A Comparison between Cases of Ovarian and Tubal Pregnancies

Ovarian pregnancy is a rare occurrence and accounts for 0.3% to 3.0% of all ectopic pregnancies. We report three cases of ovarian pregnancy diagnosed in our department. Three women treated for ovarian pregnancy from 2008 to 2018 were retrospectively identified and compared to 57 women who underwent tubal pregnancies during the same period. All cases were of spontaneous pregnancy and presented lower abdominal pain of varying intensity. Vaginal bleeding was observed in only one case among the three ovarian pregnancy cases but was detected in 70% of the tubal pregnancy cases. Transvaginal sonogram demonstrated hemoperitoneum in all three cases. These women underwent laparoscopic surgery and ruptured ovarian pregnancy was identified in all cases. There was no lesion of endometriosis or adhesion. The median estimated blood loss was significantly higher in women undergoing ovarian pregnancy than in those undergoing tubal pregnancy (330 mL vs. 80 mL, p=0.03). All three cases of ovarian pregnancy were diagnosed intraoperatively and the diagnosis was confirmed based on postoperative pathological findings. Wedge resection or enucleation was performed to remove ovarian pregnancy with laparoscopic surgery. Two of the three cases used bipolar devices and were closed with absorbable sutures to ensure hemostasis of the ovary. Laparoscopic surgery for ectopic pregnancy may be a basic procedure, but it sometimes requires suturing in a body cavity; the preoperative diagnosis of unusual ectopic pregnancy remains particularly difficult. We should keep in mind the possibility of unusual ectopic pregnancies in case of unclear implantation sites and perform early diagnostic laparoscopy to reduce the risk of complications such as rupturing, hemorrhagic shock, and maternal mortality.