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O748 THE RELATIVE RISK FACTOR AND PERINATAL OUTCOME OF PRETERM DELIVERY IN TWIN PREGNANCY
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
O746 SUPPORTING NATIONAL ROLLOUT OF STRENGTHENED BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE (BEMONC) IN ETHIOPIA: COLLABORATIVE PROJECT T. Yigzaw1 , H. Gibson1 , T. Bogale1 , A. Tekleberhan1 , M. Mekuria1 , M. Gelagay1 , A.B. Shihure1 , A. Gashaw1 . 1 Jhpiego, Addis Ababa, Ethiopia Objectives: Ethiopia has one of the highest maternal mortality ratios in the world, with 673 maternal deaths per 100,000 live births. A national EmONC survey (2008) showed only 10% of facilities met the criteria of fully functioning EmONC services. UNICEF and Jhpiego collaborated to contribute to reduction of maternal mortality and efforts to reach MDG 5 by supporting the national rollout of strengthened BEmONC care. Materials: Public health facilities and providers in Gambella, Benshangul Gumuz, Afar, Somali, Amhara and SNNP Regions. Methods: In 2010, UNICEF and Jhpiego signed a 21 /2 year cooperative agreement to assist the Ministry of Health (MOH) to improve BEmONC services by focusing on the four less developed and remote areas of two big regions. Results: Sixty five national BEmONC trainers were prepared. The trainer development pathway required candidates to complete BEmONC and training skills courses and mentored co-training experience with a master trainer until they met the competency criteria for qualification. Selected by the regions, 726 healthcare providers (36.3% of the target) received BEmONC training to date. Through a sub-agreement and mentoring from Jhpiego, the Ethiopian Midwifery Association provided two-thirds of the training. This partnership contributed to strengthening local midwifery capacity and enabling an efficient and cost-effective training cascade. As part of the effort to establish 15 regional training centers, 8 hospitals were assessed and are going through a process of clinical standardization. Performance quality improvement (PQI) has been introduced to 6 hospitals to assess, monitor and improve maternal and newborn health services. Collaboration with regional health bureaus and UNICEF was important in selecting appropriate facilities, creating government ownership and overcoming challenges. However, finding facilities with a caseload to provide sufficient learning experience was challenging. Cognizant that BEmONC training is being scaled up nationally by different agencies with varying qualities, Jhpiego assisted the MoH to adapt its competency-based BEmONC training package and develop national training implementation guide. Conclusions: The collaboration to strengthen facility-based provision of BEmONC is on track to meet national rollout targets in the six regions. Having in place standardized training sites, a training package, a training implementation guide, critical mass of national trainers and PQI will help to ensure the quality of training and BEmONC services. O747 SAFETY OF INFANT MALE CIRCUMCISION FOR HIV PREVENTION IN NYANZA PROVINCE, KENYA M.R. Young1 , R.C. Bailey1 , E. Odoyo-June2 , T.E. Irwin3 , D.O. Ongong’a4 , B. Ochomo2 , K. Agot5 , S.K. Nordstrom3 . 1 Epidemiology, University of Illinois at Chicago, Chicago, IL, United States; 2 Nyanza Reproductive Health Society, Kisumu, Kenya; 3 University of Illinois at Chicago – Obstetrics & Gynecology, Chicago, IL, United States; 4 Nyanza Provincial General Hospital, Kisumu, Kenya; 5 Impact Research and Development Organisation, Kisumu, Kenya Objectives: Male circumcision reduces risk of heterosexual HIV acquisition in men by 60% and reduces human papillomavirus and bacterial vaginosis in female partners. Infant male circumcision (IMC) is associated with reduced risk of urinary tract infections and avoidance of phimosis and other pathologies of the foreskin. Several sub-Saharan African countries plan to scale-up IMC for HIV prevention. We calculated adverse event (AE) rates and risks for
S523
AEs associated with introduction of IMC services at five government health facilities in western Kenya. Materials: Healthy infants aged two months or less and weighing at least 2.5 kg were eligible for IMC. Following parental consent, circumcision was provided free of charge under local anesthesia using the Mogen clamp. Methods: AE data were analyzed for IMC procedures performed between September, 2009 and November, 2011. This study has two data sources: (1) a case/control study examining factors associated with parental acceptance of IMC services (n = 308 IMC procedures) where infants were actively followed-up postoperatively (research infants), and (2) routine monitoring of IMC services (n = 944 IMC procedures) where post-operative follow-up was passive (non-research infants). Fisher’s exact test was used to compute differences in AE rates by age and weight of baby, cadre of provider, and experience level of provider. Results: Median age of infants was 4 days (IQR=1, 16). Postoperative review rates were high among research