Obstet Gynecol Sci.  2020 Mar;63(2):209-212. 10.5468/ogs.2020.63.2.209.

Ovarian pregnancy rupture in second trimester manifesting mental change in pregnancy: a case report

• Hwang DW
• Choi HW
• Choi YY
• Kim HS
• Kim YA
• Chun KC

• KMID: 2471760
• DOI: http://doi.org/10.5468/ogs.2020.63.2.209

Abstract

Ovarian pregnancies comprise approximately 3% of ectopic pregnancies. Moreover, ovarian pregnancies in the second trimester are extremely rare. We herein present a case of ruptured ovarian pregnancy in the second trimester. A 26-year-old Asian woman presented to our hospital complaining of an abrupt mental change. She was pregnant; however, she had not been receiving antenatal care. Her initial vital signs were unstable, and pelvic ultrasound revealed pelvic fluid collection. We analyzed the hemoperitoneum and performed exploratory laparotomy. When her abdomen was opened, we observed that her right ovary was ruptured. Placental cord insertion originated from the ovary, and a fetus was found in the pelvic cavity. The ovarian pregnancy was detected in a delayed state. Pregnant women require appropriate antenatal care, and pelvic ultrasound should be performed in the second trimester to ensure that the fetus is in the intrauterine cavity.

Keyword

Pregnancy, ovarian; Pregnancy trimester, second

MeSH Terms

Abdomen
Adult
Asian Continental Ancestry Group
Female
Fetus
Hemoperitoneum
Humans
Laparotomy
Ovary
Pregnancy
Pregnancy Trimester, Second*
Pregnancy*
Pregnancy, Ectopic
Pregnancy, Ovarian*
Pregnant Women
Rupture*
Ultrasonography
Vital Signs

Figure

• 

  Fig. 1 (A) Placenta originating from ovary_the placental cord insertion is seen to originate from the ovary. (B) Cord insertion to ovary and fetus in pelvic cavity_fetus (a) occupies the position of ovary (b), and the uterus (c) is intact. (C) Fallopian tube is seen separated from the ovary_ovary (a) connected to the uterus (b) by ovarian ligament (small arrow) and fallopian tube (large arrow) is seen separated from the ovary.

• 

  Fig. 2 Histological finding of oophorectomy_chorionic villi tissues in the wall of ovary, high magnification (×40) (A) and low magnification (×100) (B).

Reference

1. Seeber BE, Barnhart KT. Suspected ectopic pregnancy. Obstet Gynecol. 2006; 107:399–413. PMID: 16449130.

2. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002; 17:3224–3230. PMID: 12456628.

3. Grimes HG, Nosal RA, Gallagher JC. Ovarian pregnancy: a series of 24 cases. Obstet Gynecol. 1983; 61:174–180. PMID: 6823359.

4. Hallatt JG. Primary ovarian pregnancy: a report of twenty-five cases. Am J Obstet Gynecol. 1982; 143:55–60. PMID: 7081312.

5. Chow WH, Daling JR, Cates W Jr, Greenberg RS. Epidemiology of ectopic pregnancy. Epidemiol Rev. 1987; 9:70–94. PMID: 3315720.

6. Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996; 65:1093–1099. PMID: 8641479.

7. Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005; 173:905–912. PMID: 16217116.

8. Seo MR, Choi JS, Bae J, Lee WM, Eom JM, Lee E, et al. Preoperative diagnostic clues to ovarian pregnancy: retrospective chart review of women with ovarian and tubal pregnancy. Obstet Gynecol Sci. 2017; 60:462–468. PMID: 28989923.

9. Prabhala S, Erukkambattu J, Dogiparthi A, Kumar P, Tanikella R. Ruptured ovarian pregnancy in a primigravida. Int J Appl Basic Med Res. 2015; 5:151–153. PMID: 26097828.

10. Tuomivaara L, Kauppila A, Puolakka J. Ectopic pregnancy--an analysis of the etiology, diagnosis and treatment in 552 cases. Arch Gynecol. 1986; 237:135–147. PMID: 3485406.

11. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol. 2003; 101:778–784. PMID: 12681886.

12. Stovall TG, Ling FW. Ectopic pregnancy. Diagnostic and therapeutic algorithms minimizing surgical intervention. J Reprod Med. 1993; 38:807–812. PMID: 8263872.

13. Van Coevering RJ 2nd, Fisher JE. Laparoscopic management of ovarian pregnancy. A case report. J Reprod Med. 1988; 33:774–776. PMID: 2971805.

14. Tinelli A, Hudelist G, Malvasi A, Tinelli R. Laparoscopic management of ovarian pregnancy. JSLS. 2008; 12:169–172. PMID: 18435892.

15. Elwell KE, Sailors JL, Denson PK, Hoffman B, Wai CY. Unruptured second-trimester ovarian pregnancy. J Obstet Gynaecol Res. 2015; 41:1483–1486. PMID: 26017365.