How is ectopic surgery performed? How is an early ectopic pregnancy removed? Is treatment possible without surgery? Ectopic pregnancy without surgery

Normally, during conception, sperm enters the vagina, then through the cervix into the uterus. Then fertilization occurs in the fallopian tubes - the sperm fuses with the egg. A zygote is formed - a one-cell embryo, that is, the first stage of human development. The fertilized egg descends through the tubes into the uterus and begins to develop there.

But if for some reason the zygote does not enter the uterus, but gets stuck at some stage of the journey, the fetus begins to grow in the wrong place and an ectopic pregnancy is diagnosed. In 98% of cases, an ectopic pregnancy develops in the tubes, but in rare cases the fertilized egg may be located in the ovaries or abdominal cavity.

An ectopic pregnancy is quite dangerous. After all, the embryo develops at a rapid speed and can simply rupture the tube with its growth, which leads to severe internal bleeding. This can lead to irreversible consequences. Therefore, it is very important to determine the presence of ectopic pregnancy. A woman’s future reproduction and even her life depend on this. But first, let's try to figure out what can lead to such a pathology.

Causes of ectopic pregnancy

Chronic inflammatory or infectious gynecological problems. Infectious diseases of the reproductive system often lead to disruption of the fallopian tubes - they do not contract enough to push a fertilized egg into the uterus. Because of this, the egg simply cannot pass to its destination and becomes fixed where it is stuck. If a woman has suffered from inflammation of the uterus and appendages, adhesions, scars and narrowings may form in the tubes, which prevent the normal passage of the egg.
Surgery is another factor that can cause an ectopic pregnancy. This is due to the fact that after surgery, the abdominal organs may be changed, which may interfere with normal flow healthy pregnancy.
Congenital tubal pathologies. Some women have congenital tubal pathology; the tubes can be very long, narrow, tortuous, or completely obstructed. This makes it difficult for the egg to pass through the tubes.
Tumors. Regardless of whether the tumor is benign or malignant, it can prevent the egg from passing through the tube by simply squeezing it.
Hormonal imbalances. Frequent and uncontrolled use of hormonal contraceptives (especially intrauterine devices) leads to disruption of a woman’s normal hormonal levels. As a result, the mobility of the tubes decreases, the tube cannot push the egg into the uterus.
Weak sperm. Sometimes it happens that the sperm that fertilized the egg is quite weak, and the zygote is simply unable to move through the tubes.

Very often, an ectopic pregnancy develops after an invasion of the body in the past - after an induced abortion.

Symptoms of an ectopic pregnancy generally differ little from the first signs of a healthy pregnancy. The woman also begins to experience toxicosis, her menstruation is delayed, the test shows two lines. A woman feels a frequent urge to urinate, her chest becomes congested and her basal temperature rises. But how to distinguish a healthy pregnancy from an ectopic one based on the first signs? Here are a few symptoms that are characteristic of an ectopic pregnancy.

Scanty spotting blood discharge. They are often brownish in color. After a tube rupture, internal and uterine bleeding may occur.
Pain. This is the main sign of problems in the body. The pain can be cutting and stabbing, aching and sharp. Often the pain is localized on one side of the lower abdomen, namely in the tube where the egg is located. With abdominal bleeding, pain may radiate to the anus. Pain may also occur when urinating or having bowel movements. The pain increases or decreases with movement or changing body position.
Due to large blood loss, the woman experiences anaphylactic shock. She feels apathy, drowsiness, and may lose consciousness. In addition to this, her skin turns pale, her blood pressure drops, her pulse slows, and her head constantly feels dizzy.
The abnormal course of pregnancy can be indirectly determined by a pregnancy test. Everyone knows that the test reacts to the level of human chorionic gonadotropin. The level of the hCG hormone normally increases very quickly as pregnancy progresses. And if on early stages the second line on the test was weak and transparent ( low level hCG), then the next day the second strip will be much clearer. And in case of ectopic pregnancy hCG level remains small over time, so the pregnancy test shows a clear and fuzzy line even the next day.
There are special tests that not only react to the level of the hCG hormone, but also based on other hormonal changes can show the risk of developing an ectopic pregnancy and the risk of threatened miscarriage. Everything is based on immunochromatographic analysis.

If you suspect an ectopic pregnancy, you should immediately consult a doctor. After all, a timely detected pregnancy can save the pipes from rupture. To verify the presence or absence of an ectopic pregnancy, your doctor may order tests for the hCG hormone.

HCG hormone. As mentioned, the hCG hormone normally increases several times every two days. If the levels of this hormone do not increase or increase slightly, this is one of the serious indicators of the presence of an ectopic pregnancy.
Ultrasound. Already at 6-7 weeks, the fertilized egg can be seen on an ultrasound machine. Using an ultrasound, the doctor determines the location of the fertilized egg. If no seals are found in the uterine cavity, the specialist expands the search area and, in the event of an ectopic pregnancy, finds an accumulation of free water in one of the tubes. If even the egg itself is not visible, the tube is dilated during an ectopic pregnancy. But sometimes a specialist may mistake a blood clot in the uterus for a fertilized egg, especially in the early stages of pregnancy (4-5 weeks). In this case, it is necessary to perform laparoscopy for a more accurate result.
Laparoscopy is a modern and accurate way to diagnose and treat abdominal organs. Laparoscopy is a procedure in which a tiny incision is made in the patient's abdomen through which a thin tube with a lens at one end is inserted. On the other side there is an eyepiece through which you can observe a picture of the patient’s insides. If instead of a lens there is a mini video camera at the end of the tube, then the image is projected onto the screen. Laparoscopy is considered an accurate diagnostic method also because internal organs can be viewed from all angles, shifting and sliding them. This procedure is accurate and reliable in detecting ectopic pregnancy.
Puncture. This method is quite old-fashioned due to its pain and unreliability. Its principle is as follows. A needle is inserted through the woman's anus into the uterine cavity. From there the liquid is taken for analysis. If blood is found in the fluid, this indicates the presence of an ectopic pregnancy in the woman’s body. However, this diagnostic method is not 100% reliable, and it is also very unpleasant and painful. Therefore, today it is practically not used.

