Ovarian ectopic pregnancy: clinical characteristics, ultrasound diagnosis and management

Ultrasound Obstet Gynecol. 2023 Nov 29. doi: 10.1002/uog.27549. Online ahead of print.

Abstract

Objective: To compare clinical, ultrasound and biochemical characteristics of ovarian ectopic pregnancies (OEP) to tubal ectopic pregnancies (TEP).

Methods: This was a single-center, retrospective, case-control study of women with OEP compared to women with TEP between December 2010 and February 2021. OEP was defined as a pregnancy located completely or partially within the ovarian parenchyma, seen separately to a corpus luteum, where a corpus luteum was within the ipsilateral ovary. We compared demographic features, risk factors, clinical presentation, ultrasound findings and outcomes such as blood loss at surgery, blood transfusion rate, length of hospital stay, follow-up and future pregnancy outcomes of women who conceived.

Results: 20 women with OEP were identified and compared to 100 women with TEP. 15/20 (75%) OEPs were diagnosed correctly on the first scan. There was no difference between the groups in terms of maternal age, gestational age, gravidity, parity or risk factors. Compared to TEPs, OEPs were more likely to present with abdominal pain without vaginal bleeding (12/20 (60%) vs 13/100 (13%) (p=<0.01) (OR 10; 95%CI 3.45-29.20)), were more likely to contain an embryo (3/20 (15%) vs 2/100 (2%) (p=0.02) (OR 8.7; 95%CI 1.34-55.65)), have severe hemoperitoneum on ultrasound scan (9/20 (45%) vs 8/100 (8%) (p=<0.01) (OR 9.4; 95%CI 3.01-29.40)) and had higher blood loss at surgery (median 700ml vs 100ml, p=<0.01). All surgically managed OEPs had successful laparoscopic treatment (18 excisions, 1 wedge resection) with preservation of the ovary. Only 1/20 (5%) OEPs required a blood transfusion.

Conclusions: OEPs are more likely than TEPs to contain an embryo and to present with severe hemoperitoneum. In a dedicated early pregnancy setting the majority of OEPs could be detected on ultrasound scan at the initial visit, facilitating optimal minimally invasive surgical management, reducing the risk of blood transfusions and oophorectomy. Our findings can be used as a reference for clinicians who may not otherwise encounter this rare condition. This article is protected by copyright. All rights reserved.

Keywords: Ovarian ectopic; ectopic pregnancy; ovarian pregnancy; ultrasound.