Ovarian Pregnancy: 2 Case Reports and a Systematic Review

Abstract

Ovarian pregnancy is a rare but well-known pathology. However, pathophysiology, diagnosis and treatment are not established. Therefore, all case reports on ovarian pregnancy published in PubMed from November 2011 till November 2022 were reviewed and two case reports were added. In these 84 case reports, 8% of ovarian pregnancies occurred in women without or with blocked oviducts and 23% were localised on the other side than the corpus luteum. Since symptoms are not specific, ovarian pregnancy has to be suspected in all women with abdominal bleeding. Surgical excision is the preferred treatment. However, since an associated intra-uterine pregnancy cannot be excluded, care should be taken not to interrupt this intra-uterine pregnancy with the uterine cannula or by damaging the corpus luteum. In conclusion, in women with abdominal bleeding, an ovarian pregnancy cannot be excluded, even in women with a negative pregnancy test or an empty uterus on transvaginal ultrasonography. Therefore, a laparoscopy is indicated but the surgeon should realise that an associated intra-uterine pregnancy also cannot be excluded and that therefore care should be taken not to interrupt this intra-uterine pregnancy by the uterine cannula or by damaging the corpus luteum.

Keywords: corpus luteum; ectopic pregnancy; heterotopic pregnancy; laparoscopy; methotrexate.

Figure 1

Prisma flow diagram for ovarian pregnancy search in PubMed from 2011 to 2021.

Figure 2

Case 1 illustrates that the laparoscopic recognition of an ovarian pregnancy can be difficult. (A) A normal right fallopian tube (black arrow), and on the right ovary, a lesion which was not recognised as an ovarian pregnancy (blue arrow). (B) An enlarged picture with a normal right oviduct (black arrow), and a right ovary (blue arrow) with a lesion not recognised as a ruptured ovarian pregnancy (blue circle). (C) On the histological examination of the excised lesion, a cyst-like wall lined by fibrinous hemorrhagic material is seen with scattered trophoblastic nests (thin arrow) overlying the ovarian edematous stroma with a primordial follicle (thick arrow) and covered with a mesothelial lining (hematoxylin and eosin (H&E) stain, original magnification ×40). (D) Foci of trophoblastic elements are embedded within a fibrinous inflamed decidualized tissue (H&E, ×200).

Figure 3

Incidences of previous ectopic pregnancies, IVF, IUI, tubal surgery, endometriosis, pelvic surgery, PID or IUD in women with ovarian pregnancies.

Figure 4

Duration of amenorrhoea in ovarian pregnancies.

Figure 5

Presenting symptoms of ovarian pregnancies.

Figure 6

Treatment of ovarian pregnancies.