infants (294/308, 95%) and were lower in non-research infants (384/931, 41%). Seven out of 308 research infants (2.3%) and 11 out of 931 non-research infants (1.2%) had one or more documented IMCrelated AE (19/1239 total). There was one severe AE involving excision of a small piece of the lateral aspect of the glans penis. Other AEs were classified as mild or moderate and were treated conservatively. These included: intra-operative or post-operative bleeding arrested with pressure (n = 7) or sutures (n = 3), postoperative abrasion (n = 5), and wound infection (n = 4). There were no statistical differences in AE rates by provider cadre, provider experience level, age of baby or weight of baby, though our low observed AE rate limited our power to detect differences. Conclusions: Our findings suggest that IMC services provided in Kenyan Government hospitals in the context of routine IMC programming for HIV prevention have AE rates comparable to those in developed countries. O748 THE RELATIVE RISK FACTOR AND PERINATAL OUTCOME OF PRETERM DELIVERY IN TWIN PREGNANCY H. Yu1 . 1 West China second university hospital, Sichuan University, Chengdu, China Objectives: To study the high risk factor and perinatal outcome of preterm delivery between 28 and 36 gestational weeks 6days in twin pregnancies. Materials: This was a retrospective study. Methods: Twin pregnancies which monitored and delivered in the obstetric unit were studied. Single pregnancies monitored and delivered at the same time were also included as control group in the same obstetric unit. Pregnancies with fetal structural anomalies or genetic syndromes or with intrauterine death in single pregnancy and both intrauterine death in twin pregnancy were excluded. The relative risk factor of preterm delivery and perinatal outcome between two groups was compared. Results: 6065 single pregnancies and 282 twin pregnancies deliveried in the hospital were included in the study.738 singleton pregnancies and 170 twin pregnancies were deliveried between 28 and 36 weeks 6days. 4 twin pregnancies were complicated one fetus death before labor. Preterm delivery rate in twin pregnancy was significantly higher than that in single pregnancy(60.28% vs12.17%, P = 0.000). Preterm delivery resulted by premature rupture of membrane(PROM) in twin pregnancy was significantly lower than that in single pregnancy(34.12% vs 46.12%, P = 0.004). The incidence of neonate admission to the NICU had no significant difference between two groups(69.35% vs 63.8%, P = 0.077). Preterm delivery rate in twin pregnancy at 28 to 29weeks 6days, 30 to 31weeks 6days, 32 to 33weeks 6days 34 to 35weeks 6days were 3.19%, 5.32%, 13.12%, 18.44% respectively, in single pregnancy were 0.49%, 1.24%, 2.13%, 4.09%, 4.22% respectively.
S524
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Conclusions: Twin pregnancy is linked with higher preterm delivery rate. PROM is the important factor for preterm delivery in both twin pregnancy and single pregnancy. Intensity of pregnancy surveillance and intervention to prevent PROM should be done in order to reduce the preterm delivery rate, perinatal mortality and neonatal morbidity. O749 UTERINE PERIVASCULAR EPITHELIOID CELL TUMOUR Y. Yu1 , H.-y. Shi1 , H.-F. Huang1 . 1 Woman’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, HangZhou, ZheJiang, China Objectives: Uterine perivascular epithelioid cell tumour (PEComa), is a rare disease with less than fifty cases reported in the literature and less than eight cases have been reported from a single institution. Its biological behaviour remains unclear. This report describes the clinical, histological and immunohistochemical features of three cases of uterine PEComa in our hospital. Materials: Three cases of PEComa were retrieved from the archives of the Department of Pathology of Women’s Hospital ZheJiang University. Methods: Owing to the variable expression of different markers we chose to use a panel of antibodies to type our three cases including HMB45, Melan A, desmin, SMA, CK, CD34, EMA, CD1a, etc. Tissue obtained at the time of surgery was fixed in 10% buffered formalin and routinely processed for paraffin embedding. Sections were cut with a thickness of 4 mm, and stained with hematoxylin and eosin. Immunohistochemical analysis was performed using the avidinbiotin peroxidase complex technique, with commercially available antibodies listed in Table 1. Appropriate positive and negative controls were performed. Results: The clinical, pathological, and immunohistochemical features of the three cases are shown in Table 1 and Figures 1a–c. Table 1. Clinical and pathological characteristics Case
Age
Size Location (cm)
Operation
Nuclear atypia
Mitotic activity (per 50 HPF)
Coagulative necrosis
Follow-up
1
44
4.5
Myometrium
TAH&BSO
Moderate
5
2
45
1.9
cervix
None
1
Scattered foci Absent
34 months NED
3
42
2.7
submucous
D&C, TAH&BSO Hysteroscopy, TAH
37 months NED
Mild
0–1
Absent
20 months NED
TAH, total abdominal hysterectomy; BSO, bilateral salpingo-oophorectomy; NED, no evidence of disease
Figure 1.
