Unusual ectopic pregnancies

Unusual ectopic pregnancies: A retrospective analysis of
65 cases
Nan Shan1
, Dan Dong1
, Weiguo Deng2
and Yan Fu1
1
Department of Obstetrics and Gynecology, First Hospital of Jilin University, and 2
Department of Nutrition and Food
Hygiene, School of Public Health, Jilin University, Changchun, China
Abstract
Aim: The aim of this study was to retrospectively investigate unusual ectopic pregnancies (EP) and compare
them with fallopian ones.
Material and Methods: A total of 1000 cases of ectopic pregnancies were analyzed, including 65 unusual cases.
We discussed distribution, incidence, risk factors, examinations, treatments and prognoses.
Results: Ovarian pregnancy was associated with placement of intrauterine device and pelvic inflammatory
diseases. Extratubal EP have a high rate of misdiagnosis and presented more serious manifestations. Some
unusual EP could be diagnosed by ultrasonography. Ovarian pregnancy was usually manifested as positive
culdocentesis. Most of the unusual EP underwent surgery, except some early cervical and corneal pregnancies.
Conclusion: Although extratubal pregnancies are difficult to diagnose, some histories and auxiliary examina-
tions could make diagnosis easier for clinical physicians. Surgery is still the most effective approach for
treatment of unusual EP, while conservative treatment of mifepristone combined with methotrexate or curet-
tage could be used for early diagnosis and treatment of cervical pregnancy.
Key words: cervical pregnancy, cornual pregnancy, methotrexate conservative treatment, ovarian pregnancy,
unusual ectopic pregnancies.
Introduction
Nearly 95% of ectopic pregnancies (EP) are implanted
in the various segments of the fallopian tubes. The
remaining 5% implant in the ovary, peritoneal cavity, or
within the cervix.1
When the blastocyst implants or
develops in pelvic areas other than the tubes, the preg-
nancy is considered an unusual EP. Compared with
tubal ones, extratubal EP are atypical in history or
symptoms, appear belatedly and might be more dan-
gerous. Early diagnosis of extratubal EP is extremely
difficult. We analyzed a 10-year series of consecutive
cases in order to evaluate unusual EP retrospectively as
a whole, and thus to make a forward investigation for
future therapy.
Methods
From January 2000 to January 2010, 1000 cases of EP
(935 tubal pregnancies, 65 extratubal pregnancies)
were diagnosed and treated in our center. Diagnosis
was essentially clinical and based on history, clinical
signs and symptoms, physical examination, human
chorionic gonadotrophin (hCG) assessment either
in urine or in serum, and transvaginal ultrasound. In
some cases, a diagnostic curettage was performed to
Received: November 7 2012.
Accepted: April 4 2013.
Reprint request to: Dr Yan Fu, Department of Obstetrics and Gynecology, First Hospital of Jilin University, Changchun 130021, China.
Email: f_y@jlu.edu.cn
bs_bs_banner
doi:10.1111/jog.12146 J. Obstet. Gynaecol. Res. Vol. 40, No. 1: 147–154, January 2014
© 2013 The Authors 147
Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology

remove intrauterine trophoblastic tissues. The major
treatments included surgeries and conservative thera-
pies, such as mifepristone combined with methotrexate
(MTX) or curettage.
c2
-test was used to examine the correlation between
categorical factors, including the distribution, inci-
dence, risk factors, examinations, treatments and prog-
noses. Statistical analysis was performed on spss 13.5.
P < 0.05 was considered statistically significant.
Results
Incidence
The sites of implantation are listed in Table 1. Mean
maternal age upon diagnosis was 30.9 years (20–47),
and in 31 cases (47.7%), it was less than 30 years.
Risk factors
Of the 1000 EP, 44.6% of women were primigravid,
and others reported previous pregnancies, of which
17.6% had a history of cesarean sections. Based on their
histories, most patients had fertility-reducing risk
factors, such as usage of intrauterine devices (IUD,
16.3%), pelvic inflammatory diseases (19.6%), curettage
(56.8%) and previous ectopic pregnancy (5.4%). Only
one patient underwent in vitro fertilization (IVF).
As shown in Table 2, patients with a history of pelvic
inflammatory diseases showed particularly significant
differences among ovarian (c2
= 13.5, P < 0.01), cornual
(c2
= 10.2, P < 0.01) and tubal pregnancies. Placement
of IUD was significantly associated with ovarian preg-
nancy (c2
= 25.2, P < 0.01) in comparison with other
unusual EP.
