ectopic%20pregnancy
ECTOPIC PREGNANCY
Ectopic pregnancy happens when the fertilized ovum implants outside the endometrial lining of the uterus.
Accurate early diagnosis is life-saving, reduces invasive diagnostic procedures & allows conservative treatment that can preserve fertility.
Ectopic pregnancy must be excluded in women of reproductive age w/ a positive pregnancy test, abdominal pain & vaginal bleeding.
Ruptured ectopic pregnancy remains to be the leading cause of maternal mortality in the first trimester.

Surgical Intervention

  • Besides preventing death, the current focus in the surgical management of ectopic pregnancies includes preservation of fertility, rapid recovery and reduction of costs
  • Laparoscopic salpingostomy and partial salpingectomy are gaining ground over laparotomy
  • 90% of women with ectopic pregnancy and serum β-hCG levels of >200 IU/L require operative intervention owing to increasing symptoms or tubal rupture

Laparoscopy

  • Preferred approach and is superior to laparotomy when considering recovery time, rate of subsequent IUP, and recurrent ectopic pregnancy

Laparotomy

  • Surgery of choice for patients with compromised hemodynamic status or cornual ectopic pregnancy when laparoscopic approach is too difficult or if the surgeon is not trained in operative laparoscopy

Salpingostomy

  • Standard laparoscopic procedure for unruptured ectopic mass of <4 cm in length by US
  • Over the bulging anti-mesenteric border of the implantation site, a longitudinal incision is made and left unsutured
  • Salpingostomy is reasonable if there is only one tube but it carries a risk of 20% of repeated ectopic pregnancy
  • It may also be considered in women with a contralateral tubal damage or previous ectopic pregnancy, abdominal surgery or pelvic inflammatory disease 
  • There is a 5-11% risk of persistent trophoblast (detected by decrease of β-hCG levels of <20% every 72 hours)
    • β-hCG level should be followed up until it becomes undetectable or decreases to <5 IU/L (5 mIU/mL)

Salpingectomy

  • Indicated in patients with uncontrolled bleeding, extensive tubal damage, recurrent ectopic pregnancy in the same fallopian tube, severely damaged fallopian tube (eg isthmic ectopic pregnancies), ectopic gestation >5 cm, or as a sterilization procedure
  • Salpingectomy is preferred if the contralateral tube is healthy because there is a lower rate of persisting trophoblast
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