Primary Ovarian Pregnancy: A Case Report of a Rare Form of Ectopic Pregnancy

Abstract

The incidence of ectopic pregnancy in the United States is estimated at 1.3%-2% of all pregnancies. Primary ovarian pregnancy is a rare form of ectopic pregnancy in which the gestational sac is implanted in the ovary in the United States. The reported incidence is estimated at 1%-3% of all diagnosed ectopic pregnancies. However, improvements in diagnostic techniques and assisted reproductive technology are believed to be increasing the diagnosis of ovarian pregnancy. In addition, because of the availability of sensitive assays for β-hCG and increasing transvaginal ultrasound resolution, early diagnosis of ovarian pregnancy has become more feasible. We report a case of a 26-year-old woman, gravid 4, para 2, artificial abortion 1, with low abdominal fullness and dull pain for 3 days. She stated that an OB-GYN physician had diagnosed her with interstitial pregnancy. Her last menstrual period was approximately 7 weeks before admission. Laboratory data showed serumβ-hCG of 11000mIU/mL. Transvaginal sonography demonstrated an echocomplex mass within the right ovary with one living fetus with a fetal crownrump length of 0.91 cm. The cul-de-sac was clear with no accumulated fluid. The patient expressed no more desire for fertility; therefore, a laparoscopic right oophorectomy and elective bilateral tubal ligation were performed. The traditional treatment for ovarian pregnancy was oophorectomy or salpingo-oophorectomy by laparotomy. However, because of the development of laparoscopic techniques, conservative laparoscopic surgery is now preferred. Conservative laparoscopic techniques, such as wedge resection or the removal of gestational tissues, should be the first choice of treatment, particular if a patient is young and desires children. Clinical presentation, sonographic findings, and different modes of treatment are also discussed.