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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Endometriosis is a common gynaecological condition affecting about 6–10% of women of reproductive age and can be a debilitating disease. It is the second most common reason for surgery in premenopausal patients. It is defined as the presence of endometrial-like tissue outside the uterine cavity, leading to a chronic inflammatory reaction. The exact aetiology is unknown, but the retrograde menstruation model is the most widely accepted theory explaining the development of pelvic endometriosis. According to this model, menstrual blood containing endometrial fragments passes through the fallopian tubes into the pelvic cavity, resulting in the formation of peritoneal endometrial deposits. There are three distinctive pathological types of pelvic endometriosis: superficial peritoneal implants, ovarian endometriomas, and deep infiltrating nodular lesions. The extent of the disease is very variable and often does not correlate with the severity of symptoms. Although it can sometimes be asymptomatic (in about 20% of cases), endometriosis is frequently associated with severe pain and infertility. Several management options exist for endometriosis and the choice depends on several factors such as age, fertility, severity of the symptoms, and extent of the disease. This review presents three different cases of endometriosis with different complexities and presentations. The diagnosis and various medical and surgical treatment options available to the clinician will be discussed.