Ovarian pregnancy: report of three cases and review of the literature

Abstract

A 29-year-old woman presented 77 days after she had undergone in-vitro fertilization and embryo transplantation with a 15-day history of vague pain in the hypogastrium which had increased over the last 8 days. Her pulse rate was 75 bpm and blood pressure was 100/70 mmHg. Abdominal examination revealed tenderness of the hypogastrium and rebound in the left lower quadrant. A routine blood test showed her haemoglobin levels were 79 g/litre. Transvaginal sonography revealed an enlarged uterus with evidence of intrauterine pregnancy and a complex 10.4×5.5 cm mass in the left adnexal region (Figure 1). After admission, the patient was prescribed antibiotic (penicillin) and antihaemorrhagic (aminomethylbenzoic acid and Dicynone) medication, but her symptoms did not improve. On the 85th day of pregnancy, the patient complained of severe and persistent hypogastric pain. Ultrasound showed that the complex structure was now 12.6×10.5 cm. Immediate laparotomy revealed 700 ml haemoperitoneum, 300 ml of sludgy blood in the rectouterine pouch, a normal pregnant uterus, a dark smooth left ovary with a crevice on the back and the left fallopian tube adherent to the abdominal membrane. Pathology showed ovarian pregnancy with bleeding. After ovary wedge resection the patient felt better and the intrauterine pregnancy continued. To the authors' knowledge, this is the first reported case of ovarian pregnancy along with intrauterine pregnancy after in-vitro fertilization and embryo transplantation. In this case, the transferred embryo moved from the uterus into the ovary.