Ovarian Pregnancy Clinical Analysis12 Cases

Ovarian pregnancy (ovarian pregnancy, OP) is that a fertilized ovum implantes and develops in the ovarian tissue .It includes primary and secondary Ovarian pregnancy.The majority of ovarian pregnancy clinically is primary ovarian pregnancy.It is difficult to diagnose before operation,because the clinical manifestations and signs of Ovarian Pregnancy are similar to others,which leading to death caused by intra-abdominal hemorrhage.The ovarian pregnancy rate in natural fetation is about 1: (7000 ~ 40000),which is 0.5%-3.0% of ectopic pregnancy.In the past,Ovarian pregnancy was rare in clinical practice.In recent years,as the development of modern diagnostic techniques and the popularity of intrauterine devices or various assisted reproductive techniques,the trend of ovarian pregnancy has been increasing.Vagina ultrasound and Human Chorionic Gonadotropin can help diagnose ovarian pregnancy,but the finally diagnose should according to pathologic diagnosis after surgery。Ovarian pregnancy is a very serious type in ectopic pregnancy. Because the ovarian tissue contains abundant blood vessels and it lack of muscle tissue,it is difficult to stop bleeding once gestational sac breaks,it is a threat against patient's life. Therefore,timely diagnosis and treatment is very important.It is crucial to detect the disease early and take effective measures according to specific pregnancy.Objective:To Discussion of clinical features, diagnosis and treatment in Ovarian Pregnancy so that the essay can help early diagnosis and treatment.Methods:Accovding to SPSS12.0 statistical software for statistical processing,we retrospectively analyze the 12 ovarian pregnancy patient's clinical data collected in Second Affiliated Hospital of Dalian Medical University from January 2005 to December 2008, including onset age, maternity and contraceptive measures, pelvic inflammatory disease and history of abdominal surgery, uterine cavity operating history, clinical manifestations, diagnosis, treatment and prognosis.Result:1.There were 348 cases,in our hospital from 2005 to 2008 ectopic pregnancies treated with surgical treatment so the incidence, including 12 Ovarian Pregnancy was 3.45%.There were 180 cases from 2005 to 2006 ectopic pregnancies treated with surgical treatment including 6 Ovarian Pregnancies.So the incidence of Ovarian Pregnancy was 3.33%.There were 168 cases from 2005 to 2006 ectopic pregnancies treated with surgical treatment including 6 Ovarian Pregnancies.So the incidence of Ovarian Pregnancy was 3.57%.The difference incidence between those two rates was not significant (χ2=0.014,P>0.05).2.The main symptoms are cessation of menstruation, amenorrhea irregular vaginal bleeding or abdominal pain in the 12 cases,and the most obvious clinical manifestation is abdominal pain.3.As the clinical symptoms are similar to tubal pregnancy,rupture corpus luteum, it is very difficult to diagnose before operation.4.Risk factors: intrauterine device,poor intrauterine environments, pelvic and abdominal surgery.5.The 12 patients in this group were all treated with abdomen surgery. Ovarian wedge resection:10 cases were managed by this way,but one case was treated after unsuccessfully conservative treatment with systemic MTX. One case was treated with partial resection of ovarian because ovarian rupture leaded to serious blooding .12 patients were cured and discharged eventually.Conclusion:1.Clinical features:ovarian tissue contains abundant blood vessels so it is vulnerable to rupture. Ovarian tissue is lack of muscle tissue, so it is difficult to stop bleeding when the gestational sac breaks. Ovarian Pregnancy is more serious than any other ectopic pregnancy, so it is crucial to early diagnose.2.Diagnosis and differential diagnosis :As the clinical symptoms are similar to tubal pregnancy, rupture corpus luteum, it is very difficult to diagnose before operation .The final diagnosis according to pathologic diagnosis in operation or after-operation .It provides early diagnosis of ovarian pregnancy by vaginal ultrasound guiding accurate positioning, and detectingβ-hCG in the blood.3.Treatment : The main treatment is surgical management. As the ovarian tissue contains abundant blood vessels and it lacks muscle tissue,so it is not easy to stop bleeding when gestational sac breaks,which is easier leads to intra-abdominal hemorrhage. So it should be immediately treated with exploratory lapa- rotomy or laparoscopy, once the diagnosis of ovarian pregnancy is identified. At present we usually take ovarian wedge resection to protect patient's ovarian function and fertility.