How to remove an ectopic pregnancy

Diagnostics confirmed the presence of an ectopic pregnancy in the woman’s body. What's next? And then laparoscopic surgery is necessary to remove the fertilized egg from the tube. An ectopic pregnancy never goes away without cleaning. If possible, doctors try to save the integrity of the tube, but if it is completely ruptured, it is removed along with the fetal body.

If the fertilized egg is located near the entrance to the pipe, Milking is done - the egg is squeezed out without damaging the pipe.
If extrusion is impossible, salpingotomy is performed. In the place where the fertilized egg is located, the tube is cut, the egg is removed, and the incision is stitched. If the embryo is large enough, it is removed along with part of the tube. The functional ability of the tube is then preserved - the woman will be able to get pregnant.
In cases of tube rupture, a tubectomy is performed - removal of the fallopian tube along with the fertilized egg. If there is a risk to the patient's life, the tube can be removed along with the ovary.
If an ectopic pregnancy is detected in the early stages, chemotherapy is possible. The woman is given special drugs (for example, Methotrexate) that sharply suppress the development of the fetus. The drug is used until 6 weeks of fetal development, until it has cardiac activity. However, Methotrexate is a rather crude medicine that has many side effects– from kidney and liver damage to complete hair loss. This type of treatment is almost never used in Russia. This type of treatment is only possible for women who no longer plan to become mothers.

After surgery it is very important to take a course rehabilitation treatment, which will prevent the appearance of adhesions and scars on the pipes. After all, any obstructions in the tubes in the future can become another cause of ectopic pregnancy. After removal of an ectopic pregnancy, you cannot plan to conceive a child for at least six months.

If a woman suffers from an ectopic pregnancy, this does not mean that she cannot become a mother. After all, every woman has two fallopian tubes, and if, in the worst case scenario, she had one tube removed, she is left with a second, completely reproductive one. Most women who experience an ectopic pregnancy are subsequently able to give birth to healthy children. And only 6-8% remain infertile after an ectopic pregnancy.

An ectopic pregnancy is not a death sentence. Conceiving and carrying a baby is a long and complex process, during which anything can happen. Ectopic pregnancy occurs in only 2% of all pregnancies. And if this happened to you, don’t despair. Timely diagnosis and proper treatment will restore your body. And then you will be able to turn this difficult page of your life and move on, becoming a mother more than once!

Video: ectopic pregnancy - signs, symptoms and advice from doctors

Surgery for ectopic pregnancy is often performed, since the pathology is common. It can be emergency or planned, performed laparoscopically or openly.

Why surgery?

Situation during the operation

In ectopic pregnancy, the fertilized cell attaches not to the uterus, but to another organ. This situation is incompatible with the development of the embryo. This is dangerous for a woman.

There are tubal, cervical, ovarian, abdominal, intraligamentary (between the leaves of the broad ligament of the uterus) ectopic pregnancy. Localization in the fallopian tube is common, when the cell cannot penetrate the endometrium and is attached to it by chorionic villi.

If the uterine cavity provides comfortable conditions for the embryo, it is unable to develop in the tube. The organ is intended for the transit of cells to the uterus and does not contain a “cushion” of endometrium.

Limited space creates preconditions for complications. The point is not only that the development of an embryo outside the uterus is impossible. Rare cases of successful abdominal pregnancy have been described. The main danger is the likelihood of organ rupture and massive bleeding, which can be fatal.

Considering the futility of fetal development, the inability of its implantation into the uterus, the high risk of complications, a rational solution is surgery to remove an ectopic pregnancy.

Pathology in the early stages has a number of indirect symptoms:

pain in the lower abdomen;
spotting;
temperature.

If a woman suspects something is wrong and consults a doctor for diagnosis, it is possible medical abortion. See the photo of what the fallopian tube with an embryo looks like.

On early removal of an ectopic pregnancy is carried out as planned. When the pathology has led to a rupture of the pipe or its artery, an emergency operation is performed, excising the organ on the right or left side, stopping the bleeding.

The likelihood of conception after removal of the tube during an ectopic pregnancy is halved.

Who should not have surgery

Contraindications:

coma;
diseases of the heart and blood vessels;
pathologies of the respiratory system;
hernia of the anterior abdominal wall.

Laparoscopy for ectopic pregnancy is not recommended for:

massive bleeding - more than 1 liter of blood;
adhesions internal organs;
scars from previous interventions;
obesity.

It leaves a scar

In case of peritonitis, it is preferable to replace the gentle method with laparotomy, since the risk of complications is high. It is not performed when the fertilized egg is too large or there is a suspicion of a malignant tumor.

If a woman has an ectopic cervical pregnancy, it is not necessary to remove it surgically. A circular suture is placed on the cervix and curettage is performed (the procedure is also called cleaning). The manipulation can be carried out for diagnostic purposes when signs of pregnancy are present, and the fertilized egg is not visible on ultrasound.

Taking tests and examinations

Before removing an ectopic pregnancy, a diagnosis is carried out. During the examination, the gynecologist determines the increase in the size of the uterus and palpates the compaction on the side where the embryo is attached.

The clinical picture of the blood shows decreased hemoglobin, red blood cells, and hematocrit. ESR and leukocyte levels are elevated. An hCG test reveals its content in the blood, but the level is below normal.

In order to study the condition of internal organs and detect the embryo, they are prescribed ultrasonography. If there is no fertilized egg in the uterus on ultrasound and the presence of hCG in the blood, the diagnosis is inevitable.

If the diagnosis does not reliably confirm an ectopic pregnancy, the patient is hospitalized and gonadotropin levels are monitored. If it decreases or the state of health worsens, women undergo diagnostic laparoscopy. The technique allows you to accurately determine the location of the embryo and immediately eliminate the pathology.

We get tested

Types of operations for ectopic pregnancy

The nature of the intervention and the choice of access (open or minimally invasive) depend on the period of diagnosis of the disease and the general condition of the woman.

What operations are performed in the presence of an ectopic pregnancy? What's their name? The main methods are open intervention and laparoscopy. The latter is preferable in case of ectopic pregnancy, as it has a lower risk of consequences and a short rehabilitation period. But it is not always technically feasible.

Open tubectomy

Process diagram

Used when other methods are impossible or impractical. Indications:

the woman is not planning a pregnancy;
adhesions or significant anomalies in the structure of one pipe;
previous operations for infertility or obstructed tubes;
re-conception in an organ that was previously subjected to gentle treatment.

