Ovarian pregnancy: clinical characteristics, diagnostic challenges, and sonographic features-a multicenter case series with narrative literature overview.

PURPOSE: To describe the demographic, clinical, laboratory, imaging, and surgical features of 15 histologically confirmed ovarian pregnancies (OP) and to contextualize these findings within a narrative literature overview in order to improve clinical recognition and facilitate earlier diagnosis.

METHODS

A retrospective multicenter case series was conducted across two university-affiliated hospitals between 2012 and 2024. Women with histologically confirmed OP were included. Demographic data, risk factors, presenting symptoms, β-hCG dynamics, ultrasound findings, operative details, and postoperative outcomes were collected and analyzed.

RESULTS

Fifteen patients were identified. The mean age was 34.6 ± 4.2 years; 46.7% used an intrauterine device, 33.3% had prior cesarean delivery, and 13.3% conceived through assisted reproduction. Abdominal pain was the predominant symptom (86.7%), whereas vaginal bleeding occurred in 26.7%. The mean preoperative β-hCG level was 6,436 ± 5,570 mIU/mL and serial measurements showed inappropriate rises. OP was suspected preoperatively in 53.3% of cases; identification appeared higher in cases with formal ultrasound (85.7%), although this observation is limited by differences in imaging setting and documentation.. Observed sonographic features included a hyperechoic peripheral ring and a Doppler pattern demonstrating a single dominant feeding vessel; A trilaminar endometrial pattern was not observed in evaluable cases. Rupture occurred in 73.3% of patients with a median blood loss of 300 mL (IQR 10-2000 mL). All patients were treated surgically with ovarian preservation, and postoperative day-1 β-hCG declined by 59 ± 12%.

CONCLUSION

OP commonly presents with abdominal pain and minimal bleeding and carries a high rupture risk. The described sonographic patterns may represent hypothesis-generating observations that could support clinical suspicion and warranting further study.