Comparison of misdiagnosis rates
In our investigation, the 10-year rate of tubal preg-
nancy misdiagnosis was 1.4%, which was much lower
than that of extratubal ones (c2
= 440.7, P < 0.01).
Among extratubal EP, cornual (c2
= 20.5, P < 0.01) and
cervical (c2
= 4.0, P < 0.05) pregnancies had lower
rates of misdiagnosis due to the help of ultrasound
examination.
Comparison of clinical manifestations
As shown in Tables 3 and 4, EP patients showed
clinical manifestations, such as a definitely delayed
Table 1 Sites of implantation in EP
Site Case Age Parity
(above 2) (%)
Ratio
(%)
Ratio (%)
of unusual EP
Tube 935 32.4 Ϯ 4.9 515 (51.5%) 93.5 —
Ovarian 29 29.1 Ϯ 5.9 16 (55.2%) 2.90 44.6
Cornual 21 32.4 Ϯ 5.4 13 (61.9%) 2.10 32.3
Cervical 8 32 Ϯ 7.5 6 (75%) 0.80 12.3
Rudimentary horn 1 20 0 0.10 4.6
Abdominal 3 29.6 Ϯ 4.9 1 (33.3%) 0.30 3.1
Tubal stump 2 26 Ϯ 5 1 (50%) 0.20 1.5
Cesarean scar 1 30 1 (100%) 0.10 1.5
Total 1000 32.3 Ϯ 6.8 553 100 100
EP, ectopic pregnancy.
Table 2 Risk factors
Site (n) Pelvic
inflammatory
diseases (%)
Cesarean
section
IUD Pregnancy
(above 2)
(%)
Curettage
(%)
Ectopic
pregnancy
(%)
Ovarian (29) 13 (44.8%)** 2 8 (27.5%) 16 (55.2%) 16 (55.2%) 1 (3.4%)
Cornual (21) 10 (47.6%)** 3 1 (4.7%) 13 (61.9%) 12 (57.1%) 0
Cervical (8) 4 (50%) 1 1 6 (75%) 5 (62.5%) 0
Abdominal (3) 1 (33.3%) 1 0 1 (33.3%) 1 (33.3%) 0
Tubal stump (2) 1 (50%) 0 0 1 (50%) 1 (50%) 1
Cesarean scar (1) 0 1 0 1 (100%) 1 (100%) 0
Tube (935) 167 (17.9%**) 167 153 (16.4%) 515 (55.1%) 532 (56.9%) 53 (5.7%)
*P < 0.05; **P < 0.01. IUD, intrauterine device.
N. Shan et al.
148 © 2013 The Authors

menstruation over a month (85.5%), abdominal pain
(62.8%), vaginal bleeding (83.3%), cervical motion pain
(51.7%), abdominal bleeding (39.4%) and shock (13%).
Unusual EP showed more severe abdominal bleeding
(P < 0.05), abdominal muscle tension (P < 0.01), sec-
ondary anemia (P < 0.01) or shock (P < 0.01) than tubal
pregnancies.
According to the implantation sites, EP showed spe-
cific signs and symptoms: patients with ovarian preg-
nancy were observed with more abdominal bleeding
than cornual (c2
= 10.7, P < 0.01) or cervical (c2
= 13.6,
P < 0.01) pregnancies. Ovarian EP also presented
more serious secondary anemia (c2
= 9.5, P < 0.01) and
obvious cervical motion pain compared with corneal
ones. Abdominal pain was significantly different
between cervical and tubal pregnancies (c2
= 8.0,
P < 0.01).
Auxiliary examinations
In our study, women were observed with positive hCG
both in urine (94.5%) and serum (91.4%). Some patients
were admitted to hospital as an emergency so they
provided urine hCG instead of serum hCG as a diag-
nostic method of pregnancy before treatment. About
46.9% of the patients showed positive culdocen-
tesis, and 94.1% of the patients were diagnosed by
ultrasonography.
Culdocentesis was more meaningful for ovarian
pregnancy than for corneal pregnancy (c2
= 14.7,
P < 0.01). Ultrasound examinations were significantly
meaningful for tubal (c2
= 526.9, P < 0.01), cervical
(c2
= 10.5, P < 0.01) and cornual (c2
= 30.0, P < 0.01)
pregnancies (Table 5).
