Increasing incidence of ovarian pregnancy

Abstract

This paper presents the results of a review of seven ovarian pregnancies occurring during an 11 year period (1976-1986). The prevalence of the disease is higher than that expected either for the number of deliveries or for all ectopic pregnancies. The presence of etiological factors such as pelvic inflammatory disease, previous abdominal surgery, endometriosis or use of IUD, is considered. Four of these cases presented in actual users of IUD and one in an infertile woman previously diagnosed of endometriosis. The clinical pattern was similar to that recorded for tubal ectopic pregnancies. The role of IUDs and other risk factors in the apparent increase in the number of ectopic pregnancies detected is discussed. Measures to increase accuracy in the detection of early ovarian pregnancies are proposed.

PIP: To investigate further the apparent increase in the incidence of ectopic ovarian pregnancy and its possible association with IUD use, the 7 such pregnancies recorded in the authors' Barcelona hospital practice in 1976-86 were reviewed. During this period, ectopic pregnancies accounted for 1 of every 141 deliveries, which ectopic ovarian pregnancies represented 1 in every 18 ectopic pregnancies. 6 of the 7 ectopic ovarian pregnancies occurred in recent years: 1 in 1984, 2 in 1985, and 3 in 1986. The patients' mean age was 31 years (range, 28-33 years). All cases displayed both ovarian and trophoblastic tissue within the same microscopic field, while the macroscopic appearance of the homolateral tube was normal. The clinical symptoms (predominantly abdominal pain and menstrual disturbances) and physical examination results (the presence of an adnexal mass and pain at the level of the Douglas pouch) in women with ovarian pregnancies did not differ from those in women with ectopic pregnancies. Echography was highly accurate in the detection and localization of early ovarian pregnancies. 2 of the risk factors considered--pelvic inflammatory disease and previous abdominal surgery--were not present in this series of 7 cases; a 3rd-- endometriosis--was reported in 1 case, making this the most apparent risk factor.