Ectopic Pregnancy Management (Laparoscopic)

Ectopic pregnancy, an abnormal condition in which pregnancy occurs outside the uterus(womb).. It is managed by laparoscopic procedures like linear salphingostomy or by salphingectomy


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ectopic tube pregnancy

Ectopic means any tissue that is supposed to be in one place but is found elsewhere. Normally, the sperm travels from vagina towards the ovum. Once the sperm and ovum meet in the ampulla and forms the embryo. The embryo grows into a baby in the womb, for this to happen, the embryo has to travel from the ampulla (a region in fallopian tube where fertilization, i.e. meeting of male and female gamete occurs) to the womb. Normally it takes 7 to 10 days for the embryo to reach the womb. If the movement slows down due to any reason, it gets implanted wherever it is  upon reaching 7th or 10th day. Hence, pregnancy that occurs anywhere other than in the womb is an ectopic pregnancy

Understanding Surgical treatment of Ectopic pregnancy

The main objective is to remove the growing embryo from its unusual site by laparoscopic or scar-less technique, before it ruptures. One way to perform this is, the surgeon will put a cut in the tube and remove the growing baby and leave the tube to heal by itself. Other way is to cut off the tube which contains the sac, separate it from the uterus and remove it out of the body.

At times, in case of a chronic ectopic pregnancy, the pregnancy may go unidentified at first. It then later presents as a lump during normal check up. Urine pregnancy is done to confirm that it is a pregnancy. In such cases, the exact location is identified using laparoscopy. Then the ectopic pregnancy is bagged and removed through a port placed in one of the tiny incisions.

If an unfortunate case where the ectopic pregnancy bursts, surgery is definitely life saving. The site of rupture is identified, the area is thoroughly washed and the pregnancy products and pooled blood is removed out through the vagina. If extensive damage is noted in the ovary or the tubes, the respective organ is also removed.

How is SURGERY FOR Ectopic pregnancy Performed

Laparoscopic surgery is performed when the patient’s blood flow is stable and when the ectopic pregnancy is confined within the fallopian tube. 3 incisions (laparoscopic) or 1 incision (scarless) are made in this procedure. Depending on the location of pregnancy and degree of damage to the tube, any one of below surgeries are considered.

Linear salpingostomy:

A linear incision is made on the border of the affected tube over the tubal swelling. The ectopic pregnancy is scooped out and the tube is cleaned. Bleeding is controlled and the incision made is left to heal by itself.

Laparoscopic total salpingectomy:

The layer of tissue around the tube and affected area of the tube is cut off and separated from the uterus with the ectopic pregnancy inside.
The entire specimen is put into a plastic bag and removed through one of the ports.

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Lap management of ectopic pregnancy

Treatment Window

Any bleeding, abdominal or back pain during pregnancy warrants immediate attention. Once an ectopic pregnancy is identified in these patients, surgical intervention should be done at the earliest so as to avoid further complications like sepsis or shock.

Life after LAPAROSCOPIC MANAGEMENT OF ECTOPIC PREGNANCY

A woman can lead a normal life even after surgical removal of an ectopic pregnancy. Although one of the tubes might be removed in the process, as long as the other tube is functioning normally, chances of being pregnant again is high.

Surgical management of ectopic pregancy- FAQ

The exact reason is unknown, we do know that there seems to be a higher number of patients with Etopic pregnancy, who have had had tubal surgeries, pelvic infections and etc, before. Presumably some factors seem to arrest the transport of the egg, at the tubes and causing the egg to be fertilized while inside the tube.
It is one of the most dangerous things that can happen to a woman. If an ectopic pregnancy bursts, there will be progressive bleeding from the tube, which can lead to death if not treated quickly.
If a woman’s period has been delayed, and she feels a severe pain in the abdominal and in the shoulder tip, there is a high likelihood of her having an etopic pregnancy.
First a urinary pregnancy test is performed in order to confirm that the woman is pregnant. After that an Ultrasound scan, can localize the pregnancy to the tube and can even show the blood in the peritoneal cavity confirming that the woman has an ectopic pregnancy.
The patient requires surgery as soon as possible. Delay will only further endanger a patient’s life, the sooner the better.
Once the ectopic pregnancy is ruptured, then there is no question of waiting and watching. The only safe treatment available is to remove the failed fetus laparoscopically. This will save the life of the patient, which is the first priority.
A few methods have been suggested, but nothing really proved effective. Unfortunately some women have an increased tendency to develop ectopic pregnancies on a recurrent basis, and one needs to be aware and deal with it accordingly.
No. A number of studies have shown that Laparoscopic or key hole surgical techniques for ectopic gives the same results as that of open surgery but with a much more effective operating period and causes less scaring. At LIMA we have a very good series of successful surgeries for ectopic pregnancies due to the use of laparoscopic surgery.

LIMA SPECIALISTS

Dr. J. S. Rajkumar

CHIEF SURGEON

M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)


Dr. Deepa Ganesh

ADVANCE LAPAROSCOPIC GYNECOLOGIST, ROBOTIC SURGEON & COSMETIC GYNECOLOGICAL SURGEON
M.B.B.S., M.S (OBG), F.MAS, D.MAS, FICRS, Dip.MIS (GERMANY), D.ALS (FRANCE), D.ACG (USA)