Semin Reprod Med 2007; 25(2): 123-130
DOI: 10.1055/s-2007-970051
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Ectopic Pregnancies in Unusual Locations

Thomas A. Molinaro1 , Kurt T. Barnhart1 , 2
  • 1Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
  • 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
22 March 2007 (online)


The majority of ectopic pregnancies are located within the fallopian tube. Nevertheless, pregnancies have been reported to implant in the cervix, ovary, interstitial tubal segment, and at various intra-abdominal sites. The diagnosis and treatment of these unusual implantation sites presents both diagnostic and therapeutic dilemmas. The majority of data regarding these unusual ectopic pregnancies come largely from case reports and anecdotal information. In the past, treatment of these ectopic pregnancies used various combinations of surgery and/or systemic and local chemotherapy. In this article, we attempt to summarize the current data regarding diagnosis and optimal treatment of these unusual ectopic pregnancies.


  • 1 Centers for Disease Control . Pregnancy-related mortality ratios. United States 1991-1999.  MMWR CDC Surveill Summ. 2003;  52 ss-2
  • 2 Speroff L, Frtitz M. Clinical Gynecologic Endocrinology and Infertility. 7th ed. New York; Lippincott Williams & Wilkins 2004
  • 3 Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy.  Fertil Steril. 1999;  72 207-215
  • 4 Bouyer J, Coste J, Fernandez H, Pouly J L, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases.  Hum Reprod. 2002;  17(12) 3224-3230
  • 5 Cepni I, Ocal P, Erkan S, Erzik B. Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasound guided aspiration and single-dose methotrexate.  Fertil Steril. 2004;  81(4) 1130-1132
  • 6 Benson C B, Doubilet P M. Strategies for conservative treatment of cervical ectopic pregnancy.  Ultrasound Obstet Gynecol. 1996;  8 371-372
  • 7 Ushakov F B, Elchalal U, Aceman P J, Schenker J G. Cervical pregnancy: past and future.  Obstet Gynecol Surv. 1997;  52 45-59
  • 8 Spitzer D, Steiner H, Graf A, Zajc M, Staudach A. Conservative treatment of cervical pregnancy by curettage and local prostaglandin injection.  Hum Reprod. 1997;  12(4) 860-866
  • 9 Fylstra D L, Coffey M D. Treatment of cervical pregnancy with cerclage, curettage and balloon tamponade.  J Reprod Med. 2001;  46(1) 71-74
  • 10 Kung F-T, Chang S-Y. Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies.  Am J Obstet Gynecol. 1999;  181(6) 1438-1444
  • 11 Kung F T, Lin H, Hsu T Y et al.. Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection.  Fertil Steril. 2004;  81(6) 1642-1649
  • 12 Monteagudo A, Tarricone N, Timor-Tritsch I, Lenner J. Successful transvaginal ultrasound-guided puncture and injection of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy and history of a previous cervical pregnancy.  Ultrasound Obstet Gynecol. 1996;  8 381-386
  • 13 Cosin J A, Bean M, Grow D, Wiczyk H. The use of methotrexate and arterial embolization to avoid surgery in a case of cervical pregnancy.  Fertil Steril. 1997;  67(6) 1169-1171
  • 14 Jurkovic D, Hacket E, Campbell S. Diagnosis and treatment of early cervical pregnancy: a review and report of 2 cases treated conservatively.  Ultrasound Obstet Gynecol. 1996;  8 373-380
  • 15 Stovall T G, Ling F, Gray L. Methotrexate treatment of unruptured ectopic pregnancy: a report of 100 cases.  Obstet Gynecol. 1991;  77 749-755
  • 16 Stovall T G, Ling F. Single dose methotrexate: an expanded clinical trial.  Am J Obstet Gynecol. 1993;  168 1759-1762
  • 17 Hung T H, Shau W Y, Hsieh T T, Hsu J J, Soong Y K, Jeng C J. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review.  Hum Reprod. 1998;  13(9) 2636-2642
