Ectopic Pregnancy Surgery : Every Thing You Need To Know

Ectopic Pregnancy Surgery: Treating Abnormal Pregnancy Outside the Uterus

Ectopic pregnancy surgery aims to remove pregnancies that develop in locations other than the uterus, primarily within the fallopian tubes. In rare cases, the fertilized egg may implant in the cervix, ovary, abdomen, or prior cesarean scar.

Since pregnancies outside the uterus cannot progress normally and pose risks of rupture, immediate medical or surgical intervention is crucial.

While the general management of ectopic pregnancies follows a similar approach, this article specifically focuses on surgical treatment for ectopic pregnancies occurring within the fallopian tubes.

Ectopic Pregnancy Surgery: Removing Pregnancy Outside the Uterus

Ectopic pregnancy surgery is a procedure performed by an obstetrician-gynecologist (OB/GYN) under general anesthesia.

Two types of surgeries there are:

A. Salpingectomy:

• The surgeon removes the pregnancy tissue along with part or all of the damaged fallopian tube. This is done when the tube is severely affected or there is heavy bleeding.

B. Salpingostomy:

• The surgeon removes the pregnancy tissue and repairs the fallopian tube. This option is chosen when the tube is in better condition and future fertility is desired.

The specific surgery depends on factors like the condition of the fallopian tube, size of the ectopic pregnancy, and the patient’s future plans for having children. Some may opt for a bilateral salpingectomy to permanently prevent pregnancy, while others may preserve the tube for future fertility.

Regardless of the surgical approach, the chances of future pregnancy are similar as long as the remaining fallopian tube is healthy.

Different Surgical Approaches for Ectopic Pregnancy

Ectopic pregnancy surgery can be performed using two main approaches. Let’s explore each method:

1. Laparotomy:

• This surgical procedure involves making a large incision in the abdomen to remove the ectopic pregnancy tissue. It usually requires a hospital stay of one to five nights. This approach is used in emergency situations, such as when there is severe internal bleeding or extensive scar tissue present in the abdomen.

2. Laparoscopic surgery:

• This minimally invasive procedure involves inserting small surgical instruments, including a camera, through small incisions in the abdomen. The surgeon uses these tools to remove the ectopic pregnancy. Patients typically go home on the same day as the surgery, and the recovery time is quicker compared to laparotomy.

Laparoscopic surgery is considered the preferred and safest option for treating ectopic pregnancies. It has higher success rates and fewer complications.

Contraindications

• However, certain medical conditions, such as ectopic pregnancy surgery, underlying heart or lung disease, may increase the risks associated with surgery. The decision to proceed with surgery in these cases requires careful consideration of the potential benefits and risks.

Potential Risks of Ectopic Pregnancy Surgery

• Possible risks of ectopic pregnancy surgery include infection, bleeding, anesthesia-related issues, formation of scar tissue (adhesions), and the rare possibility of injury to nearby organs like the bladder or intestines. Retained pregnancy tissue is a concern primarily in cases where a salpingostomy procedure is performed.

It is important to discuss these risks and considerations with your healthcare provider to make an informed decision about the most appropriate surgical approach for your specific situation.

Purpose of Ectopic Pregnancy Surgery:

• Remove developing embryo to prevent life-threatening complications.
• Typically a last resort after considering medical management with methotrexate.
• Indications include unstable vital signs, suspected ruptured fallopian tube, or unsuccessful methotrexate treatment.
• This treatment may not be suitable for individuals due to drug sensitivity, logistical challenges, or specific health conditions such as breastfeeding, kidney disease, or chronic liver disease.

Pre-Surgery Testing for Ectopic Pregnancy:

• Diagnosis through transvaginal ultrasound and hCG measurement.
• Additional blood tests (CBC, CMP) help assess methotrexate suitability.
• Blood tests, ECG, and other tests evaluate patient’s medical condition before surgery.

Preparing for Ectopic Pregnancy Surgery:

• Location: Surgeons will perform the surgery in a hospital or surgical center.
• Attire: Wear comfortable clothes that are easy to remove, and avoid makeup and jewelry.
• Food and Drink: Follow instructions to abstain from eating or drinking before surgery.
• Medications: Discontinue medications that increase bleeding risk as advised by the surgeon.
• Informing the Team: Provide a complete list of all medications, supplements, and recreational drugs to the surgical and anesthesia team.
• Essential Items: Bring a sanitary pad, loose-fitting clothing, identification, insurance card, and have someone to drive you home.
• Overnight Stay: If staying in the hospital, pack necessary medical devices, comfortable clothes, non-skid slippers, personal toiletries, and personal items for comfort.
• Lifestyle Changes: Quit smoking prior to surgery to reduce the risk of complications.
• Follow Surgeon’s Instructions: Adhere to any additional guidelines or preparations provided by your surgeon.

What You Can Anticipate on the Day of Surgery

On the day of your surgery, you’ll go to the hospital or surgical center and check in. They may ask for your ID to make sure it’s you.

