NON TUBAL ECTOPIC PREGNANCY: AN OVERVIEW OF OVARIAN PREGNANCIES

CONTENT

-INTRODUCTION

-RISK FACTORS

-PRESENTATION

-INVESTIGATIONS

-MANAGEMENT

 

INTRODUCTION

Ovarian pregnancy as the name implies refers to an ectopic pregnancy located within the ovary. It occurs in one in every 10 000 pregnancies accounting for 0·5 - 3 per cent of all ectopic pregnancies. It may be primary or secondary depending on the initial site of implantation of the ectopic pregnancy. Primary ovarian pregnancies are those in which the developing fetus implants primarily on the ovary while secondary ovarian pregnancies are those in which the primary site of insertion was in the fallopian tube but following extrusion from the fallopian tube, the ectopic pregnancy secondarily re-implants on the ovary.

                OVARIAN PREGNANCY

 

RISK FACTORS

Secondary ovarian pregnancy shares similar risk factors with tubal pregnancy, but primary ovarian ectopic pregnancies share none of those risk factors.

 

PRESENTATION

Similar to tubal pregnancy, ovarian pregnancy often present with early pregnancy symptoms until it ruptures and then presents with abdominal pain. 

 

INVESTIGATIONS

These are similar to those done for tubal pregnancy. Although difficult to diagnose prior to surgery, in the hands of experienced sonologists, ultrasonography may be used to clinch its diagnosis prior to rupture, but in most instances, laparoscopy or laparotomy is usually the final arbiter for its definitive diagnostic.

 

MANAGEMENT

The management of ovarian pregnancy is most commonly surgical, even though few cases treated medically have been documented using systemic drugs and trans-vaginal or laparoscopic injection of drugs into the ectopic pregnancy.

Laparoscopy and wedge resection is the primary surgical method of choice in patients that are clinically stable.

Laparotomy and wedge resection of the ectopic pregnancy is employed in patients that are not haemodynamically stable or in settings without facility for laparoscopy. The aim of surgery is to retain ovarian tissues as much as possible, especially in those desirous of fertility.

 

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REFERENCES

1.  Panelli D.M, Phillips C.H, Brady P.C. Incidence, diagnosis and management of tubal and non-tubal ectopic pregnancies: a review. Fertility Research and Practice2015 1:15. DOI: 10.1186/s40738-015-0008-z

2.  Di Luigi G, Patacchiola F, La Posta V, Bonitatibus A, Ruggeri G, Carta G. Early ovarian pregnancy diagnosed by ultrasound and successfully treated with multidose methotrexate. A case report. Clin Exp Obstet Gynecol. 2012;39:390–3

3.  Joseph RJ, Irvine LM. Ovarian ectopic pregnancy: aetiology, diagnosis, and challenges in surgical management. J Obstet Gynaecol. 2012;32:472–4