Conclusions: PEComas are composed of nests and sheets of usually epithelioid, but occasionally spindled cells, with clear to granular eosinophilic cytoplasm, and, a focal association with blood vessel walls. Nearly all PEComas show immunoreactivity for both melanocytic (HMB-45 and/or melan-A) and smooth muscle (actin and/or desmin) markers. Due to the rarity of the tumor, the criteria for diagnosis of malignancy have not been fully established. Late recurrences have been reported including a case with late lung metastasis 7 years after the primary has been described. In our study, case 1 has scattered foci coagulative necrosis, moderate cytologic atypia, hypercellularity, lymphovascular invasion, the patient underwent TAH & BSO, instead of receiving chemotherapy or radiotherapy and follow-up found no recurrence of the past three years. As uterine PEComas are uncommon and less than eight cases have been reported from a single institution, direct comparative studies are difficult. More studies with larger number of patients and longer follow-up are required to gauge the biological behaviour of these rare tumours. O750 EARLY DIAGNOSIS IN OVARIAN PREGNANCY. ULTRASOUND, CLINICAL AND THERAPEUTICAL CORRELATION M. Yuri1 , G. Marconi2 , M. Diradourian2 , M. Vilela2 , A. Kenny2 , E. Young2 , J. Buzzi2 . 1 Sonography Department, Instituto de Ginecolog´ıa y Fertilidad de Buenos Aires IFER, Buenos Aires, Argentina; 2 Instituto de Ginecolog´ıa y Fertilidad I FER Gynecology Department, Buenos Aires, Argentina Objectives: Ovarian pregnancy (OP) is a rare form of ectopic pregnancy (EP) (1/6000 to 1/40000 pregnancies). Spielberg’s criteria to establish an OP diagnosis is not always possible and the lack of an absolute profile for these patients makes this diagnosis difficult. The aim of this study was to evaluate the accuracy of transvaginal ultrasound (TVS) and color Doppler (CD) examination in the diagnosis of OP, its surgical treatment and clinical correlation. Materials: During 13 years, 18731 first trimester pregnancies were evaluated by TVS and CD. A total of 6 OP were detected and prospectively evaluated. Methods: Descriptive clinical study. TVS was used to establish uterine morphology, location of OP, size of ovarian ring (OR), and the presence of free fluid. CD evaluated blood flow in the OR and was correlated with surgical findings. B-hCG levels and type of pain referred by the patient was documented and laparoscopy was performed. Morphological and histological findings, surgical treatment and follow up were registered. Results: The incidence of OP was 0.32‰ OP was associated to intrauterine device in three cases, to intrauterine insemination in one, to IVF in one and to homolateral benign teratoma in the other. TVS revealed absence of intrauterine sac, an ovarian enlargement associated to the presence of a OR within or in contact with the ovary. In all cases OP were at the right side. The diameters of the OR were between 10 and 33mm. Free fluid was significant in 5 cases (83.33%) and scarce in 1 (16.6%). CD was performed in 5 cases showing vascularization of the OR with suggestive parameters for trophoblastic flow. Five patients (83.33%) presented severe abdominal pain and 1 (16.6%) was asymptomatic. B-hCG titters ranged between 1200 and 3200 mU/ml. Diagnosis was made between 4.6 and 6 weeks of amenorrhea. In all cases EP were diagnosed prior to laparoscopy, with a strong suspicion of OP in five of them. Laparoscopy confirmed diagnosis and only OR resection were performed. Fallopian tubes had normal appearance. Pathologist reported OP in five cases and EP in one. Follow up showed negative BhCG titters and normal evolution. Three patients became pregnant. Conclusions: OP may occur in patients with a suspected EP. Diagnostic presumption can be reached by combining clinical symptoms, BhCG titters, ultrasound results and confirmed by laparoscopy and/or histology. Early diagnosis can prevent serious complications and allows conservative ovarian treatment, preserving fertility in these women.
