Second-trimester ovarian pregnancy mimicking intrauterine pregnancy and causing hemorrhagic shock in surgery: a case report and review of the literature

BACKGROUND: Ovarian pregnancies at advanced gestational ages are exceedingly rare in clinical practice. The infrequency of this condition, coupled with the nonspecific nature of its symptoms and signs, renders preoperative diagnosis extremely challenging. CASE PRESENTATION: A 29-year-old pregnant woman, G7P3 in second trimester, was transferred to our center for pregnancy termination. She had a history of three cesarean deliveries and the pregnancy was uneventful. Ethacridine lactate was administered and she experienced abdominal pain. Uterine rupture was suspected and an urgent laparotomy was performed, during which the patient was finally diagnosed with an ovarian pregnancy. Given the patient was thin and anemic, coupled with severe adhesions, abundant blood supply, and significant blood loss encountered during surgery, she developed hemorrhagic shock. The left adnexa were removed, and the patient subsequently had a favorable postoperative recovery. CONCLUSION: Ovarian pregnancies at advanced gestational ages are rare cases and difficult to diagnose. When the manifestations do not correspond with those of a typical intrauterine pregnancy, the potential for this rare form of ectopic pregnancy should be considered.