary nidation occurs in the ovary as opposed to secondary ovarian pregnancy where the initial implantation is in the Fallopian tube and the ovarian attachment is secondary to tubal abortion
Most case reports do not describe the type of surgical instrument used and hard to assess the types of instruments used for conservative management and how they differed if any from ours. This is not unexpected because the case reports or series generally focuses on the general management of ovarian pregnancy and their associated outcomes rather than the specific surgical tools or forceps used for their treatment
Summary
Ovarian pregnancy is rare and remains a diagnostic and management challenge, especially in settings where health resources are stretched [1]. A potential major surgical and clinical problem is intra-peritoneal bleeding and difficulty in achieving haemostasis to conserve the ovary. This is in addition to the difficulty in accurately arriving at a diagnosis pre-operatively. Laparoscopy was performed through a 10 mm trans-umbilical port and two further secondary (right-5 mm, left-10 mm adjustable) ports inserted on each iliac fossa, lateral to epigastric vessels The uterus and both the Fallopian tubes appeared normal without dilatation or signs of intra-tubal hemorrhage and no bleeding from the fimbriae. Histology demonstrated the presence of chorionic villi and ovarian stromal tissue including part of the corpus luteum confirming ovarian ectopic pregnancy She was followed up for 3 weeks until serum HCG was below 5 mIU/mL
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