O746 SUPPORTING NATIONAL ROLLOUT OF STRENGTHENED BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE (BEMONC) IN ETHIOPIA: COLLABORATIVE PROJECT T. Yigzaw1 , H. Gibson1 , T. Bogale1 , A. Tekleberhan1 , M. Mekuria1 , M. Gelagay1 , A.B. Shihure1 , A. Gashaw1 . 1 Jhpiego, Addis Ababa, Ethiopia Objectives: Ethiopia has one of the highest maternal mortality ratios in the world, with 673 maternal deaths per 100,000 live births. A national EmONC survey (2008) showed only 10% of facilities met the criteria of fully functioning EmONC services. UNICEF and Jhpiego collaborated to contribute to reduction of maternal mortality and efforts to reach MDG 5 by supporting the national rollout of strengthened BEmONC care. Materials: Public health facilities and providers in Gambella, Benshangul Gumuz, Afar, Somali, Amhara and SNNP Regions. Methods: In 2010, UNICEF and Jhpiego signed a 21 /2 year cooperative agreement to assist the Ministry of Health (MOH) to improve BEmONC services by focusing on the four less developed and remote areas of two big regions. Results: Sixty five national BEmONC trainers were prepared. The trainer development pathway required candidates to complete BEmONC and training skills courses and mentored co-training experience with a master trainer until they met the competency criteria for qualification. Selected by the regions, 726 healthcare providers (36.3% of the target) received BEmONC training to date. Through a sub-agreement and mentoring from Jhpiego, the Ethiopian Midwifery Association provided two-thirds of the training. This partnership contributed to strengthening local midwifery capacity and enabling an efficient and cost-effective training cascade. As part of the effort to establish 15 regional training centers, 8 hospitals were assessed and are going through a process of clinical standardization. Performance quality improvement (PQI) has been introduced to 6 hospitals to assess, monitor and improve maternal and newborn health services. Collaboration with regional health bureaus and UNICEF was important in selecting appropriate facilities, creating government ownership and overcoming challenges. However, finding facilities with a caseload to provide sufficient learning experience was challenging. Cognizant that BEmONC training is being scaled up nationally by different agencies with varying qualities, Jhpiego assisted the MoH to adapt its competency-based BEmONC training package and develop national training implementation guide. Conclusions: The collaboration to strengthen facility-based provision of BEmONC is on track to meet national rollout targets in the six regions. Having in place standardized training sites, a training package, a training implementation guide, critical mass of national trainers and PQI will help to ensure the quality of training and BEmONC services. O747 SAFETY OF INFANT MALE CIRCUMCISION FOR HIV PREVENTION IN NYANZA PROVINCE, KENYA M.R. Young1 , R.C. Bailey1 , E. Odoyo-June2 , T.E. Irwin3 , D.O. Ongong’a4 , B. Ochomo2 , K. Agot5 , S.K. Nordstrom3 . 1 Epidemiology, University of Illinois at Chicago, Chicago, IL, United States; 2 Nyanza Reproductive Health Society, Kisumu, Kenya; 3 University of Illinois at Chicago – Obstetrics & Gynecology, Chicago, IL, United States; 4 Nyanza Provincial General Hospital, Kisumu, Kenya; 5 Impact Research and Development Organisation, Kisumu, Kenya Objectives: Male circumcision reduces risk of heterosexual HIV acquisition in men by 60% and reduces human papillomavirus and bacterial vaginosis in female partners. Infant male circumcision (IMC) is associated with reduced risk of urinary tract infections and avoidance of phimosis and other pathologies of the foreskin. Several sub-Saharan African countries plan to scale-up IMC for HIV prevention. We calculated adverse event (AE) rates and risks for
S523
AEs associated with introduction of IMC services at five government health facilities in western Kenya. Materials: Healthy infants aged two months or less and weighing at least 2.5 kg were eligible for IMC. Following parental consent, circumcision was provided free of charge under local anesthesia using the Mogen clamp. Methods: AE data were analyzed for IMC procedures performed between September, 2009 and November, 2011. This study has two data sources: (1) a case/control study examining factors associated with parental acceptance of IMC services (n = 308 IMC procedures) where infants were actively followed-up postoperatively (research infants), and (2) routine monitoring of IMC services (n = 944 IMC procedures) where post-operative follow-up was passive (non-research infants). Fisher’s exact test was used to compute differences in AE rates by age and weight of baby, cadre of provider, and experience level of provider. Results: Median age of infants was 4 days (IQR=1, 16). Postoperative review rates were high among research infants (294/308, 95%) and were lower in non-research infants (384/931, 41%). Seven out of 308 