Gynäkologie und Geburtshilfe
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Abstrakt

Value of Serial Ultrasounds in Early Diagnosis and Management of Prerupture Ovarian Ectopic Pregnancy: A Case Report

Cau Van Vo, Carol A Major and Kamini Malhotra

Background: Primary ovarian pregnancy is a rare form of ectopic pregnancy. Even with the advance of ultrasound techniques and the sonographic establishment of fetal development, most ovarian pregnancies are found ruptured at the time of diagnosis or are a surprise finding at the time of surgery. In these cases, the associated hemorrhage is usually heavy and in approximately 23% of cases, the patients develop hypovolemic shock requiring blood transfusion.

Case: A 30-year-old female patient at 7.4 weeks by a certain LMP presented for prenatal care. An ultrasound at the time of presentation revealed no intrauterine gestational sac. There was however, a simple cystic mass contiguous with the left ovary. Subsequently, the patient had a BhCG level drawn which was not consistent with the ultrasound image and therefore was felt to be abnormal. A primary ovarian pregnancy was suspected after serial ultrasounds revealed an enlarging cystic ovarian mass and serial quantitative human Chorionic Gonadotripin (hCG) levels were abnormal. In addition, the patient started feeling left lower quadrant abdominal discomfort and reported a scant amount of vaginal bleeding. Due to the suspicion of a possible ovarian ectopic pregnancy, a diagnostic laparoscopy was discussed with the patient. The suspicion was solidified, in order to avoid rupture, a diagnostic laparoscopy was made and the ovarian ectopic pregnancy was confirmed. A wedge resection of the ovarian cyst was performed and the final histopathology confirmed a primary ovarian pregnancy.

Conclusion: Ultrasounds have been proven safe for management of obstetrical patients. The sonographic parameters for fetal development from conception to delivery have been well established and published.2 At this time, ultrasound is the best tool in detecting abnormal fetal development in pregnancy. In this case, serial ultrasound examinations in the early stage of the first trimester and inappropriately rising serial BhCG levels provide the clues for detecting the prerupture diagnosis of ovarian ectopic pregnancy. The combination of these two modalities and pelvic examination increase the suspicion of a diagnosis of an ovarian pregnancy and will lead to a prompt intervention to prevent morbidity, mortality and to the preservation of future fertility.