Surgical Treatment of Ectopic Pregnancy

ABSTRACT

In most cases of ectopic pregnancy, medical treatment with methotrexate is successful. However, some cases still require surgery and laparoscopy is an effective approach. The candidates for surgical treatment include women who are not suitable to or have failed methotrexate treatment, those with heterotopic pregnancy, or those who are hemodynamically unstable. In women of reproductive age with tubal pregnancy, salpingostomy is the preferred surgical method. Conversely, salpingectomy is a better treatment for women with severely damaged fallopian tube, recurrent ectopic pregnancy in the same tube, uncontrolled bleeding after salpingostomy, large tubal pregnancy (> 5 cm), heterotopic pregnancy, and for those who have completed their family. Similar to treatment of a tubal pregnancy, cervical and interstitial pregnancy could be treated medically first. Most abdominal pregnancies are diagnosed late in pregnancy. However, when the diagnosis is made early, laparoscopic removal of the pregnancy should be performed.

Ectopic pregnancy - surgery - salpingostomy - salpingectomy

REFERENCES

• 1 Khan K S, Wojdyla D, Say L, Gulmezoglu A M, Van Look P P. WHO analysis of causes of maternal death: a systematic review.  Lancet. 2006;  367 1066-1076
• 2 Della-Giustina D, Denny M. Ectopic pregnancy.  Emerg Med Clin North Am. 2003;  21 565-584
• 3 Tenore J L. Ectopic pregnancy.  Am Fam Physician. 2000;  61 1080-1088
• 4 Buckley R G, King K J, Disney J D, Gorman J D, Klausen J H. History and physical examination to estimate the risk of ectopic pregnancy: validation of a clinical prediction model.  Ann Emerg Med. 1999;  34 589-594
• 5 Nederlof K P, Lawson H W, Saftlas A F et al.. Ectopic pregnancy surveillance, United States, 1970-1987.  MMWR CDC Surveill Summ. 1990;  39(4) 9-17
• 6 Hajenius P J, Mol B W, Bossuyt P M et al.. Interventions for tubal ectopic pregnancy.  Cochrane Database Syst Rev. 2000;  CD000324
• 7 Yao M, Tulandi T. Current status of surgical and non-surgical treatment of ectopic pregnancy.  Fertil Steril. 1997;  67 421-426
• 8 Bangsgaard N, Lund C O, Ottesen B, Nilas L. Improved fertility following conservative surgical treatment of ectopic pregnancy.  BJOG. 2003;  110 765-770
• 9 Silva P D, Schaper A M, Rooney B. Reproductive outcome after 143 laparoscopic procedures for ectopic pregnancy.  Obstet Gynecol. 1993;  81 710-715
• 10 Job-Spira N, Bouyer J, Pouly J L et al.. Fertility after ectopic pregnancy: first results of a population-based cohort study in france.  Hum Reprod. 1996;  11 99-104
• 11 Mol B W, Matthijsse H C, Tinga D J et al.. Fertility after conservative and radical surgery for tubal pregnancy.  Hum Reprod. 1998;  13 1804-1809
• 12 Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy.  Fertil Steril. 1999;  72 207-215
• 13 Habana A, Dokras A, Giraldo J L, Jones E E. Cornual heterotopic pregnancy: Contemporary management options.  Am J Obstet Gynecol. 2000;  182 1264-1270
• 14 Moon H S, Choi Y J, Park Y H, Kim S G. New simple endoscopic operations for interstitial pregnancies.  Am J Obstet Gynecol. 2000;  182 114-121
• 15 Meyer W R, Mitchell D E. Hysteroscopic removal of an interstitial ectopic gestation. A case report.  J Reprod Med. 1989;  34 928
• 16 Budnick S G, Jacobs S L, Nulsen J C, Metzger D A. Conservative management of interstitial pregnancy.  Obstet Gynecol Surv. 1993;  48 694-698
• 17 Ushakov F B, Elchalal U, Aceman P J, Schenker J G. Cervical pregnancy: Past and future.  Obstet Gynecol Surv. 1997;  52 45-59
• 18 Kung F T, Lin H, Hsu T Y et al.. Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection.  Fertil Steril. 2004;  81 1642-1649
• 19 Abossolo T, Sommer J C, Dancoisne P et al.. First trimester abdominal pregnancy and laparoscopic surgical treatment. 2 case reports of evolving abdominal pregnancy treated with laparoscopy at 10 and 12 weeks.  J Gynecol Obstet Biol Reprod (Paris). 1994;  23 676-680
• 20 Ben-Rafael Z, Dekel A, Lerner A et al.. Laparoscopic removal of an abdominal pregnancy adherent to the appendix after ovulation induction with human menopausal gonadotrophin.  Hum Reprod. 1995;  10 1804-1805
• 21 Dover R W, Powell M C. Management of a primary abdominal pregnancy.  Am J Obstet Gynecol. 1995;  172 1603-1604
• 22 Morita Y, Tsutsumi O, Kuramochi K et al.. Successful laparoscopic management of primary abdominal pregnancy.  Hum Reprod. 1996;  11 2546-2547
• 23 Kwok A, Chia K K, Ford R, Lam A. Laparoscopic management of a case of abdominal ectopic pregnancy.  Aust N Z J Obstet Gynaecol. 2002;  42 300-303
• 24 Costa S D, Presley J, Bastert G. Advanced abdominal pregnancy.  Obstet Gynecol Surv. 1991;  46 515-525
• 25 Rahman M S, Al-Suleiman S A, Rahman J, Al-Sibai M H. Advanced abdominal pregnancy-observations in 10 cases.  Obstet Gynecol. 1982;  59 366-372
• 26 Rahaman J, Berkowitz R, Mitty H et al.. Minimally invasive management of an advanced abdominal pregnancy.  Obstet Gynecol. 2004;  103 1064-1068
• 27 Tulandi T. Surgical treatment of ectopic pregnancy and prognosis for subsequent fertility. http://Available at: www.utdol.com/utd/content/topic.do?topickey=gyn_surg/5788&type=A&selectedTitle=4~31 Accessed August 7, 2006
• 28 Tulandi T, Kabli N. Laparoscopy in patients with bleeding ectopic pregnancy.  J Obstet Gynaecol Can. 2006;  28 361-362