Removal of the tube (laparotomy) for ectopic pregnancy involves a transverse incision in the suprapubic region. Healing is faster than with a vertical incision. This is due to the fact that the abdominal muscles do not cross in the transverse direction.

If the operation is emergency, requiring a quick reaction from the surgeon, a vertical incision (median laparotomy) is possible. Before intervention for an ectopic pregnancy, a woman undergoes the necessary diagnostics:

blood and urine tests;
fluorography;
gonadotropin test;
coagulogram.

In case of emergency intervention, all tests are taken in the postoperative period. At the preparation stage, only the blood type, its coagulability and the Rh factor are determined.

Pipe preservation surgery

The main goal is to maintain a woman’s reproductive function. Treatment is carried out without removing the tube in the early stages of ectopic pregnancy. Conditions for holding:

the size of the fertilized egg is less than 4 cm;
no fallopian tube rupture;
After surgery, it is possible to monitor the dynamics of hCG levels.

Young women who do not have children and have previously had an organ removed due to a tubal pregnancy outside the uterus need an organ-preserving technique.

The doctor decides whether to remove the tube or not. When it is not possible to completely preserve it, partial resection is performed. The organ is dissected at the site of attachment of the embryo, the fragment is excised and the ends of the tube are sutured.

To maintain patency, it is important to remove all fetal tissue and ligate the vessels as carefully as possible during intervention.

Laparoscopy

Laparoscopic therapy for tubal pregnancy

Allows you to remove the embryo, the tube completely or partially, and stop bleeding with minimal trauma. It has advantages over laparotomy, but requires appropriate equipment and highly qualified surgeons.

Laparoscopy for ectopic pregnancy has no absolute contraindications, except for post-hemorrhagic shock with unstable hemodynamics. Sometimes it is recommended to replace it with abdominal surgery.

There are several options for organ-sparing laparoscopy.

Linear salpingotomy. It is possible to remove the embryo while preserving the organ.
Segmental resection. Preserves reproductive function, but requires plastic restoration of the tube.
Squeezing out the embryo. The most traumatic method, associated with the risk of incomplete removal of the fertilized egg outside the uterus. The operation is justified when an abortion has begun, when the embryo begins to separate from the wall of the tube.

Operations when the fetus is located in the ovary or abdominal cavity are performed in an open or closed manner. They consist of resection of a section of the ovary, removal of eggs from the peritoneum, etc. Interventions are not as diverse as in tubal pregnancy. The main task of the surgeon is to preserve reproductive function.

Open tubectomy

How is the operation performed?

Stages of open tubectomy.

An incision in the abdominal wall, examination of the pelvic cavity, removal of the uterus and appendages into the wound.
Urgently stop bleeding with a clamp (if any).
Applying clamps to the mesentery of the tube and the segment closer to the uterus, ligation of the vessels and intersection of the peritoneum.
Removing the pipe, applying sutures.
Abdominal lavage, suturing.

Progress of organ-preserving open surgery.

An incision is made, and clamps are placed on the tube on both sides of the embryo.
The tube is cut in the affected area and, depending on the size of the fetus, only the egg or part of the organ is removed.
If there is bleeding, laser or electrocoagulation is used.
The ends of the pipe are sewn end to end.
The abdominal cavity is sutured.

During laparoscopic surgery, carbon dioxide is pumped into the abdomen to provide a view of the internal organs. Such operations usually require tracheal intubation and the use of muscle relaxants. Instruments are inserted inside through small punctures.

Laparoscopic tubectomy is performed using the ligature method. A loop is thrown onto the pipe and tightened, and the part with the embryo is excised. Vessels and tissues are sealed with an electrocoagulator.

The cut section of the organ is removed through punctures. If it is large, do it in parts. The surgeon examines the surgical area, sucks out fluid and blood clots, and rinses with saline. Instruments are removed from the punctures and stitches or staples are applied.

Tying the pipe

Linear salpingectomy technique.

The instrument is inserted through the punctures.
They grab the pipe and make a longitudinal cut on the wall.
The embryo is removed using an aspirator or liquid.
Make sure there is no bleeding, suck out blood clots, and wash with saline solution.
The fallopian tube is not sutured; its integrity is restored naturally.

Segmental resection.

The surgeon grasps the location of the fertilized egg with clamps.
The affected area is excised using an electrocoagulator.
Tightens the pipe with ligatures (loops).

After segmental resection, plastic surgery is required to restore the partially excised organ. Conditions for carrying out: the length of the preserved pipe is from 5 cm, the ratio of the diameter of the sections is 1:3.

Removal of the embryo by extrusion is carried out using clamps. They are gradually moved towards the end of the pipe. The technique is feasible only if the organ is completely patency. After removing the fertilized egg, the tube is washed and its patency is checked. Complete extrusion of the embryo is carried out by washing the pelvic organs.

How long does the operation take?

15-20 minutes

The duration of operative surgery depends on the severity of the pathology. If there is no tube rupture or intrauterine bleeding, everything takes 15-20 minutes. Long serious procedure – 40-60 minutes.

If an ectopic pregnancy is removed by abdominal surgery, general anesthesia is used. When the manipulation takes place in 15-30 minutes, tracheal intubation is not required. If the surgeon needs a wide field of activity, muscle relaxants are used and intubation is performed.

Watch an online video to see how long the operation can take.

Possible complications during the rehabilitation period

Damage to the integrity of the stomach, other organs or blood vessels when an instrument is inserted into the abdominal cavity. These holes are made with special needles with protective caps. The insertion process is very demanding and can cause injury if not carefully controlled.
Infection and hemorrhage. Possibly due to damage to internal organs. If bleeding is detected, the injury is sutured.
Subcutaneous emphysema due to unsuccessful filling of the abdominal cavity with carbon dioxide. The complication is especially dangerous for women with varicose veins veins, hypertension, as there is a possibility of thrombosis. The condition is treated with blood thinning pills. Use elastic bandage with varicose veins.
If the patient has a weakened immune system and an infection has occurred, suppuration of the puncture site cannot be ruled out.

Why is the risk of adverse consequences highest when an emergency operation is performed and the woman is in serious condition? When a pipe ruptures, severe bleeding occurs, which can cause shock. To prevent it, doctors tie off the vessel and prevent blood loss.

