Unusual Ectopic Pregnancy: Beyond the Tubes

Introduction Nearly 95 percent of ectopic pregnancies are implanted in the various segments of the fallopian tube, the remaining 5 percent of non tubal ectopic pregnancies (EP) implants in the ovary, peritoneal cavity, cervix, or prior cesarean scar and are considered unusual ectopic pregnancies. Unusual EP are considered an important challenge for the gynaecologist who must recognize this condition before severe complications. The increased use of assisted reproduction techniques and the rise in cesarean deliveries have been accompanied by a rise of unusual EP, especially scar pregnancies. Diagnosis is often late because women could be asymptomatic or show unspecific pain and a severe abdominal bleeding could represent the first manifestation. Ultrasound and 3D scanning became a very useful non invasive tool for a precise diagnose. The therapeutic strategies include medical and surgical treatments but conservative management is often difficult. Citation: Giovanni Larciprete., et al. “Unusual Ectopic Pregnancy: Beyond the tubes”. EC Gynaecology 1.1S1 (2016): 12-22. Following fertilization and fallopian tube transit, the blastocyst normally implants within the uterine cavity. Implantation elsewhere is considered ectopic and comprises 1 to 2 percent of all first-trimester pregnancies in the United States. Nearly 95 percent of ectopic pregnancies are implanted in the various segments of the fallopian tube, the remaining 5 percent of nontubal ectopic pregnancies (EP) implants in the ovary, peritoneal cavity, cervix, or prior cesarean scar [1]. When the blastocyst implants or develops in pelvic areas other than the tubes, the pregnancy is considered an unusual EP [2]. Because of the atypical symptoms and clinical history, unusual EP are considered an important challenge for the gynaecologist who must recognize this condition before severe complications. Although this incidence is low, the danger and morbility from an extratubal pregnancy is higher than normal pregnancy, with a quite high misdiagnosis rate (96.6% according to Shan ., et al.) [2]. Moreover, the success rate for a subsequent pregnancy will be reduced after EP. The increased use of assisted reproduction techniques and the rise in Cesarean deliveries have been accompanied by a rise of unusual EP, especially scar pregnancies [3]. Occasionally it is possible to identify a heterotopic pregnancy due to an intrauterine pregnancy coexisting with an ectopic one. Ovarian pregnancy is a very rare and atypical ectopic pregnancy (1 in 25,000 pregnancies, of 0.5-3% of extra uterine pregnancies); there are very few reports of an accurate preoperative diagnosis utilizing sonography. The correct diagnosis is most frequently made at the surgery and requires histopathological confirmation (Figure 1 and 2) [4]. The most common risk factor associated with ovarian pregnancy is ovulation induction and assisted reproduction techniques, but other authors [2] advise that pelvic inflammatory disease, use of