Laparoscopic Management of Primary Ovarian Pregnancy

Abstract

Abstract

Background: Ovarian pregnancy is rare form of ectopic gestation. Although diagnosis is often made at surgery and requires histologic confirmation, transvaginal sonography has often been helpful. A diagnostic delay may lead to rupture, secondary implantation, or intraoperative difficulties. Awareness and early diagnosis of this condition is important for reducing the risk of these complications. Case: A 30-year-old multiparous female presented with complaints of pain in the lower abdomen, vomiting, and bleeding from her vagina following 6 weeks of amenorrhea. She had a serum ß–human chorionic gonadotropin (ß-hCG) level of 8366 mIU/mL. An ultrasound scan showed a normal uterus and left adenexa with a multiloculated right ovarian 5.2×4.5–cm cyst. Laparoscopy was performed for a suspected ovarian pregnancy and proceeded with wedge resection of right ovary with a cystectomy and bilateral tubal sterilization. Histopathologic testing showed sheets of decidual cells in the ovarian stroma, with numerous blood vessels, follicles, and degenerated trophoblastic-cells confirming the clinical diagnosis of primary ovarian pregnancy. Results: The patient's recovery was uneventful, and she was discharged on the second postoperative day. Her serum ß-hCG level became normal after 2 weeks. Conclusions: Laparoscopy is currently the “gold standard” for diagnosis of ovarian pregnancy. Although ovarian pregnancy is a rare event, awareness of this condition along with ß-hCG asssy and transvaginal sonography could assist preoperative diagnosis. (J GYNECOL SURG 31:43)