If the operation was performed while preserving the tube, the fetus was not completely removed, this can also lead to bleeding. To prevent this, the surgeon flushes the tube with saline solution with added oxytocin.

When using a coagulator, there is a possibility of burns to the tissues of the tube and ovarian ligaments. They can lead to the closure of the organ lumen and the appearance of adhesions.

The safest, but radical way to remove the consequences after surgery to remove an ectopic pregnancy is complete excision of the tube. The result depends on the qualifications of the surgeon, how much he knows modern techniques pipe plastics, what experience does he have?

What remains after the intervention?

Long-term consequences of the operation:

adhesions in the pelvis;
infertility;
recurrent ectopic pregnancy.

Prevention of these complications should begin during the operation: removal of blood clots, administration of Ringer's solution.

How much does surgery cost?

There are no quotas or priority for the treatment of ectopic pregnancy. Therapy is free. When a woman is brought to the gynecological department with a ruptured tube or bleeding, the surgeon’s task is to save a life. There is no question of payment.

Planned removal of ectopic conception can be done for a fee. The price depends on the volume of intervention, its type, result:

abdominal surgery with removal of the tube or organ-preserving surgery - about 30 thousand rubles;
the cost of the puncture and laparoscopy procedure ranges from 15 to 80 thousand rubles.

The price may vary depending on the cost of the equipment, the qualifications of the doctor, and the comfort of the clinic.

Rest in hospital

How long to stay in the hospital after surgery

Patients ask questions: how long does rehabilitation last, when is sexual intercourse allowed, and is it possible to get pregnant after surgery? It depends on the complexity of the manipulation.

Recovery takes about a month. It can be divided into 3 stages.

Bed rest on the first day. It is necessary that the anesthesia wears off completely.
Inpatient treatment for a week. Required to monitor the patient, release carbon dioxide, and prevent complications. After a week, the stitches are removed.
Home regime for 14 days. The seams are treated with a solution of manganese or iodine. You can't take a bath. Sick leave is given for the recovery period.

Sexual relations and physical activity are possible 30 days after the intervention. A sign that everything has healed will be the normalization of the monthly cycle. Conception can be planned after 3 – 4 months. This issue is resolved individually with a gynecologist.

Abroad efficiency 90%

How is an ectopic pregnancy treated abroad?

Abroad, detection of pathology using Inexscreen tests is practiced. According to statistics, their effectiveness is up to 90%. This allows doctors to treat ectopic pregnancies without surgery early on.

The drug Methotrexate is prescribed, which prevents cell division. As a result, the woman has a miscarriage.

: Borovikova Olga

gynecologist, ultrasound doctor, geneticist

Ectopic pregnancy, in which the fertilized egg is implanted somewhere outside the uterine body, is quite common today. Usually the egg is implanted into one of the fallopian tubes, much less often (≈1-2%) - into the abdominal cavity, cervix or ovary. Untimely detection of pathological gestation often leads to death, therefore early diagnosis and treatment are vital in such clinical cases important factor. A timely operation during an ectopic pregnancy will help save a woman’s life and preserve reproductive capabilities.

At the slightest suspicious symptoms, seek medical help immediately

Ectopic pregnancy occurs under the influence of a group of provoking factors, and not for any one reason. First of all, this pathology is caused by:

Chronic inflammatory pathologies of the genital organs;
Artificial insemination;
Adhesive processes developing in the woman’s reproductive system as a result of laparoscopic and abdominal operations;
Due to prolonged wearing of the intrauterine device;
Against the background of hormonal disorders;
Tumor processes in reproductive structures;
Abnormally developed uterus, congenital pathologies, etc.;
Underdevelopment, overly long or tortuous fallopian tubes, which prevents the egg from reaching the uterine body and being fully implanted;
Frequent abortions;
Adenomyosis or endometriosis, etc.

According to statistics, ectopic conception accounts for about 1.5% of the total number of all pregnancies and very often leads to rupture of the fallopian tubes.

The first signs of an ectopic

The first signs of ectopic conception, which occur in the early stages, are almost impossible to distinguish from the early symptoms of normal pregnancy, which greatly complicates the timely detection of pathology. The patient also notes the absence of menstruation, and the pregnancy test shows two lines. Even signs such as malaise, drowsiness or breast swelling are also present in the patient, as if the pregnancy is developing according to a normal scenario.

Severe weakness is often a dangerous sign

An important diagnostic symptom is the absence of a fertilized egg inside the uterus on ultrasound images. A qualified doctor will be able to determine in the early stages a fertilized egg implanted into the lumen of the cervical canal or fallopian tube. Signs such as pain can help you suspect pathology. They are aching, dull, similar to pain during menstruation, maybe a little stronger. Pain is concentrated over the symphysis pubis and may indicate tubal rupture and bleeding.

Also, signs of ectomic gestation may appear in bloody vaginal discharge. When a tubal rupture occurs, patients develop signs of peritonitis and acute blood loss, such as rapid pulse, loss of consciousness or a sharp drop in blood pressure, severe pain on palpation of the abdomen, etc. If ectopic gestation is not detected in the early stages, then it is dangerous for the woman to develop fatal complications.

Why surgery is inevitable

The procedure for removing an ectopic pregnancy is rarely done without surgery. According to statistics, pathology is detected only when the patient develops acute abdominal pain, bloody issues etc. These are the symptoms that manifest the consequences of a dead fetus emerging from the ovary or tube. According to statistics, almost all cases of VD are associated with implantation of the fertilized egg into the fallopian tubes.

In any case, if the pathology was not detected in the early stages, then it will not be possible to eliminate it only with the help of medicinal methods. The patient exhibits heavy blood loss, leading to the development of hemorrhagic shock. If doctors do not take urgent measures, the girl will die. Therefore, you should absolutely not refuse hospitalization, hoping that the pathological symptoms will go away on their own.

Even a slight release of blood into the peritoneum provokes the development of an infectious process, which leads to peritonitis. Therefore, in case of an ectopic pregnancy, removal of the tube or removal of the fertilized egg is considered an inevitable operation.

Types of surgical treatment

When a woman is told that she has an ectopic and needs urgent surgery, one of the first questions that arises in the patient’s mind is: how is the operation going? Interventions for ectopic conception can be cavitary or minimally invasive. Abdominal surgery is performed laparotomically, in which the patient is cut through the tissue on the anterior wall of the peritoneum.

