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Definition:
Ectopic pregnancy occurs
when the fertilised egg is
implanted outside the
womb.
Female Pelvic Anatomy
Risk Factors
High:
Tubal surgery, tubal sterilization, previous
ectopic, PID, IUD, tubal pathology
Moderate:
Infertility, previous genital infection, IVF.
Slight:
Previous pelvic/abdominal surgery, smoking,
douching,intercourse prior to 18 years of age
Types of Ectopic Pregnancy
Interstitial: gestation
implants in the interstitial
portion of the fallopian
tube.
Cervical
Vaginal
Broad ligament
900
800
700 LOW!!!!!
600
BhCG (U/L)
500
400
300
200
100
0
12/23/2005 12/25/2005 12/27/2005 12/30/2005 1/4/2006 1/6/2006 1/9/2006
DATE
Other Labs:
Complete blood count
Leukocytosis
Salpingectomy (Radical)
Tubal resection
1. Laparoscopy
• “Key hole” surgery
• Recommended approach
Advantages:
Less blood loss, decreased number of transfusions, less recovery time, less post-op
analgesia, cost effective
Contraindications:
ruptured EP, haemodynamic instability, surgeon’s lack of experien
Surgical options (cont’d)
2. Laparotomy
Surgical incision
through the abdominal
wall
Pfannensteil incision
Mainly used for cases
involving
haemodynamic
instability
Pre-Operative Work-Up
1. Full blood count (leukocytosis)
2. Blood group serology
3. Coagulation workup
4. Vital signs → stable for surgery
5. Review tests
• βhCG- ectopic still present
• US imaging- location, size
6. Medications:
• NKDA, GA (no allergy)
Patient Preparation
7. Pre-op nutrition- fasting (unless emergency)
8. Bowel prep- enema
9. Shave suprapubic hair
10. Patient information
• Risks and complications
• Risks of conversion to laparotomy
• Risks of salpingectomy
Surgical Complications
Laparoscopic Tools
Video monitor
1. Bipolar grasper
2. Atraumatic grasper
3. Grasping forceps
4. Toothed forceps
5. Sharp-tipped monopolar device
6. 5-10mm suction-irrigation
device
7. Scissors
Anatomical Review
1. Medial tubal A.
2. Lateral tubal A.
3. Uterine A.
4. Ovarian A.
Laparoscopic Salpingectomy
Caution:
• Endometriosis
• Utero-peritoneal fistula
Post-operative Plan
Remove urinary catheter and NG tube
Observation and analgesia
Remove IV on the evening of the procedure
Food on evening of procedure
Discharge following day
Discuss use of contraceptives
Pregnancy 2-3 months post-op (2-3 cycles)
Information regarding the risk of ectopic recurrence
The End