Medical management of an ovarian ectopic pregnancy: a case report

Journal of Medical Case Reports

Deniz Arslan³  Ertugrul Gazi Ozbey³  Mustafa Melih Erkan¹  Ozer Birge² 

[1] Celal Bayar University Hospital, Department of Gynecology and Obstetrics, Manisa, Turkey;Nyala Sudan Turkey Training and Research Hospital, Department of Gynecology and Obstetrics, West Alezza District, Southern Nyala, Darfur, Sudan;Nyala Sudan Turkey Training and Research Hospital, Department of Urology, Nyala, Darfur, Sudan

关键词: Ovarian pregnancy;    Methotrexate;    Ectopic pregnancy;   

Others  :  1235845
DOI  :  10.1186/s13256-015-0774-6

 received in 2015-07-06, accepted in 2015-11-23,  发布年份 2015

【 摘 要 】

Background

Primary ovarian ectopic pregnancy is a rare type of ectopic pregnancy which has an estimated prevalence ranging from 1:7000 to 1:70,000 accounting for almost 3 % of all ectopic cases. Here we report the case of a 25-year-old woman who presented to our clinic with abdominal pain, 6 weeks’ delay of menstruation and 3 days of vaginal bleeding, whose transvaginal ultrasonography showed an ectopic gestational sac with yolk sac inside, in her right ovary. This case shows that early diagnosis is very important particularly in places like the Sub-Saharan region of Africa.

Case presentation

A 25-year-old African woman was referred to our clinic with 6 weeks’ delay of menstruation, frequent increasing abdominal pain and 3 days of vaginal bleeding. Her general condition was good and her vital signs were normal. She felt tenderness in an abdominal examination and had a small amount of vaginal bleeding. Transvaginal ultrasonography showed an ectopic gestational sac with yolk sac inside, in her right ovary. Our final diagnosis was ectopic ovarian pregnancy and we successfully treated her with methotrexate. After 3 weeks of methotrexate administration her beta human chorionic gonadotropin was negative and a sonographic examination was completely normal.

Conclusions

Ectopic ovarian pregnancy is a very important medical situation. It should be diagnosed in its early stages otherwise it could be life-threatening and surgical treatment may be inevitable. Because of the importance of fertility, medical treatment is an acceptable option and can be feasible with early diagnosis.

【 授权许可】

   
2015 Birge et al.

【 图 表 】

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【 参考文献 】

• [1]Marcus SM, Brinsden PR. Primary ovarian pregnancy after in vitro fertilization and embryo transfer: report of seven cases. Fertil Steril. 1993; 60:167-70.
• [2]Gerin-Lajoie L. Ovarian pegnancy. Am J Obstet Gynecol. 1951; 62:920-9.
• [3]Diamond MP, DeCherny AH. Ectopic pregnancy. WB Saunders. 1991; 163:780-804.
• [4]Al-Meshari AA, Chowdhury N, Adelusi BX. Ovarian pregnancy. Int J Gynaecol Obstet. 1993; 41(3):269-72.
• [5]Sturm JT, Hankins DG, Malo JW, Cicero JJ. Ovarian ectopic pregnancy. Ann Emerg Med. 1984; 13:362-4.
• [6]Spiegelberg OX. Zur casuistic der ovarial schwangerschaft. Arch Gynekol. 1978; 13:73.
• [7]Stanley JR, Harris AA, Gilbert CF, Lennon YA, Dellinger EH. Magnetic resonance imaging in evaluation of a second trimester ovarian twin pregnancy. Obstet Gynecol. 1994; 84:648-51.
• [8]Panda JK. Primary ovarian twin pregnancy. Case report. Br J Obstet Gynecol. 1990; 97:540-1.
• [9]Bernabei A, Morgante G, Mazzini M, Guerrini E, Fava A, Danero S. Simultaneous ovarian and intrauterine pregnancy: Case report. Am J Obstet Gynecol. 1992; 167:134-5.
• [10]Kalfayan B, Gundersen JH. Ovarian twin pregnancy. Report of a case. Obstet Gynecol. 1963; 21:126-8.
• [11]Levin JH, Lacarra M, d’Ablaing G, Grimes DA, Vaermesh M. Mifepristone (RU 486) failure in an ovarian heterotopic pregnancy. Am J Obstet Gynecol. 1990; 163:543-4.
• [12]Hallat J. Primary ovarian pregnancy. A report of twenty-five cases. Am J Obstet Gynecol. 1982; 143:50-60.
• [13]Phupong V, Ultchaswadi P. Primary ovarian pregnancy. J Med Assoc Thai. 2005; 88(4):527-9.
• [14]Raziel A, Golan A, Pansky M, Ron-El R, Bukovsky I, Caspi E. Ovarian pregnancy: a report of twenty cases in one institution Cases Report. Am J Obstet Gynecol. 1990; 163:1182-5.
• [15]Herbertsson G, Magnusson S, Benediktsdottir K. Ovarian pregnancy and IUCD use in a defined complete population. Acta Obstet Gynecol Scand. 1987; 66:607-10.
• [16]Berger B, Blechner JN. Ovarian pregnancy associated with copper-7 intrauterine device. Obstetr Gynecol. 1978; 52:597-600.
• [17]Schwartz LB, Carcangiu ML, DeCherney AHX. Primary ovarian pregnancy: a case report. J Reprod Med. 1993; 38:155-8.
• [18]Lehfeldt H, Tietze C, Gorstein F. Ovarian pregnancy and the intrauterine device. Am J Obstet Gynecol. 1970; 108(7):1005-9.
• [19]Shamma FN, Schwartz LB. Primary ovarian pregnancy successfully treated with methotrexate. Am J Obstet Gynecol. 1992; 167:1307-8.
• [20]Pagidas K, Frishman GN. Nonsurgical management of primary ovarian pregnancy with transvaginal ultrasound-guided local administration of methotrexate. J Minim Invasive Gynecol. 2013; 20(2):252-4.
• [21]Di Luigi G, Patacchiola F, La Posta V, Bonitatibus A, Ruggeri G, Carta G. Early ovarian pregnancy diagnosed by ultrasound and successfully treated with multidose methotrexate. A case report. Clin Exp Obstet Gynecol. 2012; 39(3):390-3.
• [22]Chelmow D, Gates E, Penzias AS. Laparoscopic diagnosis and methotrexate treatment of an ovarian pregnancy: a case report. Fertil Steril. 1994; 62(4):879-81.
• [23]Annunziata N, Malignino E, Zarcone R. Ovarian pregnancies treated with methotrexate. Panminerva Med. 1996; 38(3):190-2.