  • 18 Bagga R, Jain V, Kalra J, Gopalan S, Kumari S. Cervical pregnancy and therapeutic options.  Acta Obstet Gynecol Scand. 2001;  80 663-664
  • 19 Ash S, Farrel S A. Hysteroscopic resection of a cervical pregnancy.  Fertil Steril. 1996;  66 842-844
  • 20 Jozwiak E A, Ulug A U, Akman M A, Bahceci M. Successful resection of a heterotopic cervical pregnancy resulting from intracytoplasmic sperm injection.  Fertil Steril. 2003;  79(2) 428-430
  • 21 Frates M C, Benson C B, Doubilet P M, Disalvo D N, Brown D C, Laing F C. Cervical ectopic pregnancy: results of conservative treatment.  Radiology. 1994;  191 773-775
  • 22 Honey L, Leader A, Claman P. Uterine artery embolization-a successful treatment to control bleeding cervical pregnancy with a simultaneous intrauterine gestation.  Hum Reprod. 1999;  14(2) 553-555
  • 23 Trambert J J, Einstein M, Banks E, Frost A, Goldberg G. Uterine artery embolization in the management of vaginal bleeding from cervical pregnancy.  J Reprod Med. 2005;  50(11) 844-850
  • 24 Suzumori N, Katano A, Sato B T et al.. Conservative treatment by angiographic artery embolization of an 11-week cervical pregnancy after a period of heavy bleeding.  Fertil Steril. 2003;  80(3) 617-619
  • 25 Chapman K. Cervical pregnancy with hydatidiform mole.  Acta Obstet Gynecol Scand. 2001;  80 657-658
  • 26 Comstock C, Huston K, Lee W. The ultrasonographic appearance of ovarian ectopic pregnancies.  Obstet Gynecol. 2005;  105(1) 42-46
  • 27 Bontis J, Grimbizis G, Tarlatzis B C, Miliaris D, Bili H. Intrafollicular ovarian pregnancy after ovulation induction/intrauterine insemination: pathophysiological aspects and diagnostic problems.  Hum Reprod. 1997;  12(2) 376-378
  • 28 Einenkel J, Baier D, Horn L-C, Alexander H. Laparoscopic therapy of an intact primary ovarian pregnancy with ovarian hyperstimulation syndrome.  Hum Reprod. 2000;  15(9) 2037-2040
  • 29 Ghi T, Banfi A, Marconi R et al.. Three-dimensional sonographic diagnosis of ovarian pregnancy.  Ultrasound Obstet Gynecol. 2005;  26 102-104
  • 30 Marret H, Hamamah S, Alonso A M, Pierre F. Case report and review of the literature: primary twin ovarian pregnancy.  Hum Reprod. 1997;  12(8) 1813-1815
  • 31 Chang F W, Chen C H, Liu J Y. Early diagnosis of ovarian pregnancy by ultrasound.  Int J Gynaecol Obstet. 2004;  85 186-187
  • 32 De Seta F, Baraggino E, Strazzanti C, De Santo D, Tracanzan G, Guaschino S. Ovarian pregnancy: a case report.  Acta Obstet Gynecol Scand. 2001;  80 661-662
  • 33 Seinera P, DiGregorio A, Arisio R, Decko A, Crana F. Ovarian pregnancy and operative laparoscopy: report of eight cases.  Hum Reprod. 1997;  12(3) 608-610
  • 34 Hsu C C, Yang T T, Hsu C T. Ovarian pregnancy resulting from cornual fistulae in a woman who had undergone bilateral salpingectomy.  Fertil Steril. 2005;  83(1) 205-207
  • 35 Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from The Society of Reproductive Surgeons Registry.  Obstet Gynecol. 2004;  103 47-50
  • 36 Vicino M, Loverro G, Resta L, Bettocchi S, Vimercati A, Selvaggi L. Laparoscopic cornual excision in a viable large interstitial pregnancy without blood flow detected by color Doppler ultrasonography.  Fertil Steril. 2000;  74(2) 407-409
  • 37 Dilbaz S, Katas B, Demir B, Dilbaz B. Treating cornual ectopic pregnancy with a single methotrexate injection.  J Reprod Med. 2005;  50(2) 141-143
  • 38 Rock J, Thompson J. Telinde's Operative Gynecology. 9th ed. Philadelphia, PA; Lippincott-Raven 2003
  • 39 Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy.  Fertil Steril. 1999;  72 207-215
  • 40 Katz D L, Barrett J P, Sanfilippo J S, Badway D M. Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy.  Am J Obstet Gynecol. 2003;  188 1113-1114
