Abstract
Background: Ectopic pregnancy is implantation of a fertilized ovum outside the endometrial cavity and remains an important cause of first-trimester maternal morbidity. Although most ectopic pregnancies are tubal, implantation may occur in the ovary, a previous caesarean scar, the cervix, myometrium, or peritoneal cavity. These uncommon sites may mimic adnexal or pelvic masses and can be difficult to diagnose clinically and radiologically. Methods: This retrospective case series included 27 histopathological confirmed ectopic pregnancies diagnosed between January 2023 and January 2025 at a tertiary care teaching hospital. Demographic, obstetric, clinical, and radiological data were retrieved from records. Surgical specimens were fixed in 10% neutral buffered formalin, processed routinely, and examined on hematoxylin and eosinstained sections. Particular attention was given to unusual implantation sites and cases with clinic-radiological diagnostic difficulty. Results: The mean age was 32.37 ± 4.25 years, and the mean estimated gestational age was 43.08 ± 16.80 days. Abdominal pain was the predominant presentation. Twenty-three cases (85.2%) were tubal, three (11.1%) were ovarian, and one (3.7%) involved a previous caesarean scar. Thirteen tubal pregnancies were left-sided and ten were right-sided. Histological examination demonstrated chorionic villi, trophoblastic tissue, decidualized stroma, fibrin, and hemorrhage in the relevant anatomical site. Several cases had been radiologically interpreted as tubo-ovarian or adnexal masses, hemorrhagic ovarian cyst, or pelvic collection before histopathological confirmation. Conclusion: Ectopic pregnancy may present at unusual implantation sites and may mimic non-gestational adnexal or pelvic lesions. Integration of clinical history, serum or urine pregnancy testing, high-quality imaging, operative findings, and histopathology is essential for accurate diagnosis and timely management.
Keywords: Ectopic