Laparoscopic Ectopic Pregnancy Evacuation Treatment | Obstetrics Treatment | Gynaecology Treatment | Ectopic Pregnancy Treatment

What is Ectopic pregnancy?

Once the egg gets fertilized, it travels down the fallopian tube to uterus. But when the tubes are damaged or blocked and fail to propel the egg toward the womb, the egg may become implanted in the tube and continue to develop there. Because almost all Ectopic pregnancies occur in one of the fallopian tubes, they are often called "tubal" pregnancies. Much less often, an egg implants in an ovary, in the cervix, directly in the abdomen, or even in a c-section scar. In rare cases, a woman has a normal pregnancy in her uterus and an Ectopic pregnancy at the same time. This is called a heterotopic pregnancy and it's more likely to happen if one has had fertility treatments, such as in-vitro fertilization.

There's no way to transplant an Ectopic (literally, "out of place") pregnancy into the uterus, so ending the pregnancy is the only option. In fact, if an Ectopic pregnancy is not recognized and treated, the embryo will grow until the fallopian tube ruptures, resulting in severe abdominal pain and bleeding. It can cause permanent damage to the tube or loss of the tube, and if it involves very heavy internal bleeding that's not treated promptly, it can even lead to death. Fortunately, the vast majority of Ectopic pregnancies are caught in time.

What are the causes?

Many factors are known to increase the risk of having an Ectopic pregnancy. Anything that alters the tubal function may affect further pregnancies. Fallopian tubes are not like a hollow pipe that sits there with the egg rolling down. They have little hairs on the inside (cilia) which move with a wave-like motion to encourage the egg toward the womb. If the tube becomes blocked or the cilia damaged then ectopic is more likely. Besides this, there are some risk factors, like:

Advancing age Pelvic inflammatory disease - eg. previous Chlamydia or gonorrhoea. Infection causes scar tissue adhesions in the tube and may damage the cilia. PID is one of the main causes of the increase seen in Ectopic pregnancies in recent years. Risk of an Ectopic pregnancy increases about 7-fold after a woman suffers acute pelvic infection. Tubal surgery - women who have had operations on their tubes are more at risk of Ectopic. This includes tubal ligation, reversal of sterilisation or tubal surgery for a previous Ectopic. Previous Ectopic - about 10-20% of those attempting pregnancy after one Ectopic will have another. DES exposure - this is a drug that was once used during pregnancy, until it was found that female babies of women who used it were at risk of developmental abnormalities of the genital system. Their tubes are more likely to be abnormal and predisposed to Ectopic pregnancy. This is a very rare problem. Previous termination of pregnancy - the risk of ectopic increases among those who have had two or more terminations, particularly if there was infection afterwards. IVF (test-tube baby) and ovulation induction - both these techniques of assisted reproduction are associated with increased chances of Ectopic pregnancy.

What are the symptoms?

Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent urination. Ectopic pregnancy can exhibit any of the following symptoms:

Abdominal or pelvic pain or tenderness. It can be sudden, persistent, and severe but may also be mild and intermittent early on. You may feel it only on one side, but the pain can be anywhere in the abdomen or pelvis and is sometimes accompanied by nausea and vomiting. Vaginal spotting or bleeding. If you're not sure you're pregnant yet, you may think you're getting a light period at first. The blood may look red or brown like the colour of dried blood, and may be continuous or intermittent, heavy or light. Pain that gets worse when you're active or while moving your bowels or coughing. It's a medical emergency when: There is severe shoulder pain. Cramping and bleeding can mean many things, but pain in the shoulder, particularly when one is lying down, is a red flag for a ruptured Ectopic pregnancy. The cause of the pain is internal bleeding, which irritates nerves that go to the shoulder area. There are signs of shock, such as a weak, racing pulse; pale, clammy skin; and dizziness or fainting. This generally indicates that a fallopian tube has ruptured.

How is it diagnosed?

Ectopic pregnancy can be tricky to diagnose. If your symptoms suggest this type of pregnancy, your caregiver will do several tests to try to confirm the diagnosis:

A blood test- to check level of the pregnancy hormone human chorionic gonadotropin (hCG). If it's high enough to suggest pregnancy, but not as high as it should be at your stage, the pregnancy may be ectopic. If you're not in pain and there's still some question about the diagnosis, the test may be repeated in two to three days. If your hCG level doesn't increase as it's supposed to, this probably indicates either an Ectopic pregnancy or a miscarriage.