Minimally invasive interventions are performed using specialized laparoscopic and endoscopic equipment through small punctures in the abdominal wall. Minimally invasive techniques are used more often, because removing the tube during an ectopic pregnancy in this way allows you to carry out the necessary surgical procedures without any complications.

Only a doctor will be able to establish the presence of indications for a certain type of intervention, determine the extent of removal in accordance with the data obtained after the examination, the patient’s condition and taking into account the risk of possible complications. Therefore, before the operation it is necessary to undergo a competent examination.

Laparotomy surgery is performed under general anesthesia through a large vertical incision in the lower abdomen. The main indications for such an invasive and traumatic intervention are conditions such as tubal rupture, adhesive pathology, heavy and intractable bleeding, or the presence of a real threat to the patient’s life.

Another method for removing an ectopic pregnancy is laparoscopic surgery. Compared to laparotomy, it does not involve large surgical incisions in the peritoneum, does not require long-term anesthesia and does not require long rehabilitation.

Progress of the operation

The duration and stages of surgical intervention depend on what technique is used to remove the VB. If the patient is noticeably pale, the bleeding bothers her for a long time and there is a pronounced hyperthermic reaction, then the patient urgently undergoes removal of the fallopian tube through laparotomy. If ectopic conception is detected in a timely manner, then planned surgical laparoscopic intervention is prescribed.

The operation can be organ-preserving or with the removal of any structures.

If ectopic conception is detected in the early stages and fetal detachment has not yet occurred, then the egg is squeezed out of the tubal lumen or an incision is made in the wall and the fetus is removed, and the wounds are sutured. Extrusion is considered a traumatic method with high risk leaving fetal tissue inside the tube.
If the egg has already been aborted, then resection or ectomy of the tube is indicated.
If the fertilized egg has implanted into the ovary, then its removal is indicated.
When the fetus is attached to the cervix, removal is carried out by curettage of the uterus. For other forms of ectopic pregnancy, curettage is not a mandatory measure.
Curettage is also performed if the doctor suspects the presence of tumor formations.

How long the operation lasts depends on its type and the volume of manipulations performed. Laparoscopic surgery takes less than an hour, abdominal surgery will take slightly longer.

Possible complications

Any medications should be taken under the supervision of specialists

Any intervention can lead to a number of different complications. When performing laparoscopic surgery, there is a risk of intraorganic damage during the puncture process. The less traumatic damage caused during the intervention, the fewer adverse consequences that may occur after surgery. If the operation is laparoscopic and the girl has the tube removed along with the fertilized egg, then in the future the probability of conceiving a child for this patient is halved, but the risk of recurrence of an ectopic in the same tube is also reduced.

After surgery, a woman may also experience bleeding or post-operative inflammation. But these complications usually occur in patients who were operated on by an insufficiently experienced surgeon. Such a condition and the operation after it never go away without a trace, but if the girl strictly follows all medical recommendations, then she will be able to successfully conceive a baby in the future even with one tube.

Rehabilitation and recovery period

At first, in the first 24 hours, the woman needs to lie down after the operation, since it takes time to recover from the anesthesia. But by the evening of the first day you can drink some water, turn around, and sit down. From the second day you need to be active through the pain, which in the future will protect you from adhesions, eliminate the need for curettage and create the necessary conditions for the absorption of gases. It’s just that it still remains in the stomach after laparoscopy, which causes painful discomfort. With the help of short walks you can get rid of such unpleasant symptoms quite quickly.

You will have to undergo a course of diet therapy for about a month after the operation. Food should be taken low-calorie, plant-based, rich in ascorbic acid, in small portions, fractionally. Fats and proteins should be limited for now. Such a diet will help eliminate post-operative discomfort and speed up the rehabilitation course. You can wash, but only in the first couple of weeks strictly in the shower, and after the procedure you need to lubricate the postoperative wounds with iodine. Physical activity is allowed approximately three weeks after the operation, but sexual rest will have to be observed for a month. Drug therapy is carried out according to medical prescriptions.

Who is contraindicated for surgery?

Laparoscopic intervention may not be performed in all clinical cases, because the procedure has a number of contraindications.

Laparoscopy is impossible if the girl is unconscious.
Such an intervention is contraindicated if the patient has respiratory or cardiovascular pathologies or an abdominal hernia.
Laparoscopy is also not recommended for accumulations of blood in the peritoneum due to massive bleeding (a liter or more).
Contraindications for laparoscopy are adhesions, obesity, and the presence of scars from previous operations.
Also prevents laparoscopic treatment of ectopic peritonitis and infectious pathologies.
For malignant tumors, similar operations are not performed, as for cervical localization of fetal implantation.

In each case, when comparing contraindications, the patient’s condition, the degree of damage, etc. must be taken into account. For one patient, a specific contraindication is absolute, and for another, it is relative.

Why is it better to choose laparoscopic ectopic removal?

If a girl was diagnosed with an ectopic early and there is still some time left before surgery, then it is better to opt for laparoscopic treatment, because this approach has many advantages. Firstly, such an operation does not leave scars on the abdomen, minimizes tissue trauma and reduces blood loss to a minimum. Secondly, the laparoscopic approach to ectopic therapy greatly speeds up the recovery of the patient, who can be sent home after just a couple of days.

If the ectopic pregnancy is localized in the cervical canal, then curettage is performed using curettage, which is more of a diagnostic and preventive nature. If bleeding after such a procedure bothers you for a sufficiently long period, this indicates that the patient has a pathology.

Detection of ectopic implantation of the fertilized egg at the earliest stages of gestation saves a woman from many problems and adverse consequences. In this case, there are all the conditions for laparoscopy, and after this operation the patient has every chance of saving both fallopian canals, and not being left with only one tube or without them at all. And by preserving the tubes in the future, the patient will be able to easily conceive a child without outside help and reproductive interventions such as ICSI or IVF, etc. In extreme cases, such technologies still provide a chance for happy motherhood, especially for those girls who have experienced more than one ectopic pregnancy and are left without tubes at all.

49234 0

The choice of surgical approach and the nature of surgical intervention during tubal pregnancy depends on a number of factors: the general condition of the patient, the amount of blood loss, the severity of the adhesions in the pelvis, the size and location of the ovum.

