Ovarian pregnancy with a Copper-7 intrauterine device in situ
Netland, P.A.; Netland, A.T.; Solomon, M.B.; Kaiser, J.S.
Journal of Family Practice 16(2): 389-390; 394-395
1983
ISSN/ISBN: 0094-3509 PMID: 6822809 Document Number: 201376
A case of primary ovarian pregnancy involving a Copper 7 (Cu 7) IUD is described, and the pertinent literature is reviewed. A 29-year old white woman, gravida 2, para 2, presented with nausea and fatigue of 1 months' duration and severe bilateral upper abdominal pain with radiation to both shoulders of 1 day's duration. Her menstrual cycles for the previous 4 months had been irregular and her last menstrual period started 35 days prior to admission. She was known to have had a Cu 7 IUD in situ for 26 months. On admission, the patient was in moderate abdominal distress. Direct and rebound tenderness with some voluntary guarding was found in the upper abdomen, with minimal lower abdominal tenderness. Pelvic examination was normal, except for slight tenderness. Pelvic examination was normal, except for slight tenderness in the right adnexal area. No vaginal bleeding was observed. Serum pregnancy test (RIA) was positive. Sonogram of the abdomen showed the IUD in situ, free fluid in the peritoneal cavity, and a mass in the right adnexal area containing fetal parts and a fetal heartbeat. Dilation and curettage after removal of the IUD obtained a minimal amount of tissue. Laparotomy revealed 500-600 ml of blood. The uterus, both fallopian tubes, and the left ovary were normal. A hemorrhagic cystic area at the distal pole of the right ovary was actively bleeding. Wedge resection of the right ovary was performed. The patient recovered well and was discharged from the hospital 4 days after the operation. The hemorrhagic ovarian mass measured 6.0x4.5x3.0 cm. Section demonstrated at 3.0 cm cavity filled with clear fluid. The cavity was lined with a smooth membrane and contained a 1.6 cm embryo. A corpus luteum, 1.5 cm in greatest dimension, was adjacent to the cavity. Microscopic sections showed an edematous stroma and an area of implantation with vascularized chorionic villi adjacent to a corpus luteum. Hemorrhage extended from the area of implantation to the ovarian surface. Sections of the fetus were histologically normal. The diagnosis was ovarian pregnancy. Available data allow an approximation of the proportion of woman years of IUD use that involve the Cu 7 IUD in the US since 1966, which is calculated to be 28%. This calculation agrees with the observed 27% of the cases of ovarian pregnancy with an IUD in situ that involved the Cu 7 IUD reported in the US literature. This comparison suggests that the Cu 7 does not increase or decrease the risk of ovarian pregnancy relative to inert plastic IUDs. Clinicians should be aware of the possibility of ovarian pregnancy in patients who use the IUD.