Gynecologic Surgery
ECTOPIC PREGNANCY

ECTOPIC PREGNANCY

ECTOPIC PREGNANCY

Ectopic pregnancy is one of the types of abnormal pregnancies and can many times be life threatening to the mother. Dr Mayur Pai is well trained in the diagnosis and treatment of ectopic pregnancy. He often performs surgeries that get rid of tubal ectopic pregnancies with minimal or no damage to the fallopian tube.

This page will highlight various aspects of ectopic pregnancy like:

What is an ectopic pregnancy?

What are the various locations of ectopic pregnancy?

What are the warning symptoms of ectopic pregnancy?

Why is it important to diagnose and treat ectopic pregnancy?

Can beta HCG help in diagnosis of ectopic pregnancy?

Can ultrasound help in diagnosis of ectopic pregnancy?

What is the role of laparoscopy in the treatment of ectopic pregnancy?

What are the chances of recurrence of ectopic pregnancy in a future pregnancy?

What are the different types of ectopic pregnancy surgeries?

What are the advantages of laparoscopic surgery over open surgery?

What is medical or non-surgical management of ectopic pregnancy?

Keep reading till the end of the page in order for better and near complete understanding of ectopic pregnancy and the treatment of ectopic pregnancy.

 

 

What is ectopic pregnancy?

In simple terms, ectopic pregnancy is any pregnancy that implants outside the normal uterine cavity.

 

What are the various locations of ectopic pregnancy?

 

 

An ectopic pregnancy can occur in the following locations:

  • Fallopian tube (90 to 95%)
  • Ovary (1%)
  • Abdomen (1 to 2%)

Uterus but outside the normal uterine cavity

 

The fallopian tube is the commonest site of ectopic pregnancy. The meeting of the sperm and egg (also called fertilization) usually takes place in the fallopian tube. The fertilised ovum or zygote is normally transported from the fallopian tube to the normal uterine cavity where it normally implants. For various reasons, the zygote may abnormally get implanted into the inner wall of the fallopian tube, and this forms a tubal ectopic pregnancy.

The commonest type of tubal ectopic pregnancy is called the ampullary ectopic pregnancy. This happens when the embryo implants in the ampullary portion of the fallopian tube.

Uterine ectopic pregnancies happen when the embryo implants in the uterus but outside the normal uterine cavity. The different sites in the uterus where ectopic pregnancies can implant are caesarean scar, cervix, and uterine cornu (in bicornuate uterus).

Very rarely the embryos implant in the ovary or abdominal cavity. These are rare sites of ectopic pregnancy.

What are the warning symptoms of ectopic pregnancy?

Ladies with ectopic pregnancy may have symptoms like a missed period followed by pain in lower abdomen, spotting or heavy vaginal bleeding or generalised weakness with even blackouts (fainting).

Many ladies in the early stages may not even have symptoms and ectopic pregnancy may be diagnosed during investigations.

Some of the above symptoms are also common in early pregnancy and it is very easy to miss an early diagnosis of ectopic pregnancy.

 

Why is it important to diagnose and treat ectopic pregnancy?

Ectopic pregnancies are responsible for 10% of pregnancy related mortalities. Many ladies have long term and short term problems due to ectopic pregnancies. Hence, it is important that ectopic pregnancies are diagnosed and treated as early as possible.

The normal uterine cavity has the ability to stretch and sustain the development of a pregnancy. In an ectopic location like the fallopian tube or the caesarean scar, the surrounding tissues cannot stretch and support the development of the pregnancy. This causes rupture of the ectopic pregnancy and the subsequent bleeding from the rupture site. The lady may experience life threatening amount of blood loss.

In a case of ruptured ectopic pregnancy, there is also concern that there may be permanent damage to the fallopian tube or the uterus. The lady may need treatment conceiving during a future pregnancy.

Can beta HCG help in diagnosis of ectopic pregnancy?

 

Beta HCG or b HCG is a blood test used to detect pregnancy. This test gives a value that can be used to co relate the ultrasound findings in a case of ectopic pregnancy.

Beta HCG test can diagnose if there is a pregnancy or not but it cannot be used to locate a pregnancy. Ultrasound examination is the best investigation used to locate a pregnancy.

 

Can ultrasound help in diagnosis of ectopic pregnancy?

Ultrasound examination is the best test to locate an ectopic pregnancy. Ultrasound examination best works when combined with beta HCG values.

At beta HCG values of 2500 to 3500, a gestational sac is usually visible in the uterine cavity by Trans vaginal ultrasonography. Higher beta HCG values in the absence of gestational sac in the uterus strongly raises suspicion of ectopic pregnancy.

In case of a ruptured ectopic pregnancy, ultrasound test helps in establishing diagnosis and helps in planning treatment of ectopic pregnancy.

 

What is the role of laparoscopy in the treatment of ectopic pregnancy?

