[Prolonged ovarian pregnancy associated with an intrauterine pregnancy. Apropos of a case]

Case of advanced ovarian pregnancy are exceptional because ovarian pregnancy itself is very rare. The authors describe a case of prolonged ovarian pregnancy with retention of the dead fetus for more than a year and associated with an intra-uterine pregnancy. Usually ovarian pregnancy finishes in rupture which occurs before the end of the first trimester. It is then difficult to make out the intergrity of the organs and in particular of the tube and indeed to recognize them. On the other hand when the mass persists intact with the development of the pregnancy in a retort shape, it is easy to see how confusion is possible and arises between it and an intra-uterine pregnancy. In this case, however, the different anatomical forms are clear and an almost definite diagnosis can be made at the time of operation (the three first criteria of Spiegelbery). The diagnosis of ovarian pregnancy is never made before operation. At the very best one can say, when things happen early, that an extra-uterine pregnancy has ruptured, or in certain particular circumstances like in the case we are reporting lithopedian. The presence of ovarian tissue in the wall of the sac--which is the fourth criterion of Spiegelberg-is easier to recognize in early accidents than in advanced cases of ovarian pregnancy in which the parenchyma of the ovary is compressed, distended and laminated by the increasing development of the fetus and the adnexae. The absence of the placenta being adherent to other organs than the ovary can then be kept as a worthwhile criterion of ovarian pregnancy.