Time trends in ovarian pregnancy: a 5-decade experience from a single medical center
- 1Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Zerifin, Israel, Affiliated with the Gray Faculty of Medical and Health Sciences, Tel Aviv University, 70300 Tel Aviv, Israel
Abstract
Objectives: Despite diagnostic advancements, ovarian pregnancy remains rare and challenging to detect preoperatively. This study examines 5 decades of trends, clinical features, and surgical outcomes in a single tertiary care center.
Methods: A retrospective review was conducted of 59 women with primary ovarian pregnancy treated between 1971 and 2025, categorized into four periods: 1971–1989 (n = 20), 1990–2001 (n = 19), 2002–2013 (n = 7), and 2014–2025 (n = 13). Long-term fertility outcomes were assessed using updated institutional medical records supplemented by telephone contact when patients were reachable.
Results: Among 317,015 deliveries, 4357 ectopic pregnancies (1.4%) were diagnosed, including 59 ovarian pregnancies (1.4% of all ectopic pregnancies). The overall ectopic pregnancy rate increased across the study periods, whereas the ovarian pregnancy rate per delivery decreased. Poisson regression confirmed a significant temporal increase in the overall ectopic pregnancy rate (p < 0.001) and a significant temporal decrease in the ovarian pregnancy rate per delivery (p = 0.007). Hemodynamic shock differed across the study periods (p = 0.003), but no significant monotonic temporal trend was observed (Cochran–Armitage test, p = 0.515). IUD use demonstrated a significant decreasing trend, from 90 to 15.4% (Cochran–Armitage test, p < 0.001). Preoperative ultrasound diagnosis remained uncommon, occurring in only 2 of 13 cases (15.4%) in the final period, although an increasing trend was observed (Cochran–Armitage test, p = 0.024). Long-term follow-up revealed that among 37 women attempting conception after ovarian pregnancy, 27 (72.9%) achieved spontaneous intrauterine pregnancy.
Conclusion: Despite advances in imaging, preoperative diagnosis of ovarian pregnancy remains uncommon in routine emergency settings. Increased awareness of characteristic ultrasound findings and timely surgical management may improve clinical outcomes and reduce severe hemorrhagic complications. Over 5 decades, improvements in surgical management were associated with reduced blood transfusion requirements and shorter hospitalization, while hemodynamic instability varied across study periods without demonstrating a significant monotonic temporal trend.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00404-026-08556-3.
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BibTeX
@article{melcer2026time,
title = {{Time trends in ovarian pregnancy: a 5-decade experience from a single medical center}},
author = {Yaakov Melcer and Ron Maymon and Amnon Levin and Maya Naor-Dovev and Noam Smorgick and Marina Pekar-Zlotin},
journal = {Archives of Gynecology and Obstetrics},
year = {2026},
month = aug,
doi = {10.1007/s00404-026-08556-3},
url = {https://doi.org/10.1007/s00404-026-08556-3},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Time trends in ovarian pregnancy: a 5-decade experience from a single medical center
AU - Yaakov Melcer
AU - Ron Maymon
AU - Amnon Levin
AU - Maya Naor-Dovev
AU - Noam Smorgick
AU - Marina Pekar-Zlotin
PY - 2026
DA - 2026/08/20
JO - Archives of Gynecology and Obstetrics
DO - 10.1007/s00404-026-08556-3
UR - https://doi.org/10.1007/s00404-026-08556-3
AB - Objectives: Despite diagnostic advancements, ovarian pregnancy remains rare and challenging to detect preoperatively. This study examines 5 decades of trends, clinical features, and surgical outcomes in a single tertiary care center. Methods: A retrospective review was conducted of 59 women with primary ovarian pregnancy treated between 1971 and 2025, categorized into four periods: 1971–1989 (n = 20), 1990–2001 (n = 19), 2002–2013 (n = 7), and 2014–2025 (n = 13). Long-term fertility outcomes were assessed using updated institutional medical records supplemented by telephone contact when patients were reachable. Results: Among 317,015 deliveries, 4357 ectopic pregnancies (1.4%) were diagnosed, including 59 ovarian pregnancies (1.4% of all ectopic pregnancies). The overall ectopic pregnancy rate increased across the study periods, whereas the ovarian pregnancy rate per delivery decreased. Poisson regression confirmed a significant temporal increase in the overall ectopic pregnancy rate (p < 0.001) and a significant temporal decrease in the ovarian pregnancy rate per delivery (p = 0.007). Hemodynamic shock differed across the study periods (p = 0.003), but no significant monotonic temporal trend was observed (Cochran–Armitage test, p = 0.515). IUD use demonstrated a significant decreasing trend, from 90 to 15.4% (Cochran–Armitage test, p < 0.001). Preoperative ultrasound diagnosis remained uncommon, occurring in only 2 of 13 cases (15.4%) in the final period, although an increasing trend was observed (Cochran–Armitage test, p = 0.024). Long-term follow-up revealed that among 37 women attempting conception after ovarian pregnancy, 27 (72.9%) achieved spontaneous intrauterine pregnancy. Conclusion: Despite advances in imaging, preoperative diagnosis of ovarian pregnancy remains uncommon in routine emergency settings. Increased awareness of characteristic ultrasound findings and timely surgical management may improve clinical outcomes and reduce severe hemorrhagic complications. Over 5 decades, improvements in surgical management were associated with reduced blood transfusion requirements and shorter hospitalization, while hemodynamic instability varied across study periods without demonstrating a significant monotonic temporal trend. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00404-026-08556-3.
SN - 0932-0067
SN - 1432-0711
ER -