Primary Ovarian Pregnancy: A Case Report With a Review of the Literature

Abstract

Ectopic pregnancy (EP) constitutes 1%-2% of all pregnancies and is one of the leading causes of maternal morbidity and mortality. The most common site of ectopic pregnancy is the ampulla. Ectopic ovarian pregnancy (EOP) is one of the rare events, with an incidence of 0.5%-3% of all pregnancies. The incidence is higher in intrauterine device users or assisted reproductive techniques. The precise aetiology and pathogenesis of EOP remain elusive. Clinically, EOP mirrors the presentation of tubal pregnancy or a ruptured luteal cyst, often leading to life-threatening hypovolemic shock. Transvaginal sonography is the primary diagnostic tool. Still pinpointing the exact location early on poses challenges, and it's usually misinterpreted as a tubo-ovarian mass, hemorrhagic cyst, or luteal cyst. Furthermore, while a suboptimal rise in serum beta-human chorionic gonadotropin (β-hCG) levels may indicate pregnancy, it doesn't definitively confirm EOP. Only histopathological examination offers a conclusive diagnosis. This paper discusses an EOP case in a young woman who experienced five months of amenorrhea and exhibited no traditional risk factors, underscoring the significant challenges inherent in preoperative diagnosis.

Keywords: ectopic pregnancy; emergency condition; maternal mortality; ovarian mass; ovarian pregnancy.

Figure 1. Ultrasonography shows an empty intrauterine sac (indicated by the star mark).

Figure 2. Ultrasonography shows increased vascularity and enlargement of the right adnexa (indicated by the star mark).

Figure 3. The intraoperative finding shows that the right ovary was enlarged with a bulging mass of 2x2 cm (indicated by the star mark).

Figure 4. Microscopy shows chorionic villi and haemorrhage, as indicated by the star mark (40x, hematoxylin, and eosin stain).

Figure 5. Microscopy shows ovarian parenchyma with blood clots inside, as indicated by the star mark (20x, hematoxylin, and eosin stain).