Implementation of an Internet-based psychological intervention for the treatment of mild depression in primary care: a hybrid effectiveness-implementation approach.

An ectopic pregnancy happens when a blastocyst implants outside the uterine cavity, typically in the fallopian tubes. Ovarian pregnancies, which are quite rare, occur in approximately one out of every 7,000 pregnancies []. The diagnosis of an ovarian pregnancy is challenging due to its nonspecific manifestations. Although ultrasound is useful in identifying ectopic pregnancies, differentiating between ovarian and tubal pregnancies by ultrasound is difficult, often necessitating laparoscopic examination for a conclusive diagnosis []. Most ovarian pregnancies are identified in early pregnancy, which are usually managed by laparoscopic ovarian wedge resection or methotrexate administration [–]. An undiagnosed or unmanaged ovarian pregnancy may lead to rupture, hemorrhagic shock, and even pose a threat to life []. Ovarian ectopic pregnancies in the second trimester are extremely rare. Most reports in the literature are case reports, with patients exhibiting significant clinical heterogeneity, making diagnosis challenging and clinical management difficult [, ]. However, the rupture of an ovarian ectopic pregnancy at a later stage of pregnancy poses a greater risk than those that rupture in the early stages, being more likely to cause severe internal bleeding, hypovolemic shock, respiratory and circulatory disturbances, and other life-threatening complications, which require particular attention from clinicians [–]. Here we describe an unusual case of second-trimester ovarian pregnancy mimicking intrauterine pregnancy, which caused hemorrhagic shock during the laparotomy. A further discussion of diagnosis and management on this rare entity is also performed based on a review of the existing literature.