Discussion and analysis of clinical misdiagnosis and missed diagnosis of ovarian pregnancy
Zhu Xiaqin
Hao Min
Liu Yun
Wang Zhiqi
Abstract：Objective To investigate the clinical characteristics,effective diagnosis and treatment methods and possible high risk factors of ovarian pregnancy,and to reduce misdiagnosis and missed diagnosis.Methods The clinical data of 32 patients with ovarian pregnancy diagnosed by surgery in Beijing Friendship Hospital,Capital Medical University from January 2013 to December 2023 were collected and analyzed.The related risk factors,surgical and pathological characteristics of the cases were analyzed,and the experience of diagnosis and treatment of ovarian pregnancy was summarized.Results Ovarian pregnancy could occur in all ages of childbearing age.The main clinical manifestations were amenorrhea,abdominal pain and vaginal bleeding.The preoperative clinical accurate diagnosis rate was low,and there were some cases of misdiagnosis.Eight cases were diagnosed with diseases other than ectopic pregnancy,such as intrauterine device displacement,pelvic inflammatory disease,and gastroenteritis,after visiting external hospitals or internal medicine departments.Before operation,only one case was clinically diagnosed as ovarian pregnancy,and the rest were diagnosed as tubal pregnancy.Thirty-one cases(96.9％)underwent gynecological ultrasound examination before operation.Only 2 cases described that the lesion was located in the ovary,and 3 cases suggested that the lesion was closely related to the ovary.There were also difficulties in intraoperative diagnosis:23 cases(71.9％)underwent laparoscopic exploration surgery,and 9 cases(28.1％)underwent laparotomy surgery.Twenty-one cases(65.6％)were clinically and pathologically consistent with ovarian pregnancy during and after surgery.Four cases(12.5％)showed no obvious villi during surgery,but corpus luteum was visible,suggesting ovarian corpus luteum rupture with pregnancy.Postoperative pathology suggested ovarian pregnancy,and the diagnosis of ovarian pregnancy was revised after surgery.Three cases(9.4％)showed ovarian rupture during surgery,with corpus luteum tissue visible around the rupture and no obvious chorionic tissue.Postoperative pathology suggested the presence of chorionic villi in abdominal hematoma,and both intraoperative and postoperative diagnoses considered ovarian pregnancy.Four cases(12.5％)underwent intraoperative exploration of both fallopian tubes,all of which were intact and showed ovarian rupture.No obvious corpus luteum rupture was observed during the operation,and the intraoperative diagnosis considered ovarian pregnancy rupture.All postoperative pathology showed no placental villi or trophoblast cells,and the postoperative chorionic gonadotropin(hCG)decreased satisfactorily.Ovarian pregnancy was still considered in the postoperative diagnosis.All patients underwent wedge resection of the affected ovary,and the patient's blood hCG decreased satisfactorily after surgery.No patients underwent secondary surgery.Conclusion Ovarian pregnancy is a rare type of emergency in obstetrics and gynecology,but intra-abdominal bleeding can endanger the life of pregnant women.Improving awareness and combining medical history,ultrasound examination,and blood hCG can improve preoperative diagnosis and treatment rates,so as to develop effective diagnosis and treatment plans more quickly.Laparoscopic ovarian wedge resection is safe and effective,and postoperative follow-up of blood hCG is necessary.
Keywords：Ectopic pregnancyOvaryShockSurgical operation
Publication Date：2025-04-18
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 566-570 )