11 - Surgical management of tubal ectopic pregnancy

Summary

Introduction

Tubal ectopic pregnancies have historically been treated by laparotomy, with removal of the affected tube considered the definitive treatment. This remains the preferred option in cases complicated by major intraperitoneal bleeding and haemorrhagic shock. However, owing to the wide availability of transvaginal ultrasound and sensitive urine pregnancy tests, nowadays most tubal ectopic pregnancies are diagnosed in women who are haemodynamically stable with minimal clinical symptoms. This has led to the introduction of less invasive options for the surgical treatment of tubal ectopic pregnancies. This chapter reviews current strategies for surgical treatment of tubal ectopic pregnancy, focusing on the advantages and disadvantages of the various approaches.

Indications for surgical treatment of tubal ectopic pregnancy

Laparoscopic surgery has evolved from being a main diagnostic to a primary treatment modality as a result of the improved accuracy of non-invasive diagnosis of tubal ectopic pregnancy. In women with a confirmed diagnosis of tubal ectopic pregnancy, the following are the indications for surgical treatment:

1. • woman who is haemodynamically unstable or evidence of significant intraperitoneal bleeding on ultrasound

2. • viable tubal ectopic pregnancy

3. • significant clinical symptoms

4. • initial serum human chorionic gonadotrophin (hCG) over 3000 iu/ml

5. • failure of or non-compliance with medical or expectant management

6. • heterotopic pregnancy with a normal viable intrauterine gestation.

Surgery should not be delayed in women with suspected tubal pregnancy showing signs of hypovolaemic shock.