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Ectopic pregnancy removal – laparoscopic: The operation
Ectopic pregnancy removal – laparoscopic: The operation
If you would like to learn about ectopic pregnancy, and the treatment of ectopic pregnancy, you will be interested in the following information.
If you are considering having a ectopic pregnancy operation or have an ectopic pregnancy operation planned, it is important to know all you can about it. This includes:
- why you need this operation
- what it will be like
- how it will affect you
- what risks are involved
- any alternatives.
The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when carrying out an ectopic pregnancy operation, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.
What is the problem?
You probably have pains in your lower abdomen. You may have collapsed because of bleeding inside your abdomen. We think you have an ectopic pregnancy.
What is an ectopic pregnancy?
Ectopic means ‘out of place’. An ectopic pregnancy is when a pregnancy starts outside your uterus instead of inside. The embryo often develops in either of your Fallopian tubes. This is called a tubal pregnancy. If not tubal, the pregnancy could be in your ovary or some other part of your pelvis.
An ectopic pregnancy is dangerous because of the risk of very serious internal bleeding. It needs to be dealt with quickly.
What are the uterus, Fallopian tubes and ovaries?
To explain where your uterus, Fallopian tubes and ovaries are, and what they do, the best place to start is at the vagina.The vagina is a tube about five inches long. It runs from just in front of the rectum up into the pelvis. It is just behind your bladder. Just in front of the vagina the bladder has it’s opening where the urine comes out. This is called the urethra.
The uterus is at the top of the vagina. It is about the size of your clenched fist. It is made of special thick muscle, but it is hollow inside with a special lining called the endometrium. The lowest part of your uterus, which juts into your vagina, is ‘the neck of the womb’, also called your cervix. Cervical smears are taken from the surface of your cervix. The main part of the uterus is called the body. At the top of the uterus there are two hollow tubes called the Fallopian tubes. There is one on each side. These end close to the ovaries. Your ovaries are slightly smaller than a golf ball. They lie deep in your pelvis just below your waist. Your ovaries make hormones and contain tiny eggs, which are too small to see with the naked eye.
What do the uterus, Fallopian tubes and ovaries do?
The uterus is where a baby normally develops during pregnancy. About once a month an egg in one of the ovaries grows and breaks free from the ovary. It moves into the Fallopian tube and travels down the tube towards the uterus. At the same time, hormones make the endometrium thicker so that if the egg is fertilised by a sperm it can lodge in the uterus.
Often, the egg is not fertilised and it dies. The hormones change and the endometrium also dies and is shed. There is some bleeding from the raw endometrium for a few days. This is a typical period. The cycle then starts again for the next month.
If the egg is fertilised it starts making extra hormones. These make the uterus and endometrium grow to take the developing baby.
What has gone wrong?
With a tubal pregnancy your fertilised egg does not pass from your Fallopian tube into your uterus. The much smaller sperm have travelled up the tube to fertilise your egg but your egg has not moved in the opposite direction. This may be because of scarring, called adhesions, in and around your Fallopian tube. This scarring could be from a previous infection in your tube or your pelvis, or from a previous operation. As the embryo develops, blood vessels from the growing placenta will burst through the thin walls of your Fallopian tube or through the tissues near the ovary. This can result in internal bleeding and pain.
The aim of the operation is to stop your bleeding by removing your ectopic pregnancy. Ideally, we only remove the pregnancy, although we may have to remove part or all of your Fallopian tube. The earlier your ectopic pregnancy is dealt with, the greater the chance of saving your Fallopian tube. We also remove any blood that has built up.
We usually do the operation using keyhole surgery, called a laparoscopy. We use the laparoscopy to first confirm that you have an ectopic pregnancy, find its exact position and then remove it. Occasionally, we convert to an open operation if we cannot complete the operation using keyhole surgery. This may be to clear out a large amount of trapped blood or if you have adhesions from previous operations or infections. Discuss the options with your gynaecologist.
This operation is often lifesaving. An ectopic pregnancy will usually bleed until it is removed. Keyhole surgery has several advantages over an open operation:
- The laparoscopy can confirm the diagnosis and the exact position of the ectopic pregnancy.
- There is less bleeding from the operation with less chance of needing a blood transfusion.
- Less pain.
- Recovery is usually quicker with a shorter hospital stay.
- The chance of having a normal pregnancy later is higher, about seven in 10 (70%) rather than about five in 10 (50%) after open surgery.
- The chance of another ectopic pregnancy is lower, about three in 20 (15%) rather than five in 20 (25%) after open surgery.
Are there any alternatives?
We can sometimes treat an ectopic pregnancy by giving a drug called methotrexate. We usually give this drug as an anti-cancer treatment. When we give it to treat an ectopic pregnancy it stops the embryo from growing any bigger. The embryo dies and the body slowly absorbs the remains. This can avoid the need for surgery.
If you need surgery you could have an open operation, called a laparotomy. Due to the benefits of laparoscopy over open operations, it is usually better to avoid this. If for some reason a laparoscopic operation is not possible, your surgeon will recommend an open operation. One reason for this would be if you were very ill due to internal bleeding from the ectopic pregnancy.
What if you do nothing?
Doing nothing is usually not an option. Continuous internal bleeding is life threatening. Sometimes tests show that the ectopic pregnancy has already stopped growing and a removal operation is not necessary. We would still need to monitor you very closely for some time.
Who should have it done?
If a pregnancy test shows you are pregnant but no fetus or sac is seen in your uterus during an ultrasound scan the pregnancy is probably ectopic. We may see a mass or fetus in your pelvis or Fallopian tube during the scan. If we confirm or believe there is a high chance that you have an ectopic pregnancy you should have this operation.
Who should not have it done?
Sometimes, it is not clear from your scans whether your pregnancy is in your uterus and not in your tube. Often we need to operate to find out what is going on. A laparoscopy will not harm a normal pregnancy and the general anaesthetic does not seem to be harmful. If we are not sure of the location of your pregnancy you could wait and repeat the ultrasound scan after a few days. This may avoid the laparoscopy, but it does carry the additional risk of a sudden serious internal bleed during the waiting period. If this happens you may need an emergency open operation.
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