Page 30 - WJOLS - World Journal of Laparoscopic Surgery

REVIEW ARTICLE
Ectopic Pregnancy: Laparoscopic Conservative Treatment and

Laparoscopic Salpingotomy

Bassim Alsadi

AbstrAct
Objective: Whether a laparoscopic salpingostomy should be done or a salpingectomy for surgical treatment of ectopic pregnancy.
Materials and methods: Literature examining and review the impact of recent advances in the diagnosis and laparoscopic conservative
treatment of ectopic tubal pregnancy. Articles published in English language using the following search engines: Medline, Pubmed, Medscape,
and Cochrane Database of Systematic Reviews.
Results: The choice of salpingostomy or salpingectomy relies upon many factors and includes shared decision-making between the surgeon
and patient. Laparoscopic surgery remains the “gold standard” in majority of women.
Conclusion: There is some evidence to suggest that future fertility outcomes are slightly improved after tubal conservation at surgery in
comparison with salpingectomy. As the incidence of ectopic pregnancy continues to rise in a population that will likely desire future fertility,
early diagnosis is key in facilitating safe utilization of more conservative management in the hope of preserving tubal function and reproductive
potential.
Keywords: Ectopic pregnancy, Laparoscopy, Salpingectomy, Salpingotomy, Ultrasound.
World Journal of Laparoscopic Surgery (2018): 10.5005/jp-journals-10033-1347

IntroductIon
Department of Obstetrics and Gynaecology, University Hospital of
An ectopic pregnancy is an extrauterine pregnancy in which North Tees and Hartlepool, Stockton on Tees, UK
a fertilized ovum implants outside the uterine cavity. Ectopic Corresponding Author: Bassim Alsadi, Department of Obstetrics
implantation occurs in 2% of all pregnancies and often affects and Gynaecology, University Hospital of North Tees and Hartlepool,
1,2
young women who desire future fertility. Stockton on Tees, UK, Phone: +4407838555994, e-mail: balsadi@
Theoretically, factors that impede migration of the conceptus to hotmail.com
the uterine cavity may predispose a woman to develop an ectopic How to cite this article: Alsadi B. Ectopic Pregnancy: Laparoscopic
gestation. These may be intrinsic anatomic defects in the tubal Conservative Treatment and Laparoscopic Salpingotomy. World J Lap
epithelium, hormonal factors that interfere with normal transport Surg 2018;11(3):138–146.
of the conceptus, or pathologic conditions that affect normal tubal Source of support: Nil

functioning. Conflict of interest: None

Ectopic pregnancy occurs when the developing blastocyst
becomes implanted at a site other than the endometrium of the
uterine cavity. The most common extrauterine location is the In a retrospective study of 2,026 pregnant women who
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fallopian tube, which accounts for 98% of all ectopic gestations. presented to the emergency department with first trimester vaginal
In addition to the immediate risks of life threatening bleeding and abdominal pain, 376 (18%) were diagnosed with
hemorrhage and those related to its treatment, women with ectopic ectopic pregnancy. Of these 376 women, 76% had vaginal bleeding
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pregnancies have a subsequent increased risk of infertility and and 7% had abdominal pain. In a population-based registry of
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recurrent ectopic pregnancy. ectopic pregnancy from France, the incidence of rupture was 18%.
Ectopic pregnancy remains the leading cause of maternal There has been a rise in the incidence because of a dramatic
morbidity and occasionally mortality in the first trimester of increase in sexually transmitted disease, use of intrauterine device
pregnancy especially in the developing countries, for example, for contraception, and iatrogenic-induced complications which
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1–3% all ectopic in Cameroon. result from an increase in the administration of in vitro fertilization
Avoidance of tubal damage is the best strategy to prevent (IVF).
ectopic pregnancies and maintain reproductive potential. Risk factors for ectopic pregnancy should be elicited, including
The prevalence of ectopic pregnancy among women with prior ectopic pregnancy, current use of an intrauterine device, prior
symptoms such as first trimester bleeding, pain, or both ranges tubal ligation, and IVF (Table 1). However, over 50% of women are
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from 6 to 16%, and the physical findings depend on whether tubal asymptomatic before tubal rupture and do not have an identifiable
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rupture has occurred. risk factor for ectopic pregnancy.
Women with intraperitoneal hemorrhage present with A population-based French study identified four factors
significant abdominal pain and tenderness, along with various that increased the risk of rupture when an ectopic pregnancy
degrees of hemodynamic instability. However, women without was suspected: (1) never having used contraception, (2) history
rupture may also present with pelvic pain or vaginal bleeding, or of tubal damage and infertility, (3) induction of ovulation, and
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both. Ectopic pregnancy may also be asymptomatic. (4) high level of human chorionic gonadotropin (hCG, at least
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