What Is the Surgical Management of Ectopic Pregnancy?

Ectopic pregnancy is a medical condition in which an embryo implants outside the uterine cavity, most commonly in the fallopian tube; thus, ectopic pregnancy is also known as tubal pregnancy.

This is a potentially fatal condition that affects at least 1 in every 1,000 pregnancies. Unfortunately, there is no chance of the pregnancy surviving or reaching term.

8 common causes of ectopic pregnancy

1. History of infertility
2. History of previous ectopic pregnancy
3. History of pelvic infection or tubal damage
4. History of pelvic surgery including sterilization
5. Previously used an intrauterine contraceptive device
6. Undergoing assisted conception such as in vitro fertilization
7. Hormonal imbalance, malfunction of the uterus and tube, and infection can all impair the tubes normal function and result in ectopic pregnancy
8. Abnormal lifestyle such as smoking or drinking alcohol may lead to ectopic pregnancy

Early symptoms of an ectopic pregnancy may be very similar to typical pregnancy.

3 early symptoms of ectopic pregnancy

1. Vaginal bleeding
2. Pain in the lower abdomen, pelvis, and lower back
3. Dizziness or weakness

If the fallopian tube ruptures, pain, and bleeding could be severe enough to cause additional symptoms, such as:

• Fainting
• Hypotension (low blood pressure)
• Shoulder pain
• Rectal pressure

When a tube bursts, you may feel sharp lower abdominal pain. This is a medical emergency, and you may need to contact a doctor immediately.

Ectopic pregnancy is typically treated with medications, surgery, or observation. The type of management is determined by the severity of the woman.

Conservative/observation management

Expectant management is effective in managing ectopic pregnancy in 40 to 80 percent of cases but entails a risk of rupture and potentially fatal shock.

A good candidate for expectant management has a beta-hCG level less than 1,000 mIU/mL and declining further daily, an ectopic mass less than three centimeters, no fetal heartbeat, and agrees to comply with follow-up requirements.

Medical or pharmacological management

• Methotrexate is a chemotherapy drug that prevents pregnancy growth. It is a medical procedure used to dissolve an ectopic pregnancy.
• If the ectopic pregnancy is small and pregnancy hormone levels are not high, medical treatment is likely to be safe.
• Methotrexate is administered through a single injection in the arm. In some cases, an infusion drip into a vein may be required.
• Concurrently, pregnancy hormone levels would be measured.

Temporary side effects of medical management of ectopic pregnancy include:

• Abdominal pain
• Nausea and vomiting
• Indigestion
• Mouth ulcers
• Sensitivity to light
• Fatigue

It may, on rare occasions, affect the liver or blood counts.

Surgical management

• As described earlier, surgical management is one way of treating an ectopic pregnancy. In emergency circumstances, this may be the only choice. The operation is usually performed under general anesthesia.

Whether you get methotrexate or have surgery to treat an ectopic pregnancy, you'll need to see the doctor for several weeks. The doctor will check your pregnancy hormone levels to ensure they are normal.

To catch an ectopic pregnancy early, go to the doctor as soon as you find out you're pregnant, especially if you've had an ectopic pregnancy before. It is recommended that you see a doctor between six and eight weeks of gestation (about two to four weeks after your missed period) to rule out ectopic pregnancy.

Having a previous ectopic pregnancy is the most dangerous risk factor for an ectopic pregnancy. That means that women who have a history of ectopic pregnancy should see their doctor as soon as the pregnancy is discovered.