Limitations for laparoscopy during tubal pregnancy are often related to the quality of equipment and the qualifications of the endoscopist. More often, surgeons are of the opinion that the necessary conditions for performing laparoscopic operations are the patient’s satisfactory condition and stable hemodynamics.

Thus, the only absolute contraindication for the use of laparoscopy for ectopic pregnancy is hemorrhagic shock of III-IV degrees, which most often occurs with blood loss of more than 1500 ml.

Along with this, there are relative contraindications to laparoscopy for ectopic pregnancy.

1. Unstable hemodynamics (hemorrhagic shock I-II degrees) with blood loss more than 500 ml.
2. Interstitial localization of tubal pregnancy.
3. Fertilized egg in the accessory horn of the uterus.

5. Rupture of the fallopian tube wall.
6. General contraindications to laparoscopy:
A. obesity;
b. pronounced adhesive process in the pelvis;
V. cardiovascular failure;
d. pulmonary failure.

However, there are reports in the literature of the successful use of laparoscopic operations for significant (more than 1500 ml) blood loss, rupture of the fallopian tube, interstitial and old tubal pregnancy.

Making a decision in favor of a laparoscopic approach in the presence of one of these contraindications is possible only if the operating room is equipped with modern equipment, the well-coordinated work of the operating team and the highly qualified surgeon.

In laparoscopic treatment of ectopic pregnancy, both radical (salpingectomy) and organ-preserving operations are performed.

Salpingectomy

A. Indications for removal of the fallopian tube

2. Pronounced anatomical changes in the pregnant fallopian tube and the accompanying adhesive process in the pelvis of III-IV degree.
3. History of plastic surgery on the fallopian tubes for tubo-peritoneal infertility.
4. Old tubal pregnancy.
5. Repeated pregnancy in the tube, previously subjected to conservative surgery for tubal pregnancy.

B. Operative technique
Anesthetic care. It is preferable to carry out endotracheal anesthesia, since the administration of muscle relaxants allows you to create sufficient PP and perform the operation in safer and more comfortable conditions. However, in some cases, when the entire operation requires no more than 10-20 minutes, intravenous anesthesia is possible. This is confirmed by the experience of a number of authors.

The operation is performed using 3 approaches: one 10 mm for the laparoscope and two - 5 or 10 mm - for instruments.

If there is blood in the abdominal cavity, it is aspirated and the pelvic cavity is washed with saline solution, since dark color blood leads to absorption large quantity light and makes inspection difficult.

When removing the fallopian tube, two techniques are used.

A. Ligature method(using an endoloop tied with a Roeder knot).

Forceps and a catgut endoloop are inserted through the trocars. Using forceps, grab the tube containing the fetal egg and place a loop on it so that the loop is located on one side under the fimbrial part of the tube, and on the other, proximal to the fetal sac, near the transition of the interstitial part of the tube to the isthmic one. The loop is tightened, thus tying the mesosalpinx and the tube in its isthmic section.

To ensure reliable hemostasis, two more similar loops are placed and tightened sequentially on the same formations. The ligatures are cut with scissors at a distance of 0.3 cm from the knot. Then the fallopian tube is grabbed with forceps and cut off 0.5 cm distal to the location of the tightened loops. The resulting stump is treated with a point electrode for additional hemostasis.

Ligature method of salpingectomy

b. Using electrocoagulation. To perform the operation, mono- or bipolar electrosurgical instruments are used. The essence of the operation is the sequential coagulation of the mesosalpinx and the isthmic part of the fallopian tube, followed by the intersection of these formations (cutting off the tube). To avoid the formation of a large zone of coagulative tissue necrosis, it is necessary to grasp small areas of the mesosalpinx with a clamp and use a dissector with narrow jaws.

Salpingectomy using bipolar or monopolar coagulation

After tubectomy, the fallopian tube is removed from the abdominal cavity through a 5 or 11 mm trocar. If the size of the pipe exceeds the diameter of the trocar, it is removed in parts. The tube can also be removed through the colpotome opening.

Using an aquapurator, liquid blood and clots are sucked out of the abdominal cavity, which is thoroughly washed with saline. After making sure that there is no bleeding from the tube stump and mesosalpinx, the instruments are removed and silk sutures or staples are applied to the skin.

Organ-preserving operations

Clinical and morphological studies indicate that many patients can undergo organ-conserving surgery. The main goal of plastic surgery during tubal pregnancy is to preserve reproductive function.

Early diagnosis of ectopic pregnancy allows in most cases to prevent tubal rupture, which expands the possibilities of organ-preserving surgery, however, there are a number of contraindications to them.

Contraindications to organ-preserving operations during tubal pregnancy:
1. The patient’s reluctance to have a pregnancy in the future.
2. Significant morphological changes in the wall of the tube (old ectopic pregnancy, significant thinning of the wall of the tube along the entire length of the fetal sac).
3. Repeated pregnancy in a tube previously subjected to organ-preserving surgery.
4. Localization of the fertilized egg in the interstitial part of the fallopian tube.
5. The duration of inflammatory diseases of the genitals is more than 5 years.
6. Pronounced adhesions in the pelvis.
7. Ectopic pregnancy after plastic surgery on the fallopian tubes for tubo-peritoneal infertility.

Necessary conditions for performing conservative plastic laparoscopic operations during tubal pregnancy:
1. The size of the fertilized egg does not exceed 4 cm in diameter.
2. Integrity of the wall of the fallopian tube.
3. Monitoring the concentration of hCG in the blood after surgery.

Particular efforts should be made to perform conservative surgery on young nulliparous women, patients with a history of infertility or the absence of a second fallopian tube. Strict adherence to patient selection criteria increases the effectiveness and safety of conservative operations.

When carrying out these operations aimed at preserving the transport function of the pipe, it is essential to comply with the following provisions:
1. Isolation and removal of all tissues of the fetal egg.
2. Careful hemostasis.
3. Maximum atraumaticity.
4. Thorough rinsing of the abdominal cavity.

Character selection plastic surgery depends on the location of the fertilized egg in the fallopian tube.

When the fertilized egg was located in the fimbrial region, an operation was initially performed to squeeze the fertilized egg out of the fallopian tube (milking of a tube). Later, in these cases, they began to use suction of the fertilized egg from the fallopian tube with an aquapurator. At the same time, many surgeons consider these techniques to be traumatic and prefer salpingotomy to them.