Treatments
As shown in Table 6, most women with unusual EP
underwent surgery, except those with cervical and
corneal pregnancies, which were treated with conser-
vative approaches, including methotrexate therapy and
curettage. During operations, we found 82.8% (24/29)
of ovarian pregnancies had active hemorrhage, which
could prove its hazard.
Discussion
Incidence and related factors
The incidence of unusual EP ranges from 4.9% to
10.1%,2
and in our study, it was 6.5% and consistent
Table 3 Clinical manifestation (1)
Site (n) Amenorrhea
(n)
Period (day) Vaginal bleeding
(n) (%)
Abdominal
pain (n) (%)
Shock (n)
Ovarian (29) 28 42.6 Ϯ 9.8 21 (72.4%) 29 (100%) 9 (32.1%)
Cornual (21) 19 66.2 Ϯ 15 13 (68.4%) 18 (94.7%) 7 (36.8%)
Rudimentary horn (1) 1 65 0 1 (100%) 0
Abdominal (3) 3 50 Ϯ 18.7 2 (66.7%) 3 (100%) 0
Tubal stump (2) 2 55.7 Ϯ 13.8 1 (50%) 2 (100%) 1
Cesarean scar (1) 1 54 1 (100%) 1 (100%) 0
Cervical (8) 7 83.9 Ϯ 28.1 7 (87.5%) 1 (12.5%) 1
Tubal (935) 794 50.9 Ϯ 11.9 788 (84.2%) 573 (61.3%**) 112 (1.2%)
*P < 0.05; **P < 0.01.
Table 4 Clinical manifestation (2)
Site (n) Abdominal
bleeding (n)
(%)
Anal
inflation
(n)
Abdominal
muscle
tension (n)
Cervical
motion pain
(n) (%)
Secondary
anemia (n)
(%)
Ovarian (29) 23 (79.3%)** 11 6 18 (62.1%)** 21 (72.4%)*
Cornual (21) 7 (33.3%) 3 2 2 (9.5%) 8 (38%)
Rudimentary horn (1) 0 0 0 0 0
Abdominal (3) 3 (100%) 1 2 1 (33.3%) 3 (100%)
Tubal stump (2) 1 (50%) 2 0 0 2 (100%)
Cesarean scar (1) 1 (100%) 1 0 1 (100%) 1 (100%)
Cervical (8) 0** 0 0 0 7 (87.5%)
Tubal (935) 359 (3.8%**) 203 (21.7%) 540 (57.8%**) 495 (52.9%) 357 (38.2%)
*P < 0.05; **P < 0.01.
Unussual ectopic pregnancies

with the reports. Although this incidence is low, the
danger and mobility from an extratubal pregnancy is
higher than normal pregnancy. Moreover, the success
rate for a subsequent pregnancy will be reduced after
EP.
In our series, the most common site of implantation
in EP is the tube, followed by the ovary, corn, cervix
and abdomen. The rarest site is the cesarean scar.
Ovarian pregnancy is very rare, accounting for 0.3%–
3.0% of EP,3
and its incidence in our investigation was
3.1%. Ovarian pregnancy is generally believed to be
associated with pelvic inflammatory diseases and pre-
vious surgery in the pelvic cavity. We found 44.8% of
the cases (13/29) had a history of pelvic inflammatory
diseases, and 55.2% (16/29) had a history of delivery or
curettage. Patients with a history of pelvic inflamma-
tory diseases showed a significant difference in ovarian
than corneal and tubal pregnancies. Furthermore, even
without inflammatory history, pelvic surgeries may
also cause ovarian inflammation and thicken the albug-
inea, which could lead to a relative lack of follicular
fluid pressure. Finally, it would generate ovulation dis-
order. Ovum might be detained in the broken follicles
and fertilized just in the ovary.
