Surgery for Ectopic Pregnancy
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
The place of conservative surgery
The place of conservative surgery
Total salpingectomy is the standard surgical method (Laparotomy for Ectopic Pregnancy). Conservative surgery (leaving the tube) increases the future chances of both ectopic and intrauterine pregnancies. This involves cutting diathermy to the anti-mesenteric border (salpingostomy/gotomy) and flushing the ectopic from the tube. Milking a fimbrial ectopic from the tube end and observing for bleeding may be acceptable.
The contralateral tube – Fertility or Sterilization
Following surgery to the affected tube, if fertility is an issue there may be benefit in clearing filmy peritubular adhesions on a contralateral tube, or even performing simple cruciate diathermy salpingostomy on a hydrosalpinx. Always record findings or surgery of the contralateral tube in the notes, this is the rate determining step in the chance of future pregnancy.
Some patients with ectopic pregnancies will appreciate tubal ligation as their families may be complete. Always ask about this before operating if the patient is stable.