In case of ampullary localization of the ovum, salpingotomy is considered to be the operation of choice.

When the fertilized egg is localized in the isthmic part of the fallopian tube, the operation of choice is currently considered to be resection of a segment of the tube with an end-to-end anastomosis. The anastomosis can be performed directly during surgery or later, preferably microsurgically. Most endoscopists believe that in case of isthmic localization of the ovum, it is advisable to perform salpingotomy.

Currently, conservative plastic surgery for ectopic pregnancy is also performed on a single fallopian tube. At the same time, the risk of a repeat ectopic pregnancy is high, but the incidence of intrauterine pregnancy in these cases significantly exceeds the level of favorable results with in vitro fertilization. Repeated conservative operations on the same fallopian tube are ineffective, since in most women, ectopic pregnancy occurs again in the operated tube.

Types of organ-preserving laparoscopic operations:
1. Laparoscopic linear salpingotomy.
2. Segmental resection of the tube.
3. Squeezing the fertilized egg out of the ampullary section of the tube.

Laparoscopic linear salpingotomy

Operation stages

1. Pipe cutting

The abdominal cavity is washed with saline solution. After clarifying the location, size and condition of the fallopian tube, the latter is grabbed with atraumatic forceps proximal to the location of the fertilized egg. The fallopian tube is opened with a monopolar electrode, microscissors or laser on the side opposite the mesosalpinx, in the longitudinal direction for 2-3 cm.

Stages of linear salpingotomy

To carry out preventive hemostasis, many authors recommend performing targeted coagulation at the site of the intended pipe incision and injecting vasoconstrictor solutions into the mesosalpinx.

2. Removal of the fertilized egg

The fertilized egg is removed using laparoscopic forceps or aspiration. The fetal receptacle is washed with saline solution. Careless instrumental removal of the remnants of the ovum can lead to injury to the endosalpinx and bleeding from the implantation site.

It is preferable to use aquadissection in these cases, which allows you to quickly, effectively and atraumatically remove the fertilized egg from the fallopian tube. A cannula is used for aspiration and irrigation, through which liquid is injected under pressure into the space between the wall of the tube and the fertilized egg.

3. Pipe rehabilitation

The lumen of the tube is thoroughly washed, the remnants of the fertilized egg and blood clots are removed. Through the pipe incision, the inner surface of the fetal sac is inspected to ensure complete removal of the fertilized egg. In cases of bleeding from the edges of the incision, point hemostasis is performed. Until recently, the issue of the necessity of suturing the pipe incision was discussed in the literature. Currently, the edges of the fallopian tube incision are left unsutured, since the long-term results with both methods are identical.

4. Final stage of the operation

Rinsing the pelvic cavity, aspiration of blood and clots.

Segmental tube resection

Segmental resection of the fallopian tube is the first stage of surgery for patients interested in preserving reproductive function. In the future, patients will have to undergo a microsurgical operation to restore the patency of the tube (salpingo-salpingoanastomosis). In recent years, thanks to the success of infertility treatment using assisted reproduction methods and high cost In microsurgical operations, resection of a segment of the fallopian tube is performed extremely rarely.

Segmental resection is recommended for unsuccessful linear salpingotomy and ongoing bleeding from the fallopian tube, with pronounced morphological changes in the wall of the tube at the site of the fertilized egg (hemorrhage, necrosis, rupture over a significant extent).
Some authors recommend performing segmental resection of the tube when the fetal egg is localized in the isthmic region.

It must be remembered that after segmental resection of the tube, the total length of the remaining sections should be at least 5-6 cm, and the ratio of the diameters of the ends of the tube should be no more than 1:3.

Segmental resection of the tube is carried out using bipolar coagulation and the application of endoligatures to the mesosalpinx of the resected area. Stopping bleeding with a monopolar dissector is unacceptable due to the formation of a larger coagulation zone than when using a microbipolar.

Operation stages

1. The abdominal and pelvic cavity are sanitized, blood and clots are removed. If necessary, adhesions in the area of the fallopian tube are dissected.
2. The section of the tube with the fertilized egg is grabbed with an atraumatic clamp and lifted upward to visualize the mesosalpinx.
3. Proximal and distal to the fetal receptacle, a bipolar clamp (microbipolar) is used to coagulate the tube as close as possible to the fetal receptacle. Scissors are used to cut tissue along the coagulation line.
4. Closer to the wall of the fallopian tube, the mesosalpinx is coagulated and crossed.
5. The pipe section is removed using one of the methods described above.

Resection of a tubal segment using bipolar forceps

Segmental resection of the pipe using a ligature method makes it possible to preserve sections of the pipe as much as possible for the upcoming reconstructive operation, since it does not cause thermal damage to the remaining segments of the pipe.

Segmental resection of the tube using a ligature method

The steps of the operation are similar to those described above. For hemostasis, endoloops are used instead of a bipolar clamp. The operation may be accompanied by more bleeding than with bipolar coagulation. To complete this, you need at least 3 endoloops.

Squeezing the fertilized egg out of the tube

The method of squeezing out the fertilized egg (FEO) from the fallopian tube is not widely used in endosurgery of tubal pregnancy. There is a description in the literature of laparoscopic removal of the fertilized egg from the end of the ampullary and fimbrial sections of the tube without dissecting its wall by aspiration of the fertilized egg or removing it using soft clamps. Most authors are skeptical about IPJ during laparoscopy, noting the significant traumatic nature of the operation and the possibility of bleeding due to incomplete removal of the fetal egg elements.

So, in the clinic headed by prof. Broy (France), previously resorted to aspiration of the fetal egg through the ampullary section of the tube. Faced with a high failure rate (17%), laparoscopic aspiration of the gestational sac was abandoned. The clinic came to the conclusion that the trophoblast is always located in the proximal part of the hematosalpinx, therefore, aspiration through the ampullary section of the tube leads to the removal of only blood clots. However, some surgeons are staunch supporters of this operation.

The purpose of the IPJ is to convert an incipient tubal miscarriage to a complete tubal miscarriage. In the vast majority of cases, during laparoscopy, signs of detachment of the ovum are detected - at least the minimal presence of blood or clots in the pelvis and fallopian tube (hematosalpinx). In the absence of these signs, one should refrain from performing an IPV. Other contraindications for surgery are the same as for laparoscopic linear salpingotomy, including rupture of the tube wall.