A vaginal exam- If the vaginal area is very tender or your caregiver detects a mass or an enlarged fallopian tube, an Ectopic is likely the cause.

An ultrasound- If the sonographer can see an embryo in the fallopian tube, you definitely have an Ectopic pregnancy. But in most cases, the embryo will have died early in the process and be too small for the sonographer to find. Instead, she may notice that a fallopian tube is swollen, and may see blood clots as well as tissue that remain from the embryo.

If the diagnosis remains unclear, your tubes may be examined more closely by using laparoscopic surgery, a procedure that may also be used to treat an Ectopic pregnancy and remove the embryo (see below).

What are the treatment options?

Once an Ectopic is diagnosed, there are several different treatments. It is not possible to take the pregnancy from the tube and put it into the womb. The options are as follows:

Expectant management

A proportion of all Ectopic will not progress to tubal rupture, but will regress spontaneously and be slowly absorbed. This may be appropriate if the level of hCG is falling and a woman is clinically well.

Medical treatment

This is done with a drug, which is given by injection. The drug is injected into a muscle and reaches the embryo through your bloodstream, where it ends the pregnancy by stopping the cells of the placenta from growing. Only a few Ectopic can be treated this way, which is the least invasive. Certain criteria must be fulfilled, such as small diameter of the Ectopic and low level of hCG. Close follow-up with further scans and blood tests is also necessary.

Open surgery or Laparotomy

This involves a 5cm incision at the top of the pubic hairline. The affected tube is brought out and either salpingotomy or salpingectomy performed. This is a major surgery and since the incisions are bigger compared to laparoscopic ones, it takes more time to heal.

Laparoscopic surgery

This is also called 'keyhole' surgery. Previously, salpingectomy by Laparotomy was the gold standard for the treatment of Ectopic pregnancy. The laparoscope has virtually eliminated the need for Laparotomy. Currently, Laparotomy is the preferred technique when the patient is hemodynamically unstable. Ofcourse it also depends on how clear the diagnosis is, how big the embryo is.

The surgeon will examine your tubes with a tiny camera inserted through a small cut in your navel and can often remove the embryo or remaining tissue while preserving your tube. (However, if there's extensive damage to the tube or you're bleeding profusely, the tube may need to be removed.) Laparoscopic surgery requires general anaesthesia, special equipment, and a surgeon experienced in the technique, and you'll need about a week to recuperate.

It may be possible to either open the tube and remove the pregnancy (salpingotomy), or remove the tube altogether (salpingectomy). The decision on which of these options is taken is very specific to each patient. In some cases - for example, if you have extensive scar tissue in the abdomen or heavy bleeding, or the embryo is too large - it may not be possible or expedient to use laparoscopic technology. If this is the case, you'll need major abdominal surgery.

By using a suction irrigator, the products of conception are flushed out

What is the prognosis?

The earlier you end an Ectopic pregnancy, the less damage you'll have in that tube and the greater your chances will be of carrying another baby to term. And even if you do lose one of your tubes, you can still have a normal pregnancy as long as your other tube is normal. If and when you do conceive again, call your health practitioner as soon as you suspect that you might be pregnant so that she can schedule you for an early sonogram and monitor you closely. Overall, your chances of having another Ectopic pregnancy are about 10 to 15 percent, depending on what caused the first one and what type of treatment you had. That means that your overall chances of having a normal pregnancy next time are still very high - about 85 to 90 percent.

If, on the other hand, you're unable to conceive because of Ectopic pregnancies or damaged tubes, the good news is that you're likely to be an excellent candidate for fertility treatments such as in vitro fertilization (IVF), in which your healthy embryos are implanted directly in your uterus.

Benefits and drawbacks

So Laparoscopic hysterectomy has many advantages like:

Less postoperative pain May shorten hospital stay May result in a quicker return to bowel function Quicker return to normal activity Better cosmetic results

So, if we were to compare an open surgery with a laparoscopic surgery, we can display it in a nutshell as under:

LAPAROSCOPIC OPEN Small Incisions (less than ½ an inch) Large Incision Hospital stay is 1 to 3 days Hospital stay of about 5 days Patients usually return to work in 5 to 10 days Return to work in about 4 weeks Lesser risk of Infection Greater risk of infection Less pain More painful Less chance of hernias More chance of hernias

For more information, kindly visit : http://www.aasthahealthcare.com/Laparoscopic-Ectopic-Pregnancy-evacuation-Treatment.htm ------------------------------------