research infants (2.3%) and 11 out of 931 non-research infants (1.2%) had one or more documented IMCrelated AE (19/1239 total). There was one severe AE involving excision of a small piece of the lateral aspect of the glans penis. Other AEs were classified as mild or moderate and were treated conservatively. These included: intra-operative or post-operative bleeding arrested with pressure (n = 7) or sutures (n = 3), postoperative abrasion (n = 5), and wound infection (n = 4). There were no statistical differences in AE rates by provider cadre, provider experience level, age of baby or weight of baby, though our low observed AE rate limited our power to detect differences. Conclusions: Our findings suggest that IMC services provided in Kenyan Government hospitals in the context of routine IMC programming for HIV prevention have AE rates comparable to those in developed countries. O748 THE RELATIVE RISK FACTOR AND PERINATAL OUTCOME OF PRETERM DELIVERY IN TWIN PREGNANCY H. Yu1 . 1 West China second university hospital, Sichuan University, Chengdu, China Objectives: To study the high risk factor and perinatal outcome of preterm delivery between 28 and 36 gestational weeks 6days in twin pregnancies. Materials: This was a retrospective study. Methods: Twin pregnancies which monitored and delivered in the obstetric unit were studied. Single pregnancies monitored and delivered at the same time were also included as control group in the same obstetric unit. Pregnancies with fetal structural anomalies or genetic syndromes or with intrauterine death in single pregnancy and both intrauterine death in twin pregnancy were excluded. The relative risk factor of preterm delivery and perinatal outcome between two groups was compared. Results: 6065 single pregnancies and 282 twin pregnancies deliveried in the hospital were included in the study.738 singleton pregnancies and 170 twin pregnancies were deliveried between 28 and 36 weeks 6days. 4 twin pregnancies were complicated one fetus death before labor. Preterm delivery rate in twin pregnancy was significantly higher than that in single pregnancy(60.28% vs12.17%, P = 0.000). Preterm delivery resulted by premature rupture of membrane(PROM) in twin pregnancy was significantly lower than that in single pregnancy(34.12% vs 46.12%, P = 0.004). The incidence of neonate admission to the NICU had no significant difference between two groups(69.35% vs 63.8%, P = 0.077). Preterm delivery rate in twin pregnancy at 28 to 29weeks 6days, 30 to 31weeks 6days, 32 to 33weeks 6days 34 to 35weeks 6days were 3.19%, 5.32%, 13.12%, 18.44% respectively, in single pregnancy were 0.49%, 1.24%, 2.13%, 4.09%, 4.22% respectively.
S524
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Conclusions: Twin pregnancy is linked with higher preterm delivery rate. PROM is the important factor for preterm delivery in both twin pregnancy and single pregnancy. Intensity of pregnancy surveillance and intervention to prevent PROM should be done in order to reduce the preterm delivery rate, perinatal mortality and neonatal morbidity. O749 UTERINE PERIVASCULAR EPITHELIOID CELL TUMOUR Y. Yu1 , H.-y. Shi1 , H.-F. Huang1 . 1 Woman’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, HangZhou, ZheJiang, China Objectives: Uterine perivascular epithelioid cell tumour (PEComa), is a rare disease with less than fifty cases reported in the literature and less than eight cases have been reported from a single institution. Its biological behaviour remains unclear. This report describes the clinical, histological and immunohistochemical features of three cases of uterine PEComa in our hospital. Materials: Three cases of PEComa were retrieved from the archives of the Department of Pathology of Women’s Hospital ZheJiang University. Methods: Owing to the variable expression of different markers we chose to use a panel of antibodies to type our three cases including HMB45, Melan A, desmin, SMA, CK, CD34, EMA, CD1a, etc. Tissue obtained at the time of surgery was fixed in 10% buffered formalin and routinely processed for paraffin embedding. Sections were cut with a thickness of 4 mm, and stained with hematoxylin and eosin. Immunohistochemical analysis was performed using the avidinbiotin peroxidase complex technique, with commercially available antibodies listed in Table 1. Appropriate positive and negative controls were performed. Results: The clinical, pathological, and immunohistochemical features of the three cases are shown in Table 1 and Figures 1a–c. Table 1. Clinical and pathological characteristics Case
Age
Size Location (cm)
Operation
Nuclear atypia
Mitotic activity (per 50 HPF)
Coagulative necrosis
Follow-up
1
44
4.5
Myometrium
TAH&BSO
Moderate
5
2
45
1.9
cervix
None
1
Scattered foci Absent
34 months NED
3
42
2.7
submucous
D&C, TAH&BSO Hysteroscopy, TAH
37 months NED
Mild
0–1
Absent
20 months NED
TAH, total abdominal hysterectomy; BSO, bilateral salpingo-oophorectomy; NED, no evidence of disease
Figure 1.
