International Journal of Current Medical And Applied Sciences, 2015, August, 7(3),189-190.

CASE REPORT

Ruptured Ovarian - A Rare Case Report 1 2 3 4 Shabina khan , Sonika Dahiya , H.K. Premi & Sarita

1Assistant professor, 2Post Graduate Student, 3Professor and HOD, 4Senior Resident. Department of and Gynecology, Rohilkand Medical College and Research Centre, Bareilly [UP], India-243006. ------Abstract: refers to an that is located in the ovary. We report a rare case of a ruptured ovarian pregnancy. A 24 years old, G₃P₂₊₀L₂ was admitted with amenorrhea of 4 months with chief complaints of severe acute abdominal pain.UPT was positive.USG revealed right sided adenexal mass of about 6.5×4.75 cm. Emergency laparotomy was done and a diagnosis of ruptured ovarian pregnancy was made. Keywords: Ovarian pregnancy, intrauterine devices, laparotomy, pathology.

Introduction: Ovarian are rare-the vast majority of postpartum complications. Her 2nd pregnancy was 6 ectopic pregnancies occur in the fallopian tube, only months back, term vaginal delivery at hospital, no about 0.15-3% of ectopics occur in ovary [1]. Primary intrapartum and postpartum complications. No history ovarian pregnancy is a rare entity, the diagnosis of of contraceptive use. which continues to challenge the practicing clinicians. On GPE: Patient was in shock. pallor ++, pulse 104/min, Since the first case reported by St. Maurice in 1689, BP 90/50 mmHg, On abdominal examination, many cases have been reported in the literature. tenderness was present in lower abdomen, more on Heartig estimated that ovarian pregnancy occurs in one right side. Per speculum examination, the vagina and in 25,000- 40,000 pregnancies. Ovarian ectopic cervix were normal, culdocentesis was done, which was pregnancy after natural conception ranges from 1 in negative. Per vaginal examination revealed normal 2000 to 1 in 60,000 deliveries and accounts for 3 % of uterine size and cervical motion tenderness was all ectopic pregnancies [2,3,4]. One in every 9 ectopic present and a palpable tender mass was felt in the right pregnancies among intrauterine device (IUD) users is fornix of about 7X7 cm. On investigation, the urine an ovarian pregnancy [5,6]. We present here a rare case pregnancy test was positive, Hb% was 8.2 gm%, total of ruptured ovarian pregnancy. leucocyte count was 10,800/cu mm, platelet count was Case Report: 2.6 lakh and the blood group was A positive Urine A 24 year old, G₃P₂₊₀L₂, came to our hospital with pregnancy test was positive. On ultra sonography, no amenorrhea of 4 months with complaints of sudden gestational sac was seen in utero but a right sided onset of pain in the lower abdomen. History of UPT was adnexal mass was seen of about 6.5cm X 4.75 cm seen done at home 1⅟₂ month back, which was negative, and free fluid in the cul-de-sac. Provisional diagnosis patient was lactating. Her last child birth was 6 month was unruptured ectopic pregnancy. Emergency back. Her previous cycles were regular with 3-4 days of laparotomy was performed. bleeding in every 30 days, average flow and no Intraoperatively, the uterus was normal in size and dysmenorrhea. Her first pregnancy was 2 years back, both the tubes were found to be normal. term vaginal delivery at hospital, no intrapartum and

Address for correspondence: Dr. Shabina khan Access this Article Online Assistant Professor, Department of Obstetrics and Gynecology, Rohilkand Medical College and Research Centre, Website: Bareilly [UP],India-243006. Email: [email protected] www.ijcmaas.com

How to cite this article: Subject: Shabina khan , Sonika Dahiya, H.K. Premi & Sarita; Ruptured Ovarian Pregnancy- A Rare Case Report; International Journal of current MedicalSubject: Sciences Medical and Applied sciences; 2015, 7(3), 189-190. Medical Sciences

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Shabina khan , Sonika Dahiya, H.K. Premi & Sarita

Intraoperatively, the uterus was normal in size and both the tubes were found to be normal. The size of both ovaries was normal. A mass measuring 7X7 cm was adhered to the right ovary and fimbrial end. The right fallopian tube was found completely normal and separate from the ovary.

Figure 1: Hemorrhagic ovarian mass Figure 2: Histopathology shows evidence of chronic Villi

The hemorrhagic ovarian mass was completely any of the classical risk factors for ectopic pregnancy. excised and was sent for histopathological When we are suspecting a ruptured tubal pregnancy, examination with a provisional differential diagnosis intraoperative finding of normal tubes should alert us of ruptured ovarian pregnancy. Her postoperative to keep an ovarian pregnancy in mind. Early diagnosis recovery was uneventful. and prompt treatment can allow for conservative Histopathology shows evidence of chorionic villi surgery and preserve the future fertility of the patient. embedded in mass arising from right ovary, normal lining of fallopian tubes were noted. References:

Discussion: 1. Nwanodi O, Khulpateea N. The preoperative Histologically, the diagnosis has been made by diagnosis of primary ovarian pregnancy; Natl Med Spiegelberg Criteria on the surgical specimen of the Assoc. 2006, 98 (5):796-8. removed ovary and tube. However, the tube and ovary 2. Hertig AT. Discussion of Gerin-Lojoie L. Ovarian are not usually removed as sonography allows for pregnancy. Am J Obstet and Gynecol. 1951;62:920. earlier diagnosis and surgeons strive to preserve the 3. Scutiero G,Di Gioia P, Spada A, Greco P. Primary ovarian pregnancy and its management. JSLS. ovary. Prior to the introduction of Spiegelberg’s 2012;16:492-494. criteria in 1878, the existence of ovarian pregnancy 4. Odejinmi F,Rizzuto MI,MacRae R,Olowu O,Hussain was in doubt, his criteria helped to identify the ovarian M.diagnosis and laparoscopic management of 12 pregnancy from other ectopics [7]. ocnsecutive cases of ovarian pregnancy and review The gestational sac is located in the region of the of literature.J Minim invasive Gynecol.2009;16:354- ovary. The gestational sac is attached to the uterus by 359. the ovarian ligament. 5. Hallet JG.Primary ovarian pregnancy. A case report Ovarian tissue is histologically proven in the wall of of 25 cases.Am J Obstet Gynecol.1982;143(1):55-60. the gestational sac. The oviduct on the affected side is 6. Grimes H,Nosal RA,Gallagher JC. Ovarian Pregnancy.A series of 24 cases.Obstet intact (this criteria however not true for a longer Gynecol.1983;61:174-180. ongoing ovarian pregnancy). 7. Spert H.Otto Spiegelberg and his criteria of Ovarian pregnancy,in Obstetric and gynecologic milestones. Conclusion: The MacMillan Company,New York,1958.255. Ovarian pregnancy is difficult to diagnose. Primary ------ovarian pregnancy may occur without the presence of

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