Background: Primary ovarian pregnancy can present as a life-threatening situation, and recognition is not always possible. A high index of suspicion will help reduce morbidity and mortality in patients with this condition. Case: A 34-year-old woman, who presented in shock even before missing a menstrual period, was taken to the operating room to address a suspected tubal pregnancy. She had conceived after receiving the fertility drug, clomiphene citrate. Both of her fallopian tubes were normal. Results: After excision of the suspected corpus luteum, the patient recovered well. While the provisional diagnosis was a ruptured corpus luteum, histology results showed that she had an ovarian pregnancy. She became pregnant spontaneously a few months after removal of the cyst and the ovarian pregnancy. Conclusions: Ovarian pregnancy can present with rupture even before a menstrual period is missed, and a high index of suspicion at laparotomy/laparoscopy is necessary if the fallopian tubes are normal.
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