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Laparoscopic Management of Ectopic Pregnancy
Gynecology / Jan 28th, 2018 4:10 pm     A+ | a-

Introduction 
 

Ectopic pregnancy is a regarded as a major cause of the maternal morbidity and mortality. This condition has been increasing over the recent years and is really affecting many women across the globe. For instance, studies show that the ectopic pregnancy causes the largest percentage of maternal mortalities in the United States, which is actually reported to be around 10% of the total such deaths. When ectopic pregnancy is diagnosed at an early stage it becomes easier to treat the condition. Today, there have been some advancements in the health sector which has enabled the introduction of certain procedures that can help bring out the accurate diagnosis of the ectopic pregnancy during the early stages. This is made possible by the use of sensitive pregnancy tests and high-resolution transvaginal ultrasound. This accurate and early diagnosis enhances the ability to treat the ectopic pregnancy. 
 
Laparoscopy is one of the best methods that are often use d today in the diagnosis of ectopic pregnancy and has always been there since it was described. The popularity of laparoscopy continues to grow across the world as a great surgical treatment for ectopic pregnancy. 
 
Symptoms of ectopic pregnancy 
 
Women should be aware of the various symptoms of ectopic pregnancy so that they can seek treatment at an early stage. These symptoms however, can be different in each woman and sometimes the symptoms may not be seen or detected by the patient herself. Studies have shown that most women start experiencing the symptoms in the sixth week of pregnancy which can be in terms of unilateral lower abdominal pain, slight vaginal bleeding and a brief period of amenorrhoea. 
 
Some of the symptoms of ectopic pregnancy may be:
 
• Lower abdominal or pelvic pain. This pain is felt in the lower abdomen and comes up suddenly or happen gradually over a period of several days. The pain can be sharp and sudden and may not go easily or may seem to come and go in intervals. This pain can affect one side of the abdomen.
• Slight vaginal bleeding- vaginal bleeding may or may not occur and it is different from that of a normal period. It may start a few weeks after a missed period. This bleeding may get heavier or even lighter than the normal period and the blood may seem darker. Therefore one can easily tell the symptom.
There are usually other symptoms such as the nausea and vomiting, dizziness and weakness, pain in your shoulder, rectum or neck, and sharp abdominal cramps.
 
Advantages of laparoscopic management for ectopic pregnancy
 
Laparoscopic approach for ectopic pregnancy is a minimally invasive procedure and is mostly preferred over the laparotomy. This procedure is associated with shorter operation periods. The practitioner is able to coordinate the instruments effectively and within a realistic short time the surgical procedure is over. Laparoscopy is also associated with less intraoperative blood loss since it involves the making of small incisions. The procedure is also associated with shorter stay in the hospital which can reduce the costs of bed occupancy for patient. After the procedure the patient does not require more analgesics. 
There are various risk factors of ectopic pregnancy which include previous ectopic pregnancy, history of infertility, damage of the tubes from the surgery, age and treatment using the in vitro fertilization. Most patients who have had a previous history of ectopic pregnancy, laparotomy is often performed on them in order to treat the condition. However, laparoscopy is considered to be best procedure when it compared with any other procedure. Today, patients who are hemodynamically unstable can go through laparoscopic treatment which yields better results. This however, was quite difficult in the past, but thanks to the advancement and increased clinical experience among various practitioners which enables this procedure to be successful even to women with large hemoperitoneum. 
 
Patients who are obese with a body mass index greater than 30 can pose some challenges to the operative laparoscopy. Obesity is generally considered to have some impact on the whether laparoscopic surgery will be performed on such patents. This based on the fact that the increased thickness of the abdominal wall can make it quite difficult to visualize the inferior epigastric vessels and to achieve pneumoperitoneum. Obese people have a lot of fats along the abdominal wall which makes it to difficult to control the instruments through the incisions.  During the operation, increased airway pressure makes the ventilation difficult in obese patients which mostly happens when they are placed in the trendelenberg position. However given all these difficulties, laparoscopic surgery is still regarded as a safe procedure to perform to treat ectopic pregnancy. 
 
Can you get pregnant after treatment for ectopic pregnancy?
 
This is one question that is greatly asked by patients even before the go through the treatment. Tot answer to this is yes you can get pregnant even after the treatment of ectopic pregnancy. You can get pregnant again and deliver a full term baby. However, this depends on what caused the ectopic pregnancy and how it was resolved.  
 
When performing laparoscopy for ectopic pregnancy the practitioner should consider the risk factors for converting laparoscopy to laparotomy. Some of the risk factors include the multiple prior surgeries and prior adhesions. The experience and skill of the surgeon matters a lot when performing this procedure. If operative laparoscopy s done by a highly skilled practitioner, the surgery can be very successful given that the all the instruments required for the operation are readily available. The surgeon should also critically analyse the condition of the patient in order to know how to go about the operation without any hinges. 
 
How laparoscopic diagnosis for ectopic pregnancy is performed?
 
The procedure includes inflating the mesosalpinx with vasopressin which is carefully done in order to avoid intravascular injection. Two incisions are made on the antimesenteric side of the tube and then aquadissetor is placed through one of the incisions which moved the surgeon in order to dissect and dislodge the ectopic pregnancy as well as the clots. 
All the products of conception can be cut into smaller pieces by the use of the aquadissector and then removed. Bleeding should be controlled by applying some pressure with the use of grasping forceps. If there is uncontrollable bleeding the surgeon should apply an endoscopic loop which will provide compression for a longer time. 
 
Postoperative care
 
There are important postoperative considerations that should be done like to control the pain and ensure the stability of the hemodynamic. Pain can be controlled by the application of oral analgesics. The good thing about laparoscopy is that is can be done and patients be discharged on the same day of the surgery. However, some patients may require overnight admission due to the bleeding and pain. Overnight admission is necessary to patients with postoperative bleeding pain so that they can be closely monitored and the best corrective measures given to them. 
 
Conclusion 
 
Laparoscopy helps manage a higher percentage of ectopic pregnancies in a minimally invasive manner. Laparoscopic approach for ectopic pregnancy has become the most recommended surgery for patients with this condition. For the obese patients this procedure may be difficult to perform but still some reports show that it can be done well especially if the practitioner is highly skilled and has all the instruments that are used in this procedure. Advancements in the laparoscopic management of ectopic pregnancy is still going one and more practitioners are becoming used to the basic as well as advanced ways of going about the procedure. This will in the near future make laparoscopy approach simply the number one treatment from ectopic pregnancy. There are several advantages that are associated with laparoscopic approach to ectopic pregnancy, which may include low bloods loss, faster recovery and reduced stay in the hospital. In fact, it can be conducted as an outpatient procedure where patients get operated and discharged the same day. Patients may experience some postoperative complications such as pain bleeding which can be controlled. 
 
 
 
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