Laparoscopic management of ectopic pregnancy

To Know everything about ectopic pregnancy, Mohali leading fertility expert Dr. Rimmi Singla to find out exactly what ectopic pregnancy is, why it occurs and how it’s treated.

Here’s everything you need to know.

What is an ectopic pregnancy and its reasons?

An ectopic pregnancy or a tubal pregnancy happens when a fertilised egg implants itself outside of the uterus.

“The huge majority of ectopic pregnancies happen, of course, in the fallopian tubes themselves, but sometimes it can even arise in other areas and not often it can happen in the stomach,” fertility specialist, gynaecologist, obstetrician and laparoscopic Surgeon Dr Rimmi Singla & Dr. Raman Singla explains.

Reasons of Ectopic Pregnancy:

Pelvic Inflammatory Disease:

Pelvic Inflammatory Disease (PID) is one of the more protruding factors related with an increased risk of ectopic pregnancy. PID, which is an infection of the female reproductive system typically caused by chlamydia or gonorrhea, can cause significant harm and scarring to the fallopian tubes.

In fact, if left untreated, gonorrhea and chlamydia can even cause the fallopian tubes to become totally blocked – leading to infertility.

“If for whatever cause there’s scarring [in the tube], and the embryo gets fixed, then obviously it can continue to grow there.”

Contraception:

While it’s infrequent to get pregnant while using an intrauterine device for contraception, you’re more likely to have an ectopic pregnancy if you fall pregnant while using an IUD. Falling expectant while using a progesterone-only oral contraceptive pill (the mini pill), can also increase risk.

Smoking:

According to Dr Raman Singla(Senior Consultant Advanced Laparoscopic & Bariatric Surgery
Director Singla Mediclinic, smoking also plays a part.

“The more that you smoke, it increases the chance that you could have an ectopic pregnancy,” he said.

Tubal surgery:

Women who have had surgeries involving the fallopian tubes, for example tubal ligation, may be at a higher risk.

History of ectopic pregnancy

If you’ve had past history of an ectopic pregnancy, your chance of having another ectopic pregnancy is high.

Dr.Rimmi Singla explained that this is because “there’s likely to be a little bit of injury to the fallopian tubes”.

According to Mohali-based fertility specialist Dr Rimmi Singla, there’s also a theory that occasionally an abnormal embryo cannot move usually down into the uterus, thus resulting in an ectopic pregnancy.

Risks of having an ectopic pregnancy:

If not treated, an ectopic pregnancy in the fallopian tube can lead to hemorrhaging or extreme bleeding, which can result in death.

“The pregnancy can enter the tubal wall, encouraging blood flow, and unfortunately if they grow to the point where they’re quite big, those blood vessels can break open, releasing loads of blood within the pelvis of a woman.”

As fallopian tubes are very small, if an embryo starts to develop in the tube, it will eventually erupt. This eruption can be life threatening to the woman.

Symptoms of Ectopic Pregnancy:

  • Pain in Lower Abdomen, and inflammation.
  • Pain while urinating.
  • Another symptom of an ectopic pregnancy is shoulder tip pain or even neck pain
  • Pain while having a bowel movement.
  • Heavy vaginal bleeding or spotting.
  • More common sign is shrill pelvic pain.

 Treatment for an ectopic pregnancy?

Medication

If a woman’s pregnancy hormone levels are developed, medication may be used to remove the ectopic pregnancy. Methotrexate, which is used to halt the growth of pregnancy tissue, only be used if the woman has slight to no pain indications. She also has to be frequently checked while on this medicine to confirm the pregnancy hormone is successfully decreasing.

Laparoscopic (keyhole) surgery to eliminate fertilised egg from fallopian tubes

A telescopic device (the laparoscope) is injected through a small cut below your navel (belly button). To support recognize your organs, carbon dioxide gas is gusted into your stomach through a needle. A couple of small incisions are also made in patient lower abdomen to work and if necessary, remove the ectopic pregnancy tissue. The procedure may involve removing your fallopian tube (salpingectomy) or opening your fallopian tube (salpingostomy) to remove the ectopic pregnancy tissue.

Laparotomy to remove the ectopic pregnancy

If the pregnancy is advanced or there has been significant associated haemorrhaging (bleeding) then your doctor may perform a laparotomy, a type of surgery involving a much larger incision.

Important Note

  • Ectopic pregnancy is a pregnancy that develops outside of the uterus and usually in the fallopian tubes.
  • Sign & Symptoms can comprise vaginal bleeding, stomach pain and cramps.
  • Women at high risk should have their pregnancy closely watched particularly during the early weeks of pregnancy.
  • An ectopic pregnancy is a life-threatening condition.