[The course and treatment of an ovarian pregnancy in the 3d trimester]

The course of a right ovarian pregnancy advanced up to the 35th week is described. The only pathognomonical symptom was a constant retrocervical tumor which was not identified as the contracted uterus. The analysis of this and 16 further cases of such ovarian pregnancies published between 1950 and 1981 leeds to the following conclusions: 1. Predisponant factors for an ovarian pregnancy occurring in a frequency of ca. 1:30,000 of all pregnancies are inflammatory diseases, surgery of the pelvis and fertility-disorders in the case-history. 2. The course of the ovarian pregnancy progreeded up to the third trimester in around 12% of the cases is characterised by an almost complete lack of symptoms. Vaginal bleedings and pain in the adnex-area may occur. 3. The monitoring as cardiotocography, chemical analysis of the placental function and the ultrasonography do not provide any clear findings to confirm the diagnosis. 4. As essential clinical indications can be considered a tumor in the pelvis of constant size discovered during the pregnancy mainly in combinations with a dislocated cervix of the uterus, a persistent anomaly of the fetal position, and a fetus palpable directly under the abdominal wall. 5. If an ovarian pregnancy is assumed an immediate operative revision is indicated. Exceptionally, in the second half of the pregnancy a delay of the operation can be justified until the fetus is able to survive. 6. The surgery of the advanced ovarian pregnancy should be as conservative as possible and reduced to the removal of the concerning adnexe.