Laparoscopy is the gold standard in the diagnosis and treatment of ectopic pregnancy. In a single key hole surgery the surgeon is able to establish the diagnosis of ectopic pregnancy, locate it and treat it.

Depending on the patient general condition and whether the ectopic pregnancy is ruptured or not one can plan a fallopian tube saving or a fallopian tube removal surgery. The details of both these surgeries are explained to the patient prior to surgery.

In case of a ruptured ectopic pregnancy, the site of bleeding can be easily identified and the bleeding can be treated effectively.

 

What are the chances of recurrence of ectopic pregnancy in a future pregnancy?

Almost 10 to 15% ladies with previous pregnancy have recurrence in a future pregnancy. This usually occurs if the cause of the previous ectopic pregnancy is inherent to the patient in the first place.

It is always advised that after one ectopic pregnancy, the lady has to do an early pregnancy test after one week of every missed period for the early detection of pregnancy. If the pregnancy test is found positive, she should get a Trans vaginal ultrasound and localise the pregnancy.

 

What are the different types of ectopic pregnancy surgeries?


Many different types of ectopic pregnancy surgeries exist. Only two types are discussed here as they are commonly used.

LAPAROSCOPIC SALPINGOSTOMY (TUBE SAVING SURGERY)

Laparoscopic salpingostomy is a laparoscopic microsurgery in which only the ectopic pregnancy tissue is removed and the fallopian tube is conserved. This surgery best works in a patient with early detection of ectopic pregnancy which is unruptured. This surgery is best suited for ladies who want to conserve future fertility.

We have had several cases of salpingostomy surgery that have undergone caesarean or another laparoscopy for other reasons whose fallopian tube was found to have no residual scar of salpingostomy. Most patients conceive naturally within the next year.

LAPAROSCOPIC SALPINGECTOMY (FALLOPIAN TUBE REMOVAL)

This surgery is done in cases of ruptured ectopic pregnancy or in cases where the patient has presented with advanced tubal ectopic pregnancy which has damaged the fallopian tube beyond repair.

This surgery is also done in cases where the couple/ patient wants no future chances of ectopic pregnancy as she has completed her reproductive career. These patients opt for removal of both fallopian tubes in the same sitting.

This surgery can be performed in 30 to 60 minutes time and the patient recovers in 1 to 2 days’ time.

What are the advantages of laparoscopic surgery over open surgery?

In a case of ectopic pregnancy, it has been our experience that laparoscopic surgery takes the same time or is faster to achieve bleeding control in a case of ectopic pregnancy. The time taken to perform an open surgery and the time to insert the laparoscopic ports is roughly the same.

Some diseases like ovarian tumors, appendicitis and pelvic infections also may present like ectopic pregnancy. Laparoscopy gives a complete view of the abdomen and helps in diagnosis and treatment of these conditions as well.

The advantage of lesser pain and blood loss and faster recovery that too with the amazing cosmetic benefits only exists in laparoscopy.

The right choice has to be made with the presenting condition of the patient and the hospitals readiness for laparoscopic and open surgery.

 

What is medical or non-surgical management of ectopic pregnancy?

There are various medications that can help resolve an ectopic pregnancy. These work very well in an early detected case of an unruptured ectopic pregnancy. Case selection for medical treatment is very important for the best results. These treatments are combined with beta HCG levels and ultrasound tests that help in monitoring the effect of the treatment

Some doctors may also use these medications to reduce bleeding prior to doing a difficult ectopic pregnancy surgery.

The different treatment choices are explained to the patient before beginning the treatment.

This treatment is best performed after admitting the patient in the hospital. One of the complications of this type of medical treatment is that the ectopic pregnancy site can start bleeding heavily. This may lead to blood loss and the patient may require emergency surgery. Also, in a case of a bleeding ectopic pregnancy site, it is sometimes not possible to do a fallopian tube sparing surgery.

As per our personal choice, we do not recommend medical therapy to couples who do not have a child or want a future pregnancy for this very reason. Though this treatment works very well, a few ladies are rendered infertile or sub fertile due to the loss of one fallopian tube. Medical treatment of ectopic pregnancy is a personal choice between the patient and her treating doctor.

In a few cases, medical treatment does not work or works sub optimally. These cases finally require surgery for ectopic pregnancy.

 

CONCLUSION:

Laparoscopic surgeries are of two basic types: tubal conserving (like salpingostomy) and tube removing (salpingectomy). The choice depends on the patient’s/ couple’s choices regarding future fertility.

Tube saving surgery is best done in cases of early detected unruptured ectopic pregnancy cases.

Laparoscopic surgery has several advantages like cosmetic benefit, less pain, less blood loss and faster recovery.

Medical or non surgical treatment works well only in well selected cases. It has a few disadvantages that have to be discussed and understood by the patient.

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