Third trimester ovarian pregnancy: A diagnostic dilemma

Ovarian pregnancy is a type of ectopic pregnancy where the fertilized ovum is implanted in the ovary. It is a rare entity and preoperative diagnosis remains problematic due to its nonspecific clinical presentation and sonographic findings. Here, we present a case of an advanced ovarian pregnancy at 28 weeks' age of gestation initially managed as a case of suspected abdominal pregnancy. Preoperative aortogram and embolization were done to minimize intraoperative blood loss. Upon exploration of the abdomen, the products of conception were contained within an intact right ovary. The patient underwent right salpingo-oophorectomy. We obtained a stillborn baby girl weighing 1410 grams with no gross deformities. Histopathology confirmed the diagnosis of an ovarian pregnancy. This case highlights the difficulties in diagnosing ovarian pregnancy despite advances in imaging and the use of preoperative embolization to minimize intraoperative blood loss and morbidity.