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P29.05: Cornual and tubal heterotopic pregnancy: conservative management with ultrasonographically guided trasvaginal embryonic reduction and laparoscopic operation
Author(s) -
Park H. R.,
Moon M. J.,
Sin S. J.,
Chang S. W.,
An E. H.,
Kang S. H.,
Park H. R.,
LEE S. H.
Publication year - 2007
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.4746
Subject(s) - heterotopic pregnancy , medicine , pregnancy , ectopic pregnancy , gestation , obstetrics , surgery , gestational sac , genetics , biology
Ovarian pregnancy was first reported by Saint Maurice de Perigot in 1682. The incidence of ovarian pregnancy has been estimated to be approximately 1 in 7 000 pregnancies and represents less than 3% of all ectopic pregnancies. Ovarian pregnancy usually presents with abdominal pain, menstrual irregularities, vaginal bleeding and a palpable adnexal mass, symptoms which are similar to those of tubal ectopic pregnancy and hemorrhagic corpus luteum cysts. However approximately 12–13% of ovarian pregnancies are maintained into the third trimester and some have even resulted in live births. A 34-year-old woman, gravida I, was admitted to Dankook University Hospital complaining of acute abdominal pain. Initial examination showed that she had rebound tenderness, slight distention and defense muscularis. Pelvic examination revealed an enlarged uterus and a right adnexal mass measuring about 10 cm. Laboratory findings gave a hemoglobin level of 6.5 mg/dL and a positive pregnancy test. Ultrasonography revealed a live fetus of 16 weeks’ gestation with normal regular heart beat in right adnexa and well-formed placental tissue just adjacent to uterine structure and large amounts of echogenic fluid collection in Morison’s pouch and left paracolic gutter. Laparotomy was performed for an extrauterine pregnancy and revealed a hemoperitoneum and a large mass in the right adnexal area (10 × 10 × 10 cm). There was a placenta and amniotic membranes inside the mass and following the umbilical cord, a fetus of 16 weeks’ gestation was found which had fallen into the abdomen. The bowel had adhesions with the right adnexal mass and adhesiolysis was performed. The mass, including the right ovary, pregnancy and right tube, was excised. Final pathological diagnosis was ectopic pregnancy, either tubal or ovarian, favoring the latter. Our case was a second trimester ovarian pregnancy which had ruptured and which necessitated emergency surgery due to hemoperitoneum.