Rupture of Ectopic Ovarian Pregnancy Accompanied by Massive Intra-abdominal Bleeding and Disorder of the Coagulation Mechanism: A Rare and Life-Threatening Obstetric Complication

Abstract

The rupture of ectopic ovarian pregnancy accompanied by massive intra-abdominal bleeding is a rare obstetric complication, occurs predominantly in the first trimester of pregnancy, and can be dangerous and life-threatening for the pregnant woman. Our case describes a 37yr old woman with a history of 4 lower segment Cesarian sections (LSCS) (Caesarean sections) and multiple surgical abortions, presenting at the ER with acute abdomen symptoms. The patient's hemodynamic status was unstable. The positive urine pregnancy test combined with the clinical and ultrasound findings established the diagnosis of the ruptured ectopic pregnancy, and immediate surgical treatment was decided. During surgery, a large amount of blood was found in the peritoneal cavity, resulting from a rupture of the right ovary and accompanied by hemorrhagic infiltration of adjacent tissues, without participation in the damage of the ipsilateral fallopian tube. It was deemed necessary to remove the ipsilateral adnexa and whole blood transfusion. The patient was discharged from our department on the fourth postoperative day. The price of beta-chorionic gonadotropic hormone was on a downward trend. Three weeks later, the level of beta-chorionic gonadotropic hormone was zero. In the present paper, a brief review is attempted regarding the diagnostic and therapeutic approach for patients with ruptured ectopic ovarian pregnancy after describing the case.

Keywords: case report; diagnosis; hemoperitoneum; ovarian pregnancy; rupture; treatment.

Figure 1. Transvaginal ultrasound imaging of an ectopic ovarian pregnancy (our case)

The presence of heterogeneity in the anatomical area of the adnexa (red arrows), combined with the absence of an intrauterine gestational sac, supports the diagnosis of ruptured ectopic pregnancy.

Figure 2. Transvaginal ultrasound imaging of ectopic ovarian pregnancy (our case)

The presence of free fluid and blood clots in the cul-de-sac (yellow arrows) and the absence of an intrauterine gestational sac support the diagnosis of ruptured ectopic pregnancy.

Figure 3. Intraoperative imaging of a ruptured ovarian pregnancy (our case)

After cleaning the pelvis from a large amount of blood and blood clots, the ovarian lesion and non-involvement of the corresponding fallopian tube are evident.

Figure 4. Histological image of a ruptured ectopic ovarian pregnancy (our case)

Rare cytotrophoblastic cells are identified within a hemorrhagic substrate

Figure 5. Histological image of a ruptured ectopic ovarian pregnancy (our case)

A part of chorionic villi and syncytium formation can be identified within the hemorrhagic substrate