Ectopic pregnancy surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
About half of ectopics result in tubal abortion and are self limiting. The option to go to surgery is thus often a difficult decision to make in an obviously stable patient with minimal evidence of blood clot on ultrasound.
Surgery
Surgery is the treatment of choice when there is rupture, hypotension, anemia, pain for > 24 hours, or a gestational sac > 4 cm on ultrasound.
Laparoscopy or laparotomy can be used to gain access to the pelvis and can be used to either incise the affected fallopian tube and remove only the pregnancy (salpingostomy) or remove the affected tube with the pregnancy (salpingectomy). The first successful surgery for an ectopic pregnancy was performed by Robert Lawson Tait in 1883.[1] Laparoscopy is cheaper and associated with an improved post-op course, however, laparotomy is preferred when there is hemodynamic instability, when the surgeon isn’t familiar with laparoscopy or if the laparoscopic approach is technically too difficult. Linear salpingostomy is recommended for ampullary EPs, whereas segmental excision with microsurgical anastomosis is suggested for isthmic pregnancies. Salpingostomy is successful in 93% of cases, and 76% of patients have patent tubes after the procedure. The most common complication is persistent ectopic tissue, which occurs 5 – 20% of the time. Salpingostomy has been shown to have equivalent rates of subsequent fertility and EP as salpingectomy. Many authors suggest salpingectomy in patients with uncontrollable bleeding, extensive tubal damage, recurrent ectopic in the same tube, and obviously, when the woman requests sterilization.
Chances of Future Pregnancy
The chance of future pregnancy depends on the status of the adnexa left behind. The chance of recurrent ectopic pregnancy is about 10% and depends on whether the affected tube was repaired (salpingostomy) or removed (salpingectomy). Successful pregnancy rates vary widely between different centries, and appear to be operator dependent. Pregnancy rates with successful methotrexate treatment compare favorably with the highest reported pregnancy rates. Often, patients may have to resort to in vitro fertilisation to achieve a successful pregnancy. The use of in vitro fertilization does not preclude further ectopic pregnancies, but the likelihood is reduced.
References
- ↑ "eMedicine - Surgical Management of Ectopic Pregnancy : Article Excerpt by R Daniel Braun". Retrieved 2007-09-17.