Conclusions: PEComas are composed of nests and sheets of usually epithelioid, but occasionally spindled cells, with clear to granular eosinophilic cytoplasm, and, a focal association with blood vessel walls. Nearly all PEComas show immunoreactivity for both melanocytic (HMB-45 and/or melan-A) and smooth muscle (actin and/or desmin) markers. Due to the rarity of the tumor, the criteria for diagnosis of malignancy have not been fully established. Late recurrences have been reported including a case with late lung metastasis 7 years after the primary has been described. In our study, case 1 has scattered foci coagulative necrosis, moderate cytologic atypia, hypercellularity, lymphovascular invasion, the patient underwent TAH & BSO, instead of receiving chemotherapy or radiotherapy and follow-up found no recurrence of the past three years. As uterine PEComas are uncommon and less than eight cases have been reported from a single institution, direct comparative studies are difficult. More studies with larger number of patients and longer follow-up are required to gauge the biological behaviour of these rare tumours. O750 EARLY DIAGNOSIS IN OVARIAN PREGNANCY. ULTRASOUND, CLINICAL AND THERAPEUTICAL CORRELATION M. Yuri1 , G. Marconi2 , M. Diradourian2 , M. Vilela2 , A. Kenny2 , E. Young2 , J. Buzzi2 . 1 Sonography Department, Instituto de Ginecolog´ıa y Fertilidad de Buenos Aires IFER, Buenos Aires, Argentina; 2 Instituto de Ginecolog´ıa y Fertilidad I FER Gynecology Department, Buenos Aires, Argentina Objectives: Ovarian pregnancy (OP) is a rare form of ectopic pregnancy (EP) (1/6000 to 1/40000 pregnancies). Spielberg’s criteria to establish an OP diagnosis is not always possible and the lack of an absolute profile for these patients makes this diagnosis difficult. The aim of this study was to evaluate the accuracy of transvaginal ultrasound (TVS) and color Doppler (CD) examination in the diagnosis of OP, its surgical treatment and clinical correlation. Materials: During 13 years, 18731 first trimester pregnancies were evaluated by TVS and CD. A total of 6 OP were detected and prospectively evaluated. Methods: Descriptive clinical study. TVS was used to establish uterine morphology, location of OP, size of ovarian ring (OR), and the presence of free fluid. CD evaluated blood flow in the OR and was correlated with surgical findings. B-hCG levels and type of pain referred by the patient was documented and laparoscopy was performed. Morphological and histological findings, surgical treatment and follow up were registered. Results: The incidence of OP was 0.32‰ OP was associated to intrauterine device in three cases, to intrauterine insemination in one, to IVF in one and to homolateral benign teratoma in the other. TVS revealed absence of intrauterine sac, an ovarian enlargement associated to the presence of a OR within or in contact with the ovary. In all cases OP were at the right side. The diameters of the OR were between 10 and 33mm. Free fluid was significant in 5 cases (83.33%) and scarce in 1 (16.6%). CD was performed in 5 cases showing vascularization of the OR with suggestive parameters for trophoblastic flow. Five patients (83.33%) presented severe abdominal pain and 1 (16.6%) was asymptomatic. B-hCG titters ranged between 1200 and 3200 mU/ml. Diagnosis was made between 4.6 and 6 weeks of amenorrhea. In all cases EP were diagnosed prior to laparoscopy, with a strong suspicion of OP in five of them. Laparoscopy confirmed diagnosis and only OR resection were performed. Fallopian tubes had normal appearance. Pathologist reported OP in five cases and EP in one. Follow up showed negative BhCG titters and normal evolution. Three patients became pregnant. Conclusions: OP may occur in patients with a suspected EP. Diagnostic presumption can be reached by combining clinical symptoms, BhCG titters, ultrasound results and confirmed by laparoscopy and/or histology. Early diagnosis can prevent serious complications and allows conservative ovarian treatment, preserving fertility in these women.