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Laparoscopic Management of Tubal Pregnancy
Ectopic PregnancyWhat is an ectopic pregnancy?
What are the risk factors for ectopic pregnancy?
Infection in the pelvis is another leading cause of ectopic pregnancy. Pelvic infections are usually caused by .ually transmitted organisms, such as chlamydia or gonorrhea. However, non-.ually transmitted bacteria can also cause pelvic infection and increase the risk of an ectopic pregnancy. Infection causes an ectopic pregnancy by damaging or obstructing the fallopian tubes. Normally, the inner lining of the fallopian tubes are coated with small hair-like projections called cilia. These cilia are important to transport the egg smoothly from the ovary through the fallopian tube and into the uterus. If these cilia are damaged by infection, egg transport becomes disrupted. The egg can settle in the fallopian tube without reaching the uterus, thus becoming an ectopic pregnancy. Likewise, infection-related scarring and partial blockage of the fallopian tubes can also prevent the egg from reaching the uterus. Like pelvic infections, conditions such as endometriosis, fibroid tumors, or pelvic scar tissue (pelvic adhesions), can narrow the fallopian tubes and disrupt egg transportation, thereby increasing the chances of an ectopic pregnancy. Prior surgeries involving the fallopian tubes or other pelvic organs are other risk factors for an ectopic pregnancy. In hopes of conceiving, some women undergo surgery to repair damaged fallopian tubes or to reverse prior tubal ligations. Any such procedure involving the fallopian tubes increases the risk for an ectopic pregnancy. Approximately 50% of pregnancies in women using intrauterine devices (IUDs) will be located outside of the uterus. However, the number of women becoming pregnant while using IUDs is extremely low. Therefore, the overall risk of ectopic pregnancies related to IUDs is very low. What are symptoms of an ectopic pregnancy? How is ectopic pregnancy diagnosed? Beta human chorionic gonadotropin (beta HCG) and progesterone, a series of blood samples are obtained. Beta HCG levels normally rise during pregnancy. An abnormal pattern in the rise of this hormone can be a clue to the presence of an ectopic pregnancy. In those with abnormal hormone patterns, an ultrasound can be performed. In patients with an ectopic pregnancy, an ultrasound can demonstrate the absence of pregnancy within the uterus. Often, a dilatation and curettage (D&C) procedure is then performed. During D&C, samples are obtained from the inner lining of the uterus to demonstrate the absence of pregnancy tissue within the uterus. What is the best method of diagnosis? The diagnosis of ectopic pregnancy is mainly clinical. Together with other supporting investigation especially Hormonal essay. What is the best treatment of unruptured tubal pregnancy? Best treatment is its surgical removal. This technique involves making several tiny cuts in the abdomen and inserting a miniature camera and surgical instruments. The surgeon then removes the appendix with the instruments, so there is usually no need to make a large incision in the abdomen. What is the benefit of laparoscopic management of tubal pregnancy? Laparoscopic management provide less postoperative morbidity. Most cases of ruptured as well as unruptured tubal pregnancy can be treated laparoscopically. Laparoscopic management is a useful method for reducing hospital stay, complications and return to normal activity. The main advantages are:
Is every patient fit for laparoscopic management of ectopic pregnancy? No. Most surgeons would not recommend laparoscopic treatment in those with large Haematoma due to Large ruptured Ectopic and interstitial ectopic pregnancy ( Ectopic pregnancy in uterine part of fallopian tube) oIf there is more than 1500cc haemoperitoneum laparoscopic approach is contraindicated o Patients with cardiac diseases and COPD should not be considered a good candidate for laparoscopic management. Laparoscopic management of ectopic pregnancy may also be more difficult in patients who have had previous lower abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum. Laparoscopy does add to the surgical risk in patients with a lowered cardio-pulmonary reserve with regard to the consequences of the pneumoperitoneum and a longer operative time. What are the complications of laparoscopic managent of ectopic pregnancy? In experienced hand there is not any specific complication directly related to laparoscopic procedure but if the surgeon is not trained enough in laparoscopy than the chance of following complication is there: Missed diagnosis Bleeding Incomplete removal of Visceral Injury Leakage of purulent exudates Intra-abdominal abscess Hernia But inexperience hand these complications are extremely rare. and altogether laparoscopic procedure has less complication than conventional surgery Minimal Access Surgeon
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