Reportedly, the use of IUD seems to be dispropor-
tionately associated with ovarian pregnancy.4,5
In our
series, 10 out of 29 patients had a history of IUD place-
ment (27.6%), which indicated statistical relevance
between IUD and ovarian pregnancy, and suggested
that IUD placement may change some manners in the
pathophysiological environment of the ovary. IUD was
hypothesized to successfully prevent all pregnancies,
except ovarian ones.6
Therefore, the history of IUD
placement is useful if a patient is suspected of ovarian
pregnancy. However, it was reported that the incidence
rate of PID among IUD users as reported from different
studies depends heavily on the definition used and the
means available for diagnosing PID. It varies from 1 per
100 to 1 per 1000 woman-years – a tenfold difference –
in different studies. PID risk has been found to be
sixfold higher in the first month after IUD insertion
than it is thereafter. Beyond the first month or so after
insertion, the incidence of PID is low among women
using IUD and at a level that appears similar to that for
women in general.7
The incidence of cervical pregnancy is less than 1%
of all EP,8,9
varying from 1/10003
to 1/18 000.4
the cause
may be associated with the following factors: (i) cesar-
ean section and usage of IUD might interfere with the
implantation of blastocyst; (ii) repeated endometrial
curettages might damage the endometrium or form a
scar, and thus retard the pass and implantation of blas-
tocyst at cervix (in our series, 75% of the cases [6/8]
reported a history of induced abortion or cesarean
section and placement of IUD, which suggested that
intrauterine surgeries could be an important cause for
cervical pregnancy); and (iii) with the development of
reproductive technology, embryo transfer as in vitro
fertilization is also a substantial cause.
Misdiagnosis rate
The misdiagnosis rate of extratubal pregnancies is
quite high (96.6%). Ovarian and tubal pregnancies are
difficult to distinguish, even by ultrasound, because
their clinical manifestations are similar. In our investi-
gation, only one case of ovarian pregnancy was diag-
nosed by ultrasound. Reportedly, all 24 cases of ovarian
pregnancies in six hospitals were preoperatively mis-
diagnosed.10
However, positive culdocentesis results
were more common in patients with ovarian pregnan-
cies than with cornual pregnancies, probably because a
Table 5 Auxiliary examination
Site (n) Serum
hCG (n)
Urine
hCG (n)
Culdocentesis
positive
(n)
Ultrasound
Diagnosis
(n)
fetal heart
movement
Persistent
hCG
secretion
Cases of
misdiagnosis
Ovarian (29) 17 (58.6%) 25 (86.2%) 20** (69%) 1 (3.4%) 1 (3.45%) 6 (20.7%) 28 (96.6%**)
Cornual (21) 13 (61.9%) 13 (61.9%) 3 (14.3%) 12 (57.1%) 0 0 5 (23.8%**)
Cervical (8) 6 (75%) 5 (62.5%) 0 5 (62.5%) 0 0 2 (25%*)
Rudimentary horn (1) 1 (100%) 1 (100%) 0 1 (100%) 0 1 (100%) 0
Abdominal (3) 2 (66.7%) 2 (66.7%) 0 0 2 (66.7%) 0 3 (100%)
Tubal stump (2) 0 2 (100%) 1 (50%) 0 0 0 2 (100%)
Cesarean scar (1) 1 (100%) 1 (100%) 0 0 0 0 1 (100%)
Tubal (935) 874 (93.5%) 896 (95.8%) 445 (47.6%) 922 (98.6%) 38 (4.06%) 0 13 (1.4%**)
Total 914 (91.4%) 945 (94.5%) 46.9 (46.9%) 941 (94.1%) 41 (4.1%) 7 (0.7%) 54 (5.4%)
*P < 0.05; **P < 0.01. hCG, human chorionic gonadotrophin.
N. Shan et al.

patient upon admission already had her ovary
ruptured and suffered from severe abdominal
hemorrhage.
Cornual pregnancy was often misdiagnosed as an
intrauterine pregnancy because its implantation site is
so close to the uterine cavity and lesions are difficult to
scrape during curettage. With the improvement of
ultrasound technology, cornual and cervical pregnan-
cies can be more accurately diagnosed. In our investi-
gation, 57.1% (12/21) of cornual pregnancies and 75%
(6/8) of cervical pregnancies were diagnosed by ultra-
sound, and their misdiagnosis rates (23.8% and 25%,
respectively) were obviously lower than that of other
extratubal pregnancies. Ultrasound is considered as
the most important examination method as it can
detect an extrauterine pregnancy with a sensitivity of
89% and a specificity of 99.8%.11
Therefore, ultrasound
examination should be encouraged during early gesta-
tion in order to screen for ectopic pregnancy in a timely
manner. Ultrasound examination before abortion and
villus check after curettage are highly recommended.
Uterine contents should be included in pathological
examination. Serum b-hCG and ultrasound should be
closely monitored without villus.
