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  • Title: Ovarian pregnancy associated with a copper-7 intrauterine device: report of a case and review of the literature.
    Author: Smith GN.
    Journal: J Am Osteopath Assoc; 1982 Jul; 81(11):796-7. PubMed ID: 7118613.
    Abstract:
    The incidence of ovarian pregnancies is rare, a ratio of approximately .7 ovarian pregnancies to every 100 ectopic pregnancies. Since 1970, an increasing number of ovarian pregnancies associated with the use of IUDs are reported. A case report of a 34-year old woman, gravida 4, with an IUD in place for 18 months is presented. The patient complained of severe pelvic pain and moderate bleeding 5-6 weeks after her last normal menstrual period. Tissue, grossly ressembling placental tissue was passed, after which the pain stopped and the bleeding became minimal. On recurrence of pain and heavier bleeding, the patient underwent a dilatation and curretage and removal of the IUD, but the pain persisted. Ultrasound revealed a normal uterus and a left adnexal mass. Exploratory laparotomy to correct what was thought to be a hemorrhagic corpeus luteum cyst, resulted in a left oophorectomy. The pathology report showed an apparent gestational sac and a 10 mm embryo. In an analysis of 33 cases of ovarian pregnancy, another author noted the presence of vaginal bleeding, abdominal pain, uterine enlargement, and adnexal masses in a majority of cases on which the data were collected. Although the IUD has been shown to reduce the incidence of uterine implantation by 99.5% and tubal implantation by 95%, it does not reduce the incidence of ovarian pregnancy. Incidence of ovarian pregnancy among IUD users is thought to be 1 for every 7-9 ectopic pregnancies, in the general population, the incidence is 1 to every 150-200 ectopic pregnancies. This is probably due to the local enzyme or chemical action on the endometrial cavity and tubes. This apparent increase in ectopic pregnancies seems to be relevant only to the number of intrauterine pregnancies prevented by the IUD. Patients with IUDs, presenting with positive pregnancy tests, irregular bleeding and abdominal pain should be evaluated by ultrasound.
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