At laparoscopy for a suspected ectopic, the surgeon finds the gestation entirely within the left ovary with the ipsilateral tube visibly intact. Which set of criteria confirms an ovarian ectopic pregnancy?
- A Tube and fimbriae intact on the affected side, gestational sac in the ovary, sac connected to the uterus by the ovarian ligament, ovarian tissue in the wall of the sac confirmed histologically ✓
- B Gestational sac in the ovary, presence of corpus luteum on the same side, beta-hCG above 5,000 mIU/mL, intact tube
- C Sac within ovarian tissue, absence of chorionic villi, negative p57 staining, tube intact
- D Tube intact, gestational sac medial to the ovary, ovarian tissue histologically surrounding villi, normal contralateral tube
Correct answer: A. Tube and fimbriae intact on the affected side, gestational sac in the ovary, sac connected to the uterus by the ovarian ligament, ovarian tissue in the wall of the sac confirmed histologically
Explanation
Spiegelberg's four criteria define ovarian pregnancy: the ipsilateral tube and fimbriae must be intact and clearly separate from the sac, the gestational sac must occupy the ovary, the ovary must connect to the uterus by the utero-ovarian ligament, and definitive ovarian tissue must be demonstrated in the sac wall histologically. Option D places the sac medial to the ovary, which describes a broad ligament or interstitial site, and option B mixes non-diagnostic laboratory findings into a histological definition.
Reference: Shaw's Textbook of Gynaecology, 18th ed.
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Written and medically reviewed by the StethoPrep medical team.