Laparoscopy for Ectopic Pregnancy is the most used surgery chosen by Obstetrics and Gynaecologists for its treatment. An ectopic pregnancy occurs as the fertilized egg gets attached to the organs other than within the uterus. Since a maximum number of ectopic pregnancies occur on the fallopian tube, it is also known as tubal pregnancies. The fallopian tubes are not meant to support the growing embryo. Hence, the fertilized egg cannot develop in a tubal pregnancy. It needs to be properly treated. An ectopic pregnancy occurs in 1 out of 50 pregnancies.
An ectopic pregnancy can fit into a fallopian tube in most ectopic pregnancies. In rare cases, the egg gets attached to the ovary, cervix, or the abdominal cavity and grows outside the reproductive system.
If one or more eggs develop in the uterus, and also in a fallopian tube, or the abdominal cavity, or cervix, it is called a heterotopic pregnancy.
The fertilized egg normally travels from the fallopian tube and reaches the uterus at the beginning of a pregnancy, where it infuses and develops. However, in some diagnosed pregnancies (link this with symptoms of pregnancy); the fertilized egg remains attached to the portion outside of the uterus. This results in an ectopic pregnancy, which is also called extrauterine pregnancy.
An ectopic pregnancy is not competent to support the fetus for a long time. It only grows large and ruptures the area it occupies. This causes heavy bleeding to the mother and endangers her. Women with symptoms of ectopic pregnancy should be provided with immediate medical care.
Complications of Ectopic Pregnancy
Ectopic pregnancy potentially damages the fallopian tube. It makes it difficult for women to become pregnant in the future.
Ectopic pregnancies, if detected early, can be handled to prevent severe complications like extreme bleeding. An ectopic pregnancy needs emergency surgery to stop severe bleeding into the abdomen. The ruptured tube is removed from the body through surgery.
The fastest treatment for ectopic pregnancy at any stage of development is the surgical removal of the fallopian tube section where the egg is implanted or the ectopic growth itself. Surgery becomes the only option if the woman undergoes internal bleeding. The surgery is done by making a small incision using laparoscopy. Such surgeries are the best relief providers and have a short recovery period.
Surgery Choices
An ectopic pregnancy growth can be removed from the fallopian tube by executing:
1. Salpingostomy, or
2. Salpingectomy
Salpingostomy – In this process, the ectopic growth is removed using a minor lengthwise cut made in the fallopian tube, also known as linear salpingostomy. The cut made during the surgery is left to close by itself. It can also be stitched to close.
Salpingectomy – In this process, the fallopian tube segment is removed. The remaining portion of the healthy fallopian tube is treated to be reconnected. Salpingectomy is required when the fallopian tube is stretched during pregnancy and it gets ruptured.
Salpingostomy and salpingectomy both can be executed through either a small incision done by using laparoscopy or through an open abdominal incision called a laparotomy. Laparoscopy can be executed in much lesser time than laparotomy. The hospital stay is hence shorter. However, laparotomy is often required for an abdominal ectopic pregnancy or in the case of emergency tubal ectopic removal.
Factors to Consider
The doctor always attempts to remove the pregnancy in the case of an ectopic pregnancy placed on a fallopian tube, rather than damaging or removing the tube.
Emergency surgery is required when the fallopian tube is ruptured in an ectopic pregnancy.
Future Fertility
The future fertility (to be linked with IVF/Infertility) and fear of having another ectopic pregnancy depend on various risk factors. These include:
1. Excessive smoking
2. Excessive alcohol consumption
3. Use of assisted reproductive technology (ART) for getting pregnant
4. The extent of fallopian tube damage
As long as the mother has one healthy fallopian tube, small tubal slit or salpingostomy and salpingectomy (a portion of a tube removed) have almost the same effect on the future fertility. In case the other tube is damaged, the doctor may attempt to do a salpingostomy. It improves the chances of the woman getting successfully pregnant in the future.
Sadly, the baby cannot be saved in case of an ectopic pregnancy. The entire treatment is to remove the pregnancy before it develops large and endangers the mother.
The treatment options for ectopic pregnancy are:
Expectant management – In this treatment process the mother’s condition is carefully monitored and then the necessary treatment is finalized.
Medication – Methotrexate medication is given to stop the pregnancy growing.
Surgery – Surgery is the option to remove the pregnancy, along with discarding the affected fallopian tube.
The advantages and disadvantages of the above-mentioned options will be discussed by your doctor with you.
Your doctor will recommend you the option which is most suitable for you. It is determined based on certain factors like:
1. Size of the pregnancy
2. Level of pregnancy hormone i.e., human chorionic gonadotropin or HCG in the blood.
Surgery
Keyhole surgery or laparoscopy is carried out to discard the pregnancy before it develops too large.
During a laparoscopy:
The mother is given a general anesthetic so that she falls asleep while the laparoscopy is carried out.
1. Incisions or small cuts are made in the tummy
2. The laparoscope, which is a small thin viewing tube surgical instrument, is inserted through the incisions.
3. The entire fallopian tube that contains the pregnancy is removed
4. If the other fallopian tube looks healthy, it is left uninterrupted.
5. In cases of ruptured fallopian tubes, the pregnancy is removed along with the entire tube.
The most effective treatment of ectopic pregnancy is to remove the affected fallopian tube. It reduces the chances of becoming pregnant yet again. Discuss with your doctor about this beforehand. The doctor will ask for your consent for having the tube removed.
Recovery from Laparoscopy for Ectopic Pregnancy
Most women are released from the hospital after a few days of the surgery. However, it can take four to six weeks for a woman to fully recover from it.
The mother is operated by an emergency surgery if her fallopian tube has already ruptured. The laparoscopic surgeon can make a bigger incision in the tummy to stop the internal bleeding. It is known as a laparotomy that repairs the fallopian tube.
Anti-D rhesus prophylaxis treatment is given to the mother after either type of surgery if her blood type is RhD negative. It involves an injection that helps to prevent the possibilities of rhesus disease in her future pregnancies.
Conclusion
Laparoscopic treatment, both salpingostomy, and salpingectomy offer maximum benefits than laparotomy in terms of:
1. Minimum blood loss
2. The requirement of less blood transfusion
3. The minimum need for postoperative analgesia and last but not least,
4. A shorter hospital stay
The process of laparoscopic removal of the baby from the mother’s fallopian tubes is one of her greatest loss. This loss means a lot for the mother who has nurtured and dreamt of her baby for long.
Speak up at your appointments with us if you have any signs of an ectopic pregnancy. Make you acquainted with the tests that we prescribe for diagnosis. Discuss the procedure of this treatment on you and your probability of getting pregnant again. You have to be sure in all aspects before going for such a major decision.
After an ectopic pregnancy, the mother needs to heal both physically and emotionally. Ask every lingering question that you might have to your health care provider. You can expect your healing to take some time. Share the emotions that you are feeling in this period with your partner. Talk to your loved ones and other close friends. You can seek support from someone else who has experienced an ectopic pregnancy. Remember, you are not alone. There are many women who go through this and will understand your pain.