Ovarian ectopic pregnancy with IUCD.

Ovarian ectopic pregnancy with IUCD We describe three cases of ovarian ectopic pregnancies with an intra-uterine device (IUCD) in situ, and suggest that prostaglandins may have played a major part in this combination. The IUCD alters the ratio of the prostaglandins secreted, so that tubal peristalsis is reversed and the fertilised ovum is carried the opposite way. Case reports Three multigravidae presented with varying degrees of abdominal pains. All of them had suffered from menstrual irregularity of recent duration, and all had had Lippes' loops inserted for over two years. X-ray films confirmed that the device was in position in each case. Laparotomy showed right-sided cystic ovarian swelling in one case and left-sided in the other two. The other ovary and both Fallopian tubes in each case were intact and un-involved. Ovarian tissue was conserved in two cases, but the ovary had to be removed in one because of heavy, uncontrollable bleeding. The pathologist reported the histological features of pregnancy in the tissue excised. Discussion Ovarian pregnancy is very rare, a ratio of 0 7 ovarian per 100 ectopic pregnancies having been suggested.' Women who wear an IUCD appear to have higher incidence, a ratio of one ovarian to nine ectopic pregnancies having been reported.2 Our cases fulfil the diagnostic criteria formulated by Spieglberg.3 Very little is known about the mode of action of the IUCD. It has been claimed that it distorts and distends the uterine cavity and thereby impairs its tonicity, or that it causes a foreign body reaction with leucocytic infiltration resulting in an environmental hostility to the ovum or that the macrophages phagocytoze the sperms. This spermatotoxic or blastotoxic hypothesis cannot explain the high relative frequencies of both tubal and ovarian ectopic pregnancies in patients fitted with IUCDs. Lehfeldt et all suggested that the anti-fertility effect is maximal in the endometrium, weaker in the tubes, and absent beyond that-that is, about the ovary. This pattern, they thought, suggested direct enzymatic or chemical action, possibly by retrograde flow from the endometrium outwards. We suggest that perhaps the chemical action is due to a substance resembling prostaglandin, which is secreted abundantly from the endometrium causing contractions and preventing implantation. Prostaglandin is also secreted from the fallopian tubes but in lesser amounts. Nevertheless, it is not secreted from the non-contractile ovaries. Alternatively, possibly the IUCD alters the ratio of the amount of the prostaglandins secreted. Therefore, instead of the …