Page 33 - WALS Journal

World Journal of Laparoscopic Surgery, May-August 2008;1(2):36-39
Babita Gupta
Role of Minimally Invasive Surgery in the

Treatment of Ectopic Pregnancy

Babita Gupta
Ex. Senior resident Kasturba Hospital, New Delhi, India
Ex. Senior resident of Safdarjung Hospital, New Delhi, India

Abstract: Ectopic Pregnancy, in which gestational sac is outside the Aims and Objectives: The aim of the review to summarize the role of
uterus, is the most common life-threatening emergency in early minimal access surgery as in the management of ectopic pregnancy.
pregnancy. The incidence of ectopic pregnancy (EP) has increased all Keywords: Ectopic pregnancy, operative laparoscopy, laparoscopic,
over the world from 0.5% thirty years ago, to a present day 1-2%. 1 salpingectomy, cornua, surgical treatment, minimal access surgery.
This complication of early pregnancy, results in not only fetal loss,
but also the potential for considerable maternal morbidity and the risk Material and Method
2-4
of maternal death. .
Until the risk factors that lead to EP are more fully understood, A literature search was performed using the search engine
early detection and appropriate management will be the most effective Google, highwire press and springerlink. Selected papers were
means of reducing the morbidity and mortality associated with this taken for the further references.
condition. 5-6 Although the incidence of EP increased, with the All articles, RCT, (randomized controlled trial) following
improvement of diagnostic approaches, patients were detected at an predominantly laparoscopic protocol were included for review.
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earlier stage and possible to be treated more conservatively. Surgery
8
remains the mainstay of treatment. Surgical treatments may be radical
(salpingectomy) or conservative (usually salpingostomy), and they Patients Selection of Laparoscopic Approach
9
may be performed by laparoscopy or laparotomy. Improved • Confirmed diagnosis
anesthesia and cardiovascular monitoring, together with advanced • Absent fetal heart beat
laparoscopic surgical skills and experience, justifies operative • Hemodynamic stable status
laparoscopy for surgical treatment of EP even in women with
hemodynamic instability. 10 • Accessibility for laparoscopic treatment and trained
Ectopic Pregnancy usually occurs 98% of cases in the uterine laparoscopist on duty.
tube. Trophoblast can be implanted at various sites:
Non-candidates for Laparoscopic Surgery
1. The ampulla (64%)
2. The isthmus (25%) • Large hemoperitoneum
3. The infundibulum (9%) • Unstable hemodynamic status (stage II or stage III shook)
4. The intramural junction (2%) • Severe pelvic adhesion
5. Ovarian (0.5%) • Refusal
6. Cervical (0.4%)
7. Abdominal (0.1%) Diagnosis
8. Intraligamental (0.05%)
1. Historical Features and Physical Findings
Ectopic pregnancy is usually diagnosed in the fist trimester of
pregnancy. The most common gestational age at diagnosis is 6
to 10 weeks. Documentation of risk factors is an essential part
of history-taking, and asymptomatic clinic patients with risk
factors may benefit from routine early imaging. However, more
than half of identified ectopic pregnancies are in women without
known risk factors. 11, 12
Risk factors associated with ectopic pregnancy include:
• Current use of intrauterine device
• Use of clomiphene citrate
• Prior tubal surgery

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