Maimoona Ashraf, Ahmed Waseem Yousaf.
Ovarian Pregnancy: A Case Report.
Proceeding Shaikh Zayed Postgrad Med Inst Jan ;14(2):109-10.

Primary ovarian pregnancy represents 3% of all ectopic gestations with an incidence of 1:7000 to 1:40,000 deliveries. It is associated with patients of high fecundity and in women having an IUCD. Preoperative diagnosis is often difficult. Conservative surgical treatment is feasible and important in preserving future fertility. Here we report a case of primary ovarian pregnancy in a 25 years old G3P2+0 with focus on early diagnosis and timely intervention. Ectopic pregnancy was suspected on the basis of amenorrhoea, irregular vaginal bleeding and pain lower abdomen along with raised serum f3-hCG level and no gestational sac in uterus on USG. Laparoscopy was done. Right primary ovarian ectopic was seen. Spiegelberg criteria was met. Conservative surgical ovarian resection with reconstruction of remaining ovarian tissue was done. Postoperative period was uneventful. Patient conceived an intrauterine pregnancy one year later.

A 25 years old G3P2 was admitted on 3-3-2000 with complaints of lower abdominal pain and irregular vaginal bleeding following amenorrhoea of 7 weeks. Her last child born was 2 years ago. Normal menstruation was resumed. She was using injection Norgest for contraception. Her LMP was on 27-12-1999. She had amenorrhoea of 7 weeks duration after which she started having irregular vaginal bleeding followed by pain lower abdomen. Her vital signs were stable. On abdominal examination there was suprapubic tenderness. Vaginal examination revealed normal sized anteverted uterus with cervical excitation and tenderness in right fornix. Emergency abdominal USG showed normal pelvic findings. Serum B-hCG was 1750 IU/ml. Laparoscopy with double puncture technique was performed on 6-3-2000. Laparoscopic findings were of normal uterus, both tubes and left ovary. Right ovary was enlarged with bluish looking unruptured ovarian mass measuring 20 cm on its posterior surface giving strong clue to the diagnosis of primary ovarian pregnancy. There was no haemoperitoneum, pelvic adhesions or endometriosis. Minilaparotomy was done. Ovarian tissue containing conceptus was resected. Remaining ovarian tissue was reconstructed. Blood transfusion was not required. Postoperative period was uneventful. Operative specimen on histopathological examination showed placental villi, blood clot and ovarian tissue in the wall of gestational sac. During follow-up visits she did not report any significant complaint. One year later she became pregnant and intact intrauterine pregnancy of 9 weeks duration was confirmed on USG on 9-3-2001.

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