A Case of Uterine Serosal Pregnancy with Both Ovarian Cysts

Choi, Yoon Young; Kim, Jeoung Suk; Koh, Min Whan

Abstract

Ectopic pregnancies accout for 1% of all pregnancies and abdominal pregnancies account for almost 1% of ectopic pregnancies. The causes of abdominal pregnancy are two. First is primaries implantation of gestational sac in the abdomen, second is migration of the embryo through a fistulous tract of the tube or uterus. Their early symptom is absent and diagnosis by ultrasonography is difficult. Thus the mortality is very high because of complications such as hemorrhage and infection due to delayed diagnosis. The accurate diagnosis mostly made by laparoscopy or laparotomy is usual. Nowadays the treatment of choice must be laparoscopy according to the development of efficient laparoscopic instrumentation and accumulating experience and skill of laparoscopic surgeon. Here we report a case of uterine serosal pregnancy at 8(+1) weeks with both ovarian cysts which was undergone pelviscopy at the impression of right tubal pregnancy. At local gynecologic clinic, they guessed the patient's lower abdominal pain was due to the torsion of both ovarian masses and transferred the patient for an operation. beta-hCG was 52,509 mIU/mL. By ultrasonographic finding both ovarian cysts and 2 cm sized gestational sac with fetal pole and fetal heart tone were found nearby right fallopian tube. Under the impression of right tubal pregnancy she underwent the emergent pelviscopic operation. Mass consisted with the gestational sac and placenta was attatched to the posterior surface of uterus and minimal amount of fresh blood in the posterior cul de sac was observed. Both tubes and the uterus were intact, and both ovarian cysts were not torted or ruptured. The mass was detached and the bed of implantation was biopsyed. Gestational sac contained the intact embryo within.