  • 41 Advincula A P, Senapati S. Interstitial pregnancy.  Fertil Steril. 2004;  82(6) 1660-1662
  • 42 Tulandi T, Vilos G, Gomel V. Laparoscopic treatment of interstitial pregnancy.  Obstet Gynecol. 1995;  85(3) 465-467
  • 43 Grobman W A, Milad M P. Conservative management of a large cornual ectopic pregnancy.  Hum Reprod. 1998;  13(7) 2002-2004
  • 44 Moon H S, Choi Y J, Park Y H, Kim S G. New simple endoscopic operations for interstitial pregnancies.  Am J Obstet Gynecol. 2000;  182 114-121
  • 45 Meyer W R, Mitchell D. Hysteroscopic removal of an interstitial ectopic gestation. A case report.  J Reprod Med. 1989;  34 928-929
  • 46 Zhang X, Xinchang L, Fan H. Interstitial pregnancy and transcervical curettage.  Obstet Gynecol. 2004;  104(5) 1193-1195
  • 47 Fisch J D, Ortiz B, Tazuke S, Chitkara U, Giudice L. Medical management of interstitial ectopic pregnancy: a case report and literature review.  Hum Reprod. 1998;  13(7) 1981-1986
  • 48 Barnhart K, Spandorfer S, Coutifaris C. Medical treatment of interstitial pregnancy. A report of three unsuccessful cases.  J Reprod Med. 1997;  42 521-524
  • 49 Al-Khan A, Jones R, Fricchione D, Appuzio J. Intravenous methotrexate for the treatment of interstitial pregnancy.  J Reprod Med. 2004;  49 121-122
  • 50 Cheng C L, Wang P, Chiu C, Yang M, Hung J. Successful conservative treatment for advanced interstitial pregnancy.  J Reprod Med. 2002;  47(5) 424-426
  • 51 Deruelle P, Lucot E, Lions C, Yann R. Management of interstitial pregnancy using selective uterine artery embolization.  Obstet Gynecol. 2005;  106(5) 1165-1167
  • 52 Brewer H, Gefroh S, Bork M, Munkarah A, Hawkins R, Redman M. Asymptomatic rupture of a cornual ectopic in the third trimester.  J Reprod Med. 2005;  50(9) 715-718
  • 53 Bernstein H B, Thrall M M, Clark W B. Expectant management of intramural ectopic pregnancy.  Obstet Gynecol. 2001;  97 826-827
  • 54 Atrash H K, Friede A, Hogue C. Abdominal pregnancy in the United States: frequency and maternal mortality.  Obstet Gynecol. 1987;  69 333-337
  • 55 Dover R W, Powell M C. Management of a primary abdominal pregnancy.  Am J Obstet Gynecol. 1995;  172 1603-1604
  • 56 Fisch B, Peled Y, Kaplan B, Zehavi S, Neri A. Abdominal pregnancy following in vitro fertilization in a patient with previous bilateral salpingectomy.  Obstet Gynecol. 1996;  88(4) 642-643
  • 57 Varma R, Mascarenhas R, Jame D. Successful outcome of advanced abdominal pregnancy with exclusive omental insertion.  Ultrasound Obstet Gynecol. 2003;  21 192-194
  • 58 Onan M A, Turp A B, Saltık A, Akyurek N, Taskiran C, Himmetoglu O. Primary omental pregnancy: case report.  Hum Reprod. 2005;  20(3) 807-809
  • 59 Rahman M S, Al-Suleiman S, Rahman J, Al-Sibai M H. Advanced abdominal pregnancy-observations in 10 cases.  Obstet Gynecol. 1982;  59 366-372
  • 60 Ludwig M, Kaisi M, Bauer O, Diedrich K. The forgotten child-a case of heterotopic, intraabdominal and intrauterine pregnancy carried to term.  Hum Reprod. 1999;  14(5) 1372-1374
  • 61 Tsudo T, Harada T, Yoshioka H, Terakawa N. Laparoscopic management of early unruptured abdominal pregnancy.  Obstet Gynecol. 1997;  90(4) 687-688
  • 62 Tromans P M, Coulson R, Lobb M. Abdominal pregnancy associated with extremely elevated serum alpha-fetoprotein: case report.  Br J Obstet Gynaecol. 1984;  91 296-298
  • 63 Morita Y, Tutsumi O, Kuramochi K, Momoeda M, Yoshikawa H, Taketani Y. Successful laparoscopic management of primary abdominal pregnancy.  Hum Reprod. 1996;  11(11) 2546-2547
  • 64 Jazayeri A, Davis T A, Contreras D N. Diagnosis and management of abdominal pregnancy. a case report.  J Reprod Med. 2002;  47(12) 1047-1049
  • 65 Rahaman J, Berkowitz R, Mitty H, Gaddipati S, Brown B, Nezhat F. Minimally invasive management of an advanced abdominal pregnancy.  Obstet Gynecol. 2004;  103 1064-1068
