EC Gynaecology

Presentation: A 30-year-old female presented with sharp, sudden-onset lower abdominal pain referring to her right shoulder associated with loss of consciousness, sweating, nausea, and vomiting. She had a blood pressure of 90/60 and an IMEWS score of 3.

Diagnosis: Urgent bedside ultrasound revealed fluid in the Pouch of Douglas suggestive of internal bleeding, with no intrauterine pregnancy seen. A serum B-hCG level of 4671 iu/L led to a clinical diagnosis of a ruptured ectopic pregnancy.

Treatment: Laparoscopy revealed a friable mass of trophoblastic tissue on the lateral pole of the left ovary. Upon removal, a 1 cm deep crater with active bleeding was noted. This was arrested by cauterisation of the floors and edges.

Discussion/Conclusion: Cauterisation of affected ovarian tissue without resection can be an effective option for the management of ectopic pregnancy if performed early, enabling minimal functional loss without sacrificing histopathological diagnosis.

 Keywords: Laparoscopic Conservative Management; Ovarian Ectopic Pregnancy; B-hCG

1. Raziel A., et al. “Ovarian pregnancy: A report of twenty cases in one institution”. American Journal of Obstetrics and Gynecology4 (1990): 1182-1185.
2. Joseph R and Irvine L. “Ovarian ectopic pregnancy: Aetiology, diagnosis, and challenges in surgical management”. Journal of Obstetrics and Gynaecology5 (2012): 472-474.
3. Sergent F., et al. “Grossesses ovariennes: réévaluation des critères diagnostiques [Ovarian pregnancies: revaluation of diagnostic criteria]”. Journal of Gynecology Obstetrics and Human Reproduction 8 (2002): 741-746.
4. Jha S., et al. “Ovarian ectopic pregnancy”. BMJ Case Reports (2011): bcr0820103250.
5. Birge O., et al. “Medical management of an ovarian ectopic pregnancy: a case report”. Journal of Medical Case Reports1 (2015): 290.
6. Oliver R., et al. “Management of extra-tubal and rare ectopic pregnancies: case series and review of current literature”. Archives of Gynecology and Obstetrics2 (2007): 125-131.
7. Gebeh A., et al. “Laparoscopic surgery for ovarian pregnancy using diathermy hook with conservation of ovary: a case report and literature review”. Journal of Clinical Medicine4 (2013): 214-219.
8. Gadir A A. “Is it time to abandon Spiegelberg’s diagnostic criteria and radical surgical management of ovarian ectopic pregnancies”. Journal of Clinical Case Reports9 (2018): 10001170.
9. Farquhar C. “Ectopic pregnancy”. The Lancet9485 (2005): 583-591.