Ovarian ectopic pregnancy: A success story

Abstract

Ovarian pregnancy is a rare form of ectopic pregnancy. Clinical and imaging diagnosis is challenging and so can be the management, as was in our case, where the pregnancy being located in the ovary was not clear in the beginning. Various case series have concluded that an ovarian pregnancy, in a few cases, can present as an adnexal mass. We present a case of left ovarian pregnancy in a 31-year-old woman. Transvaginal ultrasound showed an empty uterus and a left adnexal mass. A suboptimal rise in beta-human chorionic gonadotropin (β-hCG) levels suggested an ectopic pregnancy. The patient declined a surgical intervention, even after explaining the risks and a likely need of surgery, in view of high β-hCG level. A single dose of methotrexate was given in the presence of hemodynamic stability and absence of pain. Subsequently, a laparoscopy was performed when the patient presented with pain abdomen and a rising β-hCG level, 7 days after methotrexate was administered. Ovarian wedge resection was done. Histopathological assessment confirmed the diagnosis. Increasingly, operative laparoscopy is the method employed for the surgical management of ovarian ectopic pregnancy. In view of concerns about future fertility, the current practice is to resect ovarian pregnancy and preserve healthy ovarian tissue.