OVARIAN ECTOPIC PREGNANCY IN AKTH: CASE SERIES

Background: Ovarian pregnancy is a rare form of extra-uterine pregnancy. Clinical presentation varies from asymptomatic to life threatening ones.Case: We report two cases of multiparous patients who presented with ruptured primary ovarian ectopic pregnancy with haemoperitoneum managed in Aminu Kano Teaching Hospital, Kano. The diagnosis was made at surgery and they had salpingo-oophorectomy. Histopathological result confirmed the diagnosis.Conclusion: The most common clinical factor that gives high index of suspicion is the use of IUD.

Ovarian pregnancy is a rare form of extra-uterine pregnancy.Clinical presentation varies from asymptomatic to life threatening ones. We

report two cases of multiparous patients who presented with ruptured primary o v a r i a n e c t o p i c p re g n a n c y w i t h haemoperitoneum managed in Aminu Kano
Teaching Hospital, Kano.The diagnosis was made at surgery and they had salpingooophorectomy. Histopathological result confirmed the diagnosis.
The most common clinical factor that gives high index of suspicion is the use of IUD.

Ovarian Pregnancy, IUD, Laparotomy, Aminu Kano Teaching Hospital, Kano
Ovarian ectopic is a rare variant of ectopic pregnancy occurring in 1 -3% of all ectopic pregnancies.The incidence is on the rise with causes attributable to better diagnostic modalities, increase use of intra-uterine devices, ovulation induction drugs and assisted reproductive techniques.Accurate pre-operative diagnoses of primary ovarian ectopic pregnancy is challenging and undoubtedly further delay may lead to serious maternal morbidity or even mortality.Mrs M.H, a 37years old G P + 0 2A last child birth was 18 months before presentation who presented at gynaecological unit of Aminu The urinary Beta Human Chorionic Gonadotropin(BHCG) was positive.
Haemoglobin concentration was 7.8g/dl.Pelvic USS result which she presented with showed empty uterus, haemoperitoneum and a left complex adnexal mass measuring 7 x 6 x 5cm.
Emergency laparotomy was done with a preoperative provisional diagnosis of ruptured left tubal ectopic pregnancy after informed consent was taken.Intraoperatively, uterus was bulky, both tubes were normal.Haemoperitoneum was 1.2L.The right ovary was normal.Left salpingo-oophorectomy was done.The patient had an uneventful postoperative recovery, the diagnosis of ruptured ovarian ectopic was made according to Spiegelberg's criteria.Macroscopic examination showed ovarian specimen measuring 5 x 4 x 3cm, weighing 10g.The cross section revealed haemorrbagic surface.Histopathotogical examination review section of ovarian tissue showing cyst lined by luteinized granulose cells, chorionic villi, trophoblastic cells and corpus luteum within the stroma of the ovary.The sections from the fallopian tube showed no evidence of gestational tissue.Therefore, diagnosis of primary ruptured ovarian ectopic pregnancy was confirmed.Three units of O+ blood grouped and crossmatched for her were transfused in the immediate postoperative period.She was counseled on intra-operative findings, the haemoglobin concentration at discharge (5 day) was 10.2gldl.She was followed over six months and she was asymptomatic with regular menstrual cycle.
The second case is Mrs G.Z, a 25 years old G P + OA1 last child birth was 22months before presentation who presented at gynaecological unit of Aminu Kano Teaching Hospital with complaint of 6weeks Amenorrhea and lower abdominal pain of 6 hours duration.She presented with sudden onset of th Case 2 Microscopic examination showed ovarian tissue with cystic lesion lined by luteinized granulosa cells, trophoblastic cells, chorionic villi and area of haemorrhage.The sections from the fallopian tube showed no evidence of gestational tissue.Thus, the diagnosis of primary ruptured ovarian ectopic pregnancy was confirmed.
T h e p o s t o p e r a t i v e h a e m o g l o b i n concentration was 8.5gldl and was not symptomatic, so she was not transfused.She was counseled on intra-operate finding and contraception.
An ectopic pregnancy is defined as implantation and development of an embryo

DISCUSSION
outside the uterine endometruim.The most common location continues to be fallopian tube (95%), then rare sites include the ovary (3.2%) or abdomen (1.3%).Ovarian ectopic pregnancy is a rare and life threatening condition and its early detection is perhaps the most difficult compared to other forms of extra-uterine pregnancies.
Ovarian pregnancy, may occur if fertilization occur in the peritoneal cavity and then fertilized ovum implanted on the ovary or fertilization occur in the tube then via tubal abortion or rupture, product of conception implanted on ovarian surface.It is a rare entity but the incidence has been on the rise due to better diagnostic modalities, wider use of contraceptive The diagnostic dilemma can be overcome sometimes before rupture by the use of high resolution transvaginal ultrasonography followed by diagnostic laparoscopy.These were not done for the two (2) cases reported because they presented with features suggestive of acute abdomen.Intra-operately, diagnosis of ovarian ectopic was made using the Spiegelberg's criteria which was later confirmed postoperatively by histological report.The mainstay of surgical treatment for ovarian pregnancy is salpingooophorectomy or conservative surgical management like ovarian wedge resection depending on the extent of tissue destruction.However salpingo-oophorectomy of the affected side was done for the two reported cases after thorough assessment of vitality of ovarian tissue.
The other treatment option is methotrexate (conservative treatment) but was not considered because the two cases reported were ruptured and needed immediate surgery.
In conclusion, ovarian ectopic is a rare variant of ectopic pregnancy which is not only difficult to diagnose but often misdiagnosed as tubal ectopic pregnancy.Most often diagnoses is made intra-operatively and confirmed by histopathological report.The management is essentially surgical however medical management with methotrexate therapy has been reported for few selected cases.10,11,12