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What Is the Surgical Management of Ectopic Pregnancy? Risks & Causes

Medically Reviewed on 1/21/2022

The surgical management of ectopic pregnancy entails operating and removing the pregnancy while you are sedated.

The surgical management of ectopic pregnancy entails operating and removing the pregnancy while you are sedated.

Doctors may advise surgery to remove the ectopic pregnancy as the best course of action if:

  • The level of pregnancy hormone (beta hcG) is high.
  • The ectopic pregnancy is large, as seen in the scan.
  • The scan reveals significant internal bleeding.
  • Either expectant or medical management fails. 

Surgical management procedure

  • Laparoscopy: Under general anesthesia, a surgical procedure is performed to remove the ectopic pregnancy through smaller incisions.
  • Laparotomy: If the tube has ruptured and there is a lot of internal bleeding, the operation may need to be performed by making a bigger incision through the abdomen.

In most cases, the surgeon makes three small incisions in the abdomen. One incision is made inside the navel, and one or two incisions are made lower down on the abdomen.

  • To allow the surgeon to visualize the site of ectopic pregnancy, they insert a laparoscope (a thin, flexible instrument with a camera and light source on its end) through the incision in the navel. They usually remove the fallopian tube if an ectopic pregnancy is confirmed.
  • It is sometimes possible to make a cut in the tube and remove the pregnancy while leaving the tube intact. The disadvantage of this is that not all the pregnancy tissue is always removed. Furthermore, this tube may be damaged, increasing the likelihood of another ectopic pregnancy occurring in that tube in the future.
  • Although most ectopic pregnancy operations are performed using laparoscopic or keyhole surgery, an open operation may be required in some cases. This is more likely if you have experienced significant bleeding or if keyhole surgery is not technically feasible.
  • You may only need to stay in the hospital for one day for keyhole surgery. You may need to stay for two to four days after open surgery.

Doctors who perform the surgery will carefully examine both fallopian tubes to determine the best course of action.

  • Salpingectomy:
    • If there is significant damage or bleeding, the affected tube must be removed. If the opposite fallopian tube appears normal, this is often the procedure of choice.
  • Salpingotomy:
    • If the damage is minor and there is no danger of the fallopian tube being damaged, the ectopic can sometimes be removed from the tube by making a small cut, extracting the ectopic, and leaving the tube intact but with a small scar.

Risks of surgery

  • Minor complications: Occur in 1 to 2 cases in every 100 and include
    • Inability to detect the ectopic pregnancy
    • Local or systemic infection caused during the operation
    • Minor bruising and bleeding at the incision site
    • Vomiting and nausea
  • Major complications: They are rare and occur in an estimated 1 to 2 cases in every 1,000 and include
    • Inability to perform a laparoscopy and consequent need for a laparotomy
    • Organ damage, such as bowel or bladder damage
    • A major artery may be damaged (blood vessel)
    • Pelvic nerves have been damaged
    • Complications associated with the use of carbon dioxide during the procedure, such as gas bubbles entering the veins or arteries
    • Anesthetic-induced severe allergic reaction
    • Need of additional surgery

A laparoscopic procedure usually takes 30 to 60 minutes, but if a laparotomy is required, it may take longer.

What is ectopic pregnancy?

Ectopic pregnancy is a medical condition in which an embryo implants outside the uterine cavity, most commonly in the fallopian tube; thus, ectopic pregnancy is also known as tubal pregnancy.

This is a potentially fatal condition that affects at least 1 in every 1,000 pregnancies. Unfortunately, there is no chance of the pregnancy surviving or reaching term.

8 common causes of ectopic pregnancy

  • History of infertility
  • History of previous ectopic pregnancy
  • History of pelvic infection or tubal damage
  • History of pelvic surgery including sterilization
  • Previously used an intrauterine contraceptive device
  • Undergoing assisted conception such as in vitro fertilization
  • Hormonal imbalance, malfunction of the uterus and tube, and infection can all impair the tubes normal function and result in ectopic pregnancy
  • Abnormal lifestyle such as smoking or drinking alcohol may lead to ectopic pregnancy
  • Early symptoms of an ectopic pregnancy may be very similar to typical pregnancy.

    3 early symptoms of ectopic pregnancy

  • Vaginal bleeding
  • Pain in the lower abdomen, pelvis, and lower back
  • Dizziness or weakness
  • If the fallopian tube ruptures, pain, and bleeding could be severe enough to cause additional symptoms, such as:

    • Fainting
    • Hypotension (low blood pressure)
    • Shoulder pain
    • Rectal pressure

    When a tube bursts, you may feel sharp lower abdominal pain. This is a medical emergency, and you may need to contact a doctor immediately.

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    How is ectopic pregnancy managed?

    Ectopic pregnancy is typically treated with medications, surgery, or observation. The type of management is determined by the severity of the woman.

    Conservative/observation management

    Expectant management is effective in managing ectopic pregnancy in 40 to 80 percent of cases but entails a risk of rupture and potentially fatal shock.

    A good candidate for expectant management has a beta-hCG level less than 1,000 mIU/mL and declining further daily, an ectopic mass less than three centimeters, no fetal heartbeat, and agrees to comply with follow-up requirements.

    Medical or pharmacological management

    • Methotrexate is a chemotherapy drug that prevents pregnancy growth. It is a medical procedure used to dissolve an ectopic pregnancy.
    • If the ectopic pregnancy is small and pregnancy hormone levels are not high, medical treatment is likely to be safe.
    • Methotrexate is administered through a single injection in the arm. In some cases, an infusion drip into a vein may be required.
    • Concurrently, pregnancy hormone levels would be measured.

    Temporary side effects of medical management of ectopic pregnancy include:

    • Abdominal pain
    • Nausea and vomiting
    • Indigestion
    • Mouth ulcers
    • Sensitivity to light
    • Fatigue

    It may, on rare occasions, affect the liver or blood counts.

    Surgical management

    • As described earlier, surgical management is one way of treating an ectopic pregnancy. In emergency circumstances, this may be the only choice. The operation is usually performed under general anesthesia.

    Whether you get methotrexate or have surgery to treat an ectopic pregnancy, you’ll need to see the doctor for several weeks. The doctor will check your pregnancy hormone levels to ensure they are normal.

    To catch an ectopic pregnancy early, go to the doctor as soon as you find out you’re pregnant, especially if you’ve had an ectopic pregnancy before. It is recommended that you see a doctor between six and eight weeks of gestation (about two to four weeks after your missed period) to rule out ectopic pregnancy.

    Having a previous ectopic pregnancy is the most dangerous risk factor for an ectopic pregnancy. That means that women who have a history of ectopic pregnancy should see their doctor as soon as the pregnancy is discovered.

    Medically Reviewed on 1/21/2022

    References

    Image Source: iStock Images

    Surgical treatment of ectopic pregnancy: https://pubmed.ncbi.nlm.nih.gov/19231293/

    Diagnosis and Management of Ectopic Pregnancy: https://www.aafp.org/afp/2005/1101/p1707.html

    Ectopic Pregnancy (booklet): https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/ectopic-pregnancy-booklet/

    Diagnosis and treatment of ectopic pregnancy: https://bcmj.org/articles/diagnosis-and-treatment-ectopic-pregnancy

    Management of Ectopic Pregnancy: https://www.gfmer.ch/SRH-Course-2010/national-guidelines/pdf/Management-Ectopic-Pregnancy-SLCOG.pdf

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