ABSTRACT
Ovarian pregnancy is an extremely rare form of ectopic pregnancy, accounting for just 0.5% to 3.0% of all
cases, though its incidence may be increasing with the growing use of assisted reproductive technologies
and improved imaging techniques. The diagnosis remains particularly challenging due to the rarity of intact
ovarian gestational sacs and the difficulty in distinguishing it from other conditions like ruptured corpus
luteum cysts or tubal abortions.
A recent case involved a 35-year-old woman, gravida 3 para 2 with one prior cesarean delivery, who
presented with two days of severe abdominal pain. Ultrasound examination revealed a right adnexal mass
consistent with a nonviable pregnancy at 16 weeks and 4 days gestation, showing no fetal cardiac activity
and collapsed fetal skull bones. This led to a diagnosis of unruptured ovarian pregnancy requiring
emergency laparotomy, where the mass was successfully excised. Histopathological examination later
confirmed the diagnosis, and the patient recovered well over a 10-day hospitalization before being
discharged.
The case underscores the significant diagnostic and management challenges posed by ovarian pregnancies,
which often require surgical exploration for definitive diagnosis. The absence of cardiac activity and fetal
collapse in this patient indicated a nonviable pregnancy necessitating urgent intervention to prevent life
threatening hemorrhage. While laparoscopic approaches are preferred for stable patients, the large mass
size and significant blood loss in this case mandated laparotomy. It highlights the importance of maintaining
high clinical suspicion for ovarian pregnancy in patients presenting with adnexal masses and absent
intrauterine gestation, especially at advanced gestational ages.
Timely surgical intervention remains crucial in these cases, with fertility-sparing techniques being
prioritized where possible. Histopathological confirmation continues to serve as the gold standard for
definitive diagnosis. This case illustrates both the diagnostic complexities and serious risks associated with
ovarian pregnancy, particularly when presenting at later gestational stages, emphasizing the critical need
for early recognition and prompt management to prevent potentially life-threatening complications. The
increasing use of ART may lead to more frequent encounters with this rare condition, making awareness of
its presentation and management increasingly relevant in clinical practice.
Keywords: Ectopic pregnancy, ovarian pregnancy, surgical management
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