Before the Ectopic Pregnancy Surgery

What happens before your surgery may vary depending on your doctor and your situation, but here are the general steps:

• After checking in, you’ll go to a special area where you’ll change into a hospital gown. A nurse will ask about the medicines you take, check your vital signs like your heart rate and blood pressure, and put a small tube called an IV in your hand or arm for give you liquid fluids and medicines.
• Your surgeon will come and talk to you about the operation and you might need to sign a paper giving your permission for the surgery. The anesthesiologist, who will make sure you’re asleep and comfortable during the surgery, will also come and explain what they’ll do and any risks involved. Then, the medical staff will transport you to the operating room either by having you walk or by using a bed with wheels.

During the Ectopic Pregnancy Surgery

• When you enter the operating room, the surgical team will transfer you to a table. The anesthesiologist will then give you medication either through a mask that you breathe in or through an IV to make you fall asleep. You won’t remember anything that happens during the surgery after this point.
• Following that, the medical staff will insert a breathing tube known as an endotracheal tube into your windpipe. This tube is connected to a machine called a ventilator, which will assist you in breathing throughout the surgery.

Ectopic pregnancy surgery usually takes around 45 to 90 minutes. Here’s what generally happens during the surgery:

• Incision

The surgeon will make one or more cuts on your abdomen. Whether it is a laparotomy (one big cut) or laparoscopy (several small cuts) determines the size and number of cuts.

•  Visualization

The surgeon will look at the fallopian tube that has the ectopic pregnancy through the cuts. Sometimes, they may pump carbon dioxide gas into your abdomen to see better.

• Salpingectomy

The surgeon may remove part or all of the fallopian tube with the ectopic pregnancy using special tools like clamps, scissors, and heat-emitting devices.

• Salpingostomy

Alternatively, the surgeon may make a cut in the tube where the ectopic pregnancy is and remove the tissue with a suction tool.

If it’s a laparoscopy, they will put the tissue in a pouch and take it out of your abdomen. The medical staff will allow the cut in the tube to heal on its own.

• Closure

During ectopic pregnancy surgery You will receive stitches, surgical glue, or tape to close the cuts on your abdomen, and the medical staff will cover them with a dressing.

• Pathology Review

The medical professionals may send the removed tissue to a lab to confirm that it was an ectopic pregnancy.

Post Surgery

• After the surgery, the medical staff will remove the breathing tube and transfer you to a recovery room. There, you’ll slowly wake up from the anesthesia. A nurse will keep an eye on your vital signs and help you with any pain or nausea you might feel after the surgery.
• Once you are fully awake and alert, the medical staff will either permit you to go home (if you had a laparoscopy) or transport you to a hospital room (if you had a laparotomy).

Recovery After Ectopic Pregnancy Surgery

1. After your laparoscopic ectopic pregnancy surgery, you should be able to go back to your normal activities within about a week.
2. If you had a laparotomy, it may take two to six weeks to fully recover.
3. During your recovery, you might feel soreness and swelling in your belly.
4. You may also have some mild nausea for a day or two.
5. Make sure to take the pain medicine your doctor gave you as instructed.
6. Eating plain and light foods like toast, crackers, and chicken broth can help with this.
7. It’s normal to have vaginal bleeding for one to four weeks after the surgery.
8. To avoid infections, your doctor may ask you not to use tampons during your recovery.

Contact Your Surgeon: When to Reach Out

It’s important to get in touch with your surgeon if you encounter any of the following situations:

• Fever

  When your body temperature goes higher than normal , it means you have a fever. It usually happens when your body is fighting off an infection or illness. But if you have high fever after ectopic pregnancy surgery, it needs doctor attention.

• Heavy vaginal bleeding accompanied by clots or unusual discharge

  If you notice that you are bleeding heavily from your vagina, especially if there are big clots or strange-looking discharge, after ectopic pregnancy surgery, it could be a sign of something wrong. You should seek medical attention to figure out the cause.

• Feeling lightheaded or experiencing fainting spells

  Lightheadedness is the term used to describe the feeling of dizziness or the sensation of potential fainting. Sometimes people even faint, which means losing consciousness for a short time. These symptoms can be a sign of a health problem and you should take it seriously.

• Persistent pain that isn’t relieved by medication

  If you have ongoing pain that doesn’t go away even after taking pain medication, it could be a sign that something is not right. It’s important to let your doctor know about this so they can investigate the cause of the pain and give appropriate treatment.

• Continuous nausea and vomiting

  Experiencing nausea and vomiting is when you feel sick to your stomach and repeatedly throw up. If these symptoms don’t go away and keep happening over a period of time, it’s important to consult a doctor to find out what’s causing them.

• Indications of surgical site infections, such as redness, swelling, or abnormal drainage

  If you notice any signs of infection around the Ectopic pregnancy surgical site, such as redness, swelling, or abnormal fluid drainage, after recently undergoing surgery, it could indicate that the wound is infected. You should contact your healthcare provider to get proper treatment.

• Increasing abdominal swelling

  If you feel, After the surgery your belly is becoming larger and swollen? We refer to it as abdominal swelling. This could be a sign of a medical condition, such as fluid buildup or an underlying problem with your organs. It’s important to have it checked by a doctor to determine the cause.

If you experience any of these symptoms, reach out to your surgeon for further guidance and medical attention and figure out the cause.

Also Read -> How To Recognize And Treat Ectopic Pregnancy?

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Brinda