  • 66 Phupong V, Tekasakul P, Kankaew K. Broad ligament twin pregnancy.  J Reprod Med. 2001;  46(2) 144-146
  • 67 Deshpande N, Mathers A, Acharya U. Broad ligament twin pregnancy following in-vitro fertilization.  Hum Reprod. 1999;  14(3) 852-854
  • 68 Kitade M, Takeuchi H, Kikuchi I, Shimanuki H, Kumakiri J, Kinoshita K. A case of simultaneous tubal-splenic pregnancy after assisted reproductive technology.  Fertil Steril. 2005;  83(4) 1042
  • 69 Cormio G, Santamato S, Vimercati A, Selvaggi L. Primary splenic pregnancy.  J Reprod Med. 2003;  48l(6) 479-481
  • 70 Cardosi R J, Nackley A C, Londono J, Hoffman M. Embolization for advanced abdominal pregnancy.  J Reprod Med. 2002;  47(10) 861-863
  • 71 Olsen M E. Laparoscopic treatment of intraligamentous pregnancy.  Obstet Gynecol. 1997;  89 862
  • 72 Zinger M, Rosenfeld D. Failed treatment of abdominal pregnancy with methotrexate.  J Reprod Med. 2001;  46(4) 392-394
  • 73 Ginath S, Malinger A G, Golan A, Shahmurov A M, Glezerman B M. Successful laparoscopic treatment of a ruptured primary abdominal pregnancy.  Fertil Steril. 2000;  74(3) 601-602
  • 74 Pisarska M D, Casson P R, Moise K J, Dimaio D J, Buster J E, Carson S A. Heterotopic abdominal pregnancy treated at laparoscopy.  Fertil Steril. 1998;  70(1) 159-160
  • 75 Bernstein H B, Thrall M, Clark W. Expectant management of intramural ectopic pregnancy.  Obstet Gynecol. 2001;  97(2) 826-827
  • 76 Katano K, Ikuta K, Matsubara H, Oya N, Nishio M, Suzumori K. A case of successful conservative chemotherapy for intramural pregnancy.  Fertil Steril. 1999;  72 744-746
  • 77 Khalifa Y, Redgment C J, Yazdani N, Taranissi M, Craft I L. Pregnancy. Intramural pregnancy following difficult embryo transfer.  Hum Reprod. 1994;  9 2427-2428
  • 78 Kucera E, Helbich T, Sliutz G, Joura E A. The modern management of interstitial or intramural pregnancy-is MRI an “alloyed” diagnostic gold standard or the real thing?.  Fertil Steril. 2000;  73(5) 1063
  • 79 Hsieh Y Y, Chang C C, Tsai H D, Yeh L S, Hsu T Y, Yang T C. Intramural pregnancy with negative b-hCG.  J Reprod Med. 1998;  43 468-470
  • 80 Jin H, Zhou J, Yu Y, Dong M. Intramural pregnancy, a report of two cases.  J Reprod Med. 2004;  49(7) 569-572
  • 81 Lee C L, Wang C, Chao A, Yen C-F, Soong Y-K. Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar.  Hum Reprod. 1999;  14(5) 1234-1236
  • 82 Valley M T, Pierce J G, Daniel T B, Kaunitz A M. Cesarean scar pregnancy: imaging and treatment with conservative surgery.  Obstet Gynecol. 1998;  91(5) 838-840
  • 83 Graesslin O, Dedecker F, Quereux C, Gabriel R. Conservative treatment of ectopic pregnancy in a cesarean scar.  Obstet Gynecol. 2005;  105(4) 869-871
  • 84 Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar.  Ultrasound Obstet Gynecol. 2000;  16 592-593
  • 85 Shih J C. Cesarean scar pregnancy: diagnosis with three dimensional (3D) ultrasound and 3D power Doppler.  Ultrasound Obstet Gynecol. 2004;  23 306-307
  • 86 Shufaro Y, Nadjari M. Implantation of a gestational sac in a cesarean section scar.  Fertil Steril. 2001;  75(6) 1217
  • 87 Marchiole P, Gorlero F, De Caro G. Intramural pregnancy embedded in a previous cesarean section scar treated conservatively.  Ultrasound Obstet Gynecol. 2004;  23 305-309
  • 88 Yang M-J, Jeng M-H. Combination of transarterial embolisation of uterine arteries and conservative surgical treatment for pregnancy in a cesarean section scar. A report of 3 cases.  J Reprod Med. 2003;  48 213-216
  • 89 Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson C J. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar.  Ultrasound Obstet Gynecol. 2003;  21 220-227

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