At laparotomy for a presumed ectopic pregnancy, a surgeon finds the gestational sac embedded in the left ovary. Which set of Spiegelberg criteria confirms primary ovarian pregnancy?

• A Tube on the affected side must be ruptured, the sac must occupy the ovary, and chorionic villi must be present in the tube
• B Tube on the affected side must be intact and clearly separate from the ovary, the sac must occupy the ovary, and the ovary must be attached to the uterus by the ovarian ligament ✓
• C Both tubes must be normal, the sac must be within the broad ligament, and the ovary must be separate from the sac
• D The tube must be intact, the sac must be within the uterus, and the corpus luteum must be on the opposite side

Explanation

Spiegelberg criteria require an intact ipsilateral tube distinctly separate from the involved ovary, the gestational sac situated within the ovary, and the ovary connected to the uterus by the ovarian ligament, with ovarian tissue demonstrable histologically in the sac wall. These criteria exclude secondary implantation from a tubal abortion. Broad ligament pregnancy defines a ligamentous, not ovarian, ectopic.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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