Rupture of Ovarian Pregnancy in a Woman with Low Beta-hCG Levels

Serena Resta,Maria Grazia Porpora,Simona Evangelista,Adele Ticino,Eliana Fuggetta,Federica D’Itri

doi:10.1155/2012/213169

Serena Resta, Maria Grazia Porpora + Show 4 more

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https://doi.org/10.1155/2012/213169

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Abstract

Background. Ovarian pregnancy is a rare form of ectopic pregnancy. It is often difficult to distinguish from tubal pregnancy, and diagnosis and management are frequently a challenge. Case. A 33-year-old nulligravida woman presented with light vaginal bleeding and bilateral lower quadrants abdominal pain. Beta-human chorionic gonadotropin (beta-hCG) level (592 mUI/mL) and clinical and ultrasound (US) findings were suspicious for tubal pregnancy. On the third day, despite beta-hCG decrease (364 mUI/mL), she complained of severe pain in the lower abdomen, and physical examination revealed abdominal rebound tenderness. US showed a large amount of fluid in the abdominal cavity. Because of the unstable clinical condition, emergency laparoscopy and resection of left ovarian ectopic pregnancy were performed. Histology confirmed ovarian gestation. Conclusion. This case shows that ectopic pregnancy rupture may occur despite low levels of beta-hCG. Hemoperitoneum is not contraindication to laparoscopy.

Highlights

We report a case of ruptured ovarian pregnancy misdiagnosed as tubal pregnancy, which caused significant hemoperitoneum and was successfully treated by conservative laparoscopy
Ovarian pregnancy is a rare variant of ectopic pregnancy
Diagnosis of ovarian pregnancy is necessary in order to avoid more serious complications and emergency invasive procedures [2]

Summary

Background

Ovarian pregnancy is a rare form of ectopic pregnancy. It is often difficult to distinguish from tubal pregnancy, and diagnosis and management are frequently a challenge. A 33-year-old nulligravida woman presented with light vaginal bleeding and bilateral lower quadrants abdominal pain. Beta-human chorionic gonadotropin (beta-hCG) level (592 mUI/mL) and clinical and ultrasound (US) findings were suspicious for tubal pregnancy. Despite beta-hCG decrease (364 mUI/mL), she complained of severe pain in the lower abdomen, and physical examination revealed abdominal rebound tenderness. US showed a large amount of fluid in the abdominal cavity. Because of the unstable clinical condition, emergency laparoscopy and resection of left ovarian ectopic pregnancy were performed. This case shows that ectopic pregnancy rupture may occur despite low levels of beta-hCG.

Introduction

Case Presentation

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Discussion