Pregnancy on a cesarean scar can be easily misdiag-
nosed as inevitable abortion or cervical pregnancy due
to the low implantation site of the blastocyst. It shows
similar early manifestations as intrauterine pregnancy,
threatened abortion, trophoblastic tumor or cervical
pregnancy. It could cause vaginal bleeding during
curettage if misdiagnosed as intrauterine pregnancy.
The diagnosis of pregnancy on cesarean scar is depen-
dent on ultrasound, especially the uterine longitudinal
sonogram. Ultrasound could reveal the correlation
between cesarean scar and blastocyst clearly and
thereby provide an objective and reliable diagnosis.
Auxiliary examination was helpless in abdominal
pregnancy, and our cases were all confirmed by
surgery.
Clinical manifestations
More obvious cervical motion pain was observed
besides abdominal pain, vaginal bleeding and amenor-
rhea in ovarian pregnancy. Ovarian tissues lack
muscles but are rich in vessels. When an ovary is rup-
tured, severe abdominal hemorrhage, secondary
anemia (21/29, 72.4%) or even shock (9/29, 31.0%) may
occur.
In cervical pregnancy, the endocervix is eroded by
trophoblast, and the pregnancy proceeds to develop in
the fibrous cervical wall. The higher the trophoblast is
Table6Treatments
SiteConservative
treatment
No
treatment
LaparotomyAdnexectomySubtotal
resectionof
uterus
HysterectomyCurettageLaparoscopic
resection
Tube(935)113(12.1%)30(3.2%)531(56.8%)5(0.5%)000261(27.9%)
Ovarian(29)0020(69%)1(3.4%)0009(31%)
Cornual(21)5(23.8%)1(4.8%)7(33.3%)1(4.8%)5(23.8%)1(4.8%)5(23.8%)0
Cervical(8)6(75%)0001(12.5%)3(37.5%)2(25%)0
Abdominal(3)003(100%)1(33.3%)0000
Rudimentaryhorn(1)001(100%)00000
Tubalstump(2)001(50%)00000
Cesareanscar(1)00001(100%)000

implanted in the cervical canal, the higher capacity it
has to grow and hemorrhage. Some diagnostic criteria
for cervical pregnancy are:
1 Clinical signs and symptoms: recurring vaginal
bleeding without pain was observed during early
gestation, often followed by uncontrolled hemor-
rhage. In our investigation, 87.5% (7/8) of cases were
observed with vaginal bleeding, involving three
cases of emergency.
2 Gynecological examination: cervix is dilated; cervical
canal increasingly thickens like barrel. Doctors could
see or even touch placenta in cervix. Two cases pre-
sented cervical dilation and another two cases
showed a flabby cervix. The examination may cause
severe hemorrhage, so it should be deliberated
before examination.
3 Serum b-hCG assessment and ultrasound examina-
tion. Quantitative serum hCG in cervical pregnancy
is often present below the normal pregnancy due to
poor blood supply. Compared with other unusual
EP, cervical pregnancy showed atypical abdominal
pain or bleeding. This may be the result of early
admission.
In abdominal pregnancy, with either tubal abortion or
intraperitoneal rupture, the entire conceptus may
be extruded from the tube. If an early conceptus is
expelled essentially undamaged into the peritoneal
cavity, its placental attachment may persist, or it may be
reimplanted almost anywhere and grow as an abdomi-
nal pregnancy. This is unusual, and most small concep-
tuses can be reabsorbed. They may occasionally remain
in the cul-de-sac for years as an encapsulated mass, or
even become calcified to form a lithopedion.11
All our cases are secondary. The first one occurred
due to rupture of tubal pregnancy, and then the con-
ceptus developed on the posterior wall of bladder. The
second one was from rupture of rudimentary horn
pregnancy and the conceptus grew in Douglas’ space
on the ligament of the right iliac fossa. The last one
happened due to tubal interstitial pregnancy and the
conceptus dropped into the abdominal cavity. During
the operation, the fetus was found alive in the abdomi-
nal cavity surrounded by blood. The placenta was
attached to the greater omentum.
Treatment and prognosis
Twenty-eight out of 29 women with ovarian preg-
nancies underwent surgery by resection of the ovarian
wedge or partial oophorectomy. Most reports advocate
preserving ovarian tissues as much as possible.
Doctors cut off the affected annex only under serious
damages.
