Time trends in ovarian pregnancy: a 5-decade experience from a single medical center

Despite diagnostic advancements, ovarian pregnancy remains rare and challenging to detect preoperatively. This study examines 5 decades of trends, clinical features, and surgical outcomes in a single tertiary care center. A retrospective review was conducted of 59 women with primary ovarian pregnancy treated between 1971 and 2025, categorized into four periods: 1971–1989 ( n = 20), 1990–2001 ( n = 19), 2002–2013 ( n = 7), and 2014–2025 ( n = 13). Long-term fertility outcomes were assessed using updated institutional medical records supplemented by telephone contact when patients were reachable. Among 317,015 deliveries, 4357 ectopic pregnancies (1.4%) were diagnosed, including 59 ovarian pregnancies (1.4% of all ectopic pregnancies). The overall ectopic pregnancy rate increased across the study periods, whereas the ovarian pregnancy rate per delivery decreased. Poisson regression confirmed a significant temporal increase in the overall ectopic pregnancy rate ( p < 0.001) and a significant temporal decrease in the ovarian pregnancy rate per delivery ( p = 0.007). Hemodynamic shock differed across the study periods ( p = 0.003), but no significant monotonic temporal trend was observed (Cochran–Armitage test, p = 0.515). IUD use demonstrated a significant decreasing trend, from 90 to 15.4% (Cochran–Armitage test, p < 0.001). Preoperative ultrasound diagnosis remained uncommon, occurring in only 2 of 13 cases (15.4%) in the final period, although an increasing trend was observed (Cochran–Armitage test, p = 0.024). Long-term follow-up revealed that among 37 women attempting conception after ovarian pregnancy, 27 (72.9%) achieved spontaneous intrauterine pregnancy. Despite advances in imaging, preoperative diagnosis of ovarian pregnancy remains uncommon in routine emergency settings. Increased awareness of characteristic ultrasound findings and timely surgical management may improve clinical outcomes and reduce severe hemorrhagic complications. Over 5 decades, improvements in surgical management were associated with reduced blood transfusion requirements and shorter hospitalization, while hemodynamic instability varied across study periods without demonstrating a significant monotonic temporal trend.