Laparoscopic Management of Ectopic Pregnancy

Prof. Dr. R. K. Mishra

What is ectopic Pregnancy?

Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. By having an ectopic pregnancy, the fertilized egg implants somewhere outside the uterus. An ectopic pregnancy is generally in one of the fallopian tubes.

What this means is the egg will not develop into a baby, which can be devastating towards the pregnant woman.

In a few cases an ectopic pregnancy causes no noticeable symptoms and is only detected during routine pregnancy testing. At first, an ectopic pregnancy may not cause any signs or symptoms. In other cases, early indications of an ectopic pregnancy may be the just like those of any pregnancy - a missed period, breast tenderness and nausea. However, nearly all women do have symptoms which usually become apparent between week five and week 14 of being pregnant. An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and also the growing tissue might destroy various maternal structures. Not treated, life-threatening hemorrhaging is possible. Early treatment of an ectopic pregnancy can help preserve the possibility for future healthy pregnancies.

Ectopic Pregnancy

What are the sign and symptoms?

They include:

Abnormal vaginal bleeding

Abdominal pain, typically just in one side, which could vary from mild to severe.

If an ectopic pregnancy is detected in an early stage, a medicine called methotrexate is sometimes needed to stop the egg developing. In many cases mrthotrexate work very nicely, specially in early cases. The pregnancy tissue is then absorbed into the woman’s body.

Ectopic pregnancies detected in a more advanced stage will require surgery to remove the trophoblast and sometime the entire tube. A tubal pregnancy - the most typical kind of ectopic pregnancy - happens when a fertilized egg gets stuck coming to the uterus, often because the fallopian tube is inflamed, damaged or misshapen. Hormonal imbalances or abnormal fetal development might also play a role. Sometimes, the specific reason for an ectopic pregnancy remains a mystery.

If an ectopic pregnancy is left to develop, there's a risk the fertilized egg could keep growing and cause the fallopian tube to rupture, which can cause life-threatening internal bleeding.

Signs of a ruptured fallopian tube are:

  1. Sudden, severe, sharp pain
  2. Feeling faint and dizzy
  3. Feeling or just being sick
  4. Diarrhoea
  5. Shoulder tip pain

A ruptured fallopian tube is a medical emergency.

Inside a normal pregnancy an egg is fertilised by sperm within the fallopian tubes, which connect the ovaries to the womb. The fertilised egg then moves in to the womb and implants itself into the womb lining (endometrium), where it grows and develops.

An ectopic pregnancy is the place a fertilised egg implants itself away from womb. It most often occurs in a fallopian tube (this is what's called a tubal pregnancy), usually as the result of damage to the fallopian tube or even the tube not working properly.

What is the incidence and what are the causes of ectopic pregnancy?

Less commonly as in around 2 in 100 cases, an ectopic pregnancy can happen in an ovary, within the abdominal space or perhaps in the cervix. As much as approximately 20 in each and every 1,000 pregnancies are ectopic. Various factors are related to ectopic pregnancy, including:

Previous ectopic pregnancy. If you have had one ectopic pregnancy, you're more prone to have another. Inflammation or infection. Inflammation from the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the chance of ectopic pregnancy. Often, these infections come from gonorrhea or chlamydia. Fertility issues. Some research suggests an association between problems with fertility - in addition to use of fertility drugs - and ectopic pregnancy.

Structural concerns. An ectopic pregnancy is more likely for those who have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can boost the chance of ectopic pregnancy.

Contraceptive choice. With proper use, pregnancy when utilizing an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a lasting method of contraception commonly known as "having your tubes tied." Although pregnancy after tubal ligation is rare, if it happens it's more likely to be ectopic.

What is the treatment of ectopic pregnancy?

If the ectopic pregnancy is detected early, a shot from the drug methotrexate is sometimes accustomed to stop cell growth and dissolve existing cells. Following the injection, physician will monitor blood of the patient for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, patient will need another injection of methotrexate.

In other cases, ectopic pregnancy is treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or perhaps in or around the navel. Then laparoscopic surgeon uses a thin tube equipped with a camera lens and lightweight laparoscope to view the area or ectopic pregnancy. Other instruments like harmonic, ligasure, scissors, grasper etc. could be inserted in to the abdomen through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is really a lot damaged, it could have to be removed which is called salpingectomy.