In the past, it was suggested to cut off the uterine
corpus to avoid rupture of cornual pregnancy, and
hysterectomy was recommended if necessary. In our
study, seven cases (33.3%) underwent lesion resection
on corpus; and five cases (23.8%) received sub-
total hysterectomy due to ruptures. In recent years,
many successful cases of conservative treatment were
reported. We treated five patients with conservative
therapies, including mifepristone, curettage and
MTX, which achieved excellent results. However,
some reports also pointed out that conservative treat-
ment for patients in this type of pregnancy with long-
time amenorrhea and abdominal pain may not
succeed easily.
Before 12 weeks’ gestation, invasion of trophoblastic
cells in the cervical wall is not deep enough, so conser-
vative treatments for cervical pregnancy can be suc-
cessful.12
Treatments include: (i) hysterectomy and
subtotal hysterectomy (they are operated only after
failure of conservative treatments or uncontrolled hem-
orrhage [they were used in three cases]); and (ii) con-
servative treatments (the key was early diagnosis and
treatment). Recently, the use of curettage and hysterec-
tomy has been reduced gradually. They are only used
as alternative therapies for MTX and uterine artery
embolization. Reportedly, MTX can be used by sys-
temic or local injection. It could reach a high effect of
80%.13
Usage of both mifepristone and MTX was better
than single MTX for cervical pregnancy, as the former
showed a high success rate and lower toxicity.14
This
method could enhance the toxicity to trophoblast cells
and kill the embryo effectively.
In our investigation, four cases of conservative treat-
ments and two cases of curettage were successful.
However, vaginal bleeding may still occur after con-
servative treatments. Doctors should closely monitor
patients’ conditions. One patient underwent hysterec-
tomy after conservative treatment due to recurring
vaginal bleeding.
Rudimentary horn in the uterus is the result of devel-
opmental defects on lower segment in the duct of
Muller, which caused unequal formation on both sides.
A small appendage formed next to the normal uterus
and connected it through a bunch of fibrous tissues.15
Compared with the normal uterus, the rudimentary
uterus has thicker muscles (most hypoplasia) with
dense vessels. Thus, severe hemorrhage often occurs
after the rupture of pregnancy.
N. Shan et al.

For rudimentary horn uterine pregnancy, general
considerations are to excise the rudimentary horn in
the uterus.16,17
Gynecologists should excise both rudi-
mentary horn and its ipsilateral tube to avoid future
tubal pregnancy.18
They should do the same in abdo-
minal surgeries, once a rudimentary horn uterus
is identified. One patient in our group underwent
resection of rudimentary horn uterus and ipsilateral
salpingectomy.
In abdominal pregnancy, blastocyst may invade into
maternal organs or vessels, and thus cause bleeding or
rupture of maternal organs. It should be immediately
treated upon diagnosis. Three cases underwent resec-
tion of lesions in the abdomen and one suffered ipsi-
lateral salpingectomy.
Cesarean scar pregnancy accounted for 6.1% of the
ectopic pregnancies with a history of cesarean section.19
The isthmus had poor muscles due to the uterine scar
but had rich proliferations of connective tissues and
vessels. If the incision site is ruptured, or the placenta
is separated, uncontrolled bleeding would occur.
Hysterectomy is needed if necessary.20
Surgical treat-
ment, including laparotomy and hysterotomy, were
attempted with success.21
Conservative treatments
include systemic or direct injection of MTX.22,23
The
combination of MTX, uterine artery embolization and
laparoscopic excision, followed by hysteroscopy to
assess scar integrity, was reported.24
In conclusion, although extratubal pregnancies are
difficult to diagnose, some histories and auxiliary
examinations could make diagnosis easier for clinical
physicians. IUD placement and history of pelvic
inflammatory disease were closely related to ovarian
pregnancy. Ultrasonography is meaningful for diagno-
sis of tubal, cervical and corneal pregnancies, whereas
ovarian pregnancy is usually manifested with positive
culdocentesis.
Surgery is still the most effective approach for
unusual ectopic pregnancies, while conservative treat-
ments, such as mifepristone combined with MTX or
curettage, could be used for early diagnosis and treat-
ment of cervical pregnancy.
With the globally increasing incidence of sexually
transmitted diseases, the prevalence of unusual ectopic
pregnancy is anticipated to increase. Their rarity, the
complex history and atypical clinical characteristics of
the condition may cause them to be ignored by an
unsuspecting clinician. Thus, high-level awareness
should be maintained at all times by clinicians. This can
reduce the mortality and morbidity associated with
these emergencies.
Acknowledgments
We would like to take this opportunity to thank to all
authors who have contributed to this paper.
Disclosure
None.
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