To successfully carry out the operation, you must adhere to the following recommendations for its step-by-step implementation.

Operation stages

1. The pelvis is freed from blood and clots. If there are adhesions in the tube area, salpingo-ovariolysis is performed. If fimbrial ring stenosis is detected, fimbryolysis must be performed. Elimination of stenosis of the distal part of the tube is an indispensable condition for the operation, especially with large sizes of the ovum. In the case of isthmic localization of the fertilized egg and minor manifestations of tubal miscarriage, a tube for aspiration-irrigation without side holes is inserted into the ampullary section. Using a stream of liquid under pressure (and, if possible, the tube itself), the fertilized egg is additionally peeled off.

2. Proximal to the fetal receptacle, the tube is grasped with atraumatic clamps. By carefully clamping the fallopian tube, trying not to capture the mesosalpinx, the fertilized egg is squeezed towards the distal section. To avoid unnecessary tissue trauma, instruments should not be allowed to slide along the fallopian tube. They need to be moved by alternately squeezing the pipe in front of the fruit container.

The instruments should be located close to each other (jaw to jaw). If the hematosalpinx is large, the IPJ can be performed in parts. The gestational sac should not be aspirated. Firstly, this does not guarantee its complete removal, and secondly, to evacuate blood clots (often dense ones), it is necessary to use a powerful electric suction. The aspirator-irrigator tube can cause significant damage to the endosalpinx.

Stages of the VPJ operation

3. After IPJ, the lumen of the tube is washed with Ringer’s solution to remove remaining small blood clots and elements of the fertilized egg. Chromosalpingography (antegrade hydrotubation) is performed, the uniformity of stretching of the ampullary section of the tube is observed, assessing the completeness of the removal of peritubar adhesions and the presence of possible intratubal adhesions (retrograde hydrotubation). When the pipe walls are overstretched due to large sizes It is recommended to add 10-15 units of oxytocin to the solution for hydrotubation of the fetal egg.

4. The operation is completed with sanitation of the pelvic cavity. Laparoscopy allows you to remove a fairly large fetus from the abdominal cavity.

Complications and their prevention

The frequency and nature of complications depend on the correct selection of patients for a particular type of laparoscopic operation, the qualifications of the surgeon and the equipment of the operating room with modern equipment. The incidence of complications is significantly lower after salpingectomy. Complications are divided into intraoperative and postoperative.

Intraoperative complications

A. Hemodynamic disorders
Hemodynamic disturbances may be associated with bleeding and the use of vasoconstrictors. If hemodynamics are unstable during laparoscopic surgery, hemorrhagic shock may develop. It is necessary to eliminate the cause of bleeding as quickly as possible. Much depends on the equipment of the operating room, the qualifications of the surgeon and the coordination of work with the anesthesiologist.

Surgeons, especially abroad, often use vasoconstrictor drugs during laparoscopic operations. When using vasopressin, hemodynamic disorders may occur, including pulmonary edema. They develop as a result of drug resorption after local administration or when accidentally entering a vessel.

Vasopressin, entering the general bloodstream, can cause generalized vascular spasm with increased blood pressure and bradycardia. This in turn can lead to transient ischemic spasm of the heart vessels, heart rhythm disturbances, and the appearance of symptoms of left ventricular failure with the risk of pulmonary edema. With large blood loss against the background of a decrease in blood volume and tissue hypoxia, this risk increases significantly. The antidiuretic effect of vasopressin must also be taken into account. In France, its use has been prohibited since 1991.

Recently, a synthetic analogue of vasopressin has been used - terlipressin (Remestip from Ferring). As a result of replacing arginine with lysine and adding 3 molecules of glycine, it was possible to minimize unwanted side effects natural hormone. The antidiuretic effect of terlipressin is 100 times less than that of vasopressin, and the duration of action is 3-5 hours. The safety and high efficiency of this drug open up broad prospects for its use in endosurgery.

B. Continued bleeding from the fallopian tube during conservative operations
This complication is more common with progressive tubal pregnancy of short term and its isthmic localization. The cause of bleeding during conservative surgery for ectopic pregnancy may be incomplete removal of the trophoblast. Patients after such an operation are considered to be at risk for the development of chorion persistence. To detach the ovum, aquadissection is necessary, and bleeding from the edges of the wound should be targetedly coagulated with a microbipolar.

In cases of bleeding from the tube, it is necessary to repeatedly sanitize its cavity with saline solution with the addition of oxytocin; It is recommended to administer remestyp into the mesosalpinx or intravenously. If there is no effect from of these activities Resection of the fetal sac or tubectomy is indicated. For very short periods of ectopic pregnancy, if it progresses, preference should be given to conservative therapy with methotrexate (see below).

B. Electrosurgical damage to the fallopian tube
If you carelessly stop bleeding, especially with the help of monopolar coagulation, significant thermal damage to the wall of the fallopian tube is possible, subsequently leading to obliteration of its lumen. If the fetal egg is fimbrial, during bleeding control it is necessary to ensure that the own ovarian ligament is not subjected to coagulation. This can lead to disruption of the blood supply to the infundibular section of the tube. If there are a large number of adhesions or an encysted hematocele, care must be taken when separating adhesions, since there is a high probability of injury to neighboring organs.

Postoperative complications

Chorion persistence occurs after conservative plastic surgery with a frequency of 5-10%. In a group at risk for the development of this complication, preventive therapy with methotrexate is carried out (see section “Drug treatment”). In case of chorion persistence, methotrexate therapy is recommended according to one of the following regimens. When clinical symptoms of progressive pregnancy appear and hemoperitoneum develops, the need for relaparoscopy arises. The extent of the operation depends on the patient’s interest in preserving the tube, the degree of morphological changes and the concentration of the β-subunit of hCG in the blood.

In the absence of significant changes in the pipe wall and the desire to maintain reproductive function It is recommended to rinse the cavity of the fallopian tube with saline and inject 40 mg of methotrexate into the lumen of the tube. After organ-sparing operations for ectopic pregnancy, it is necessary to examine the content of the beta-subunit of hCG in the blood 2-3 times a week, and in a group at risk for the development of chorion persistence and if this complication occurs, the concentration of the beta-subunit of hCG is monitored daily.

Tuboperitoneal fistula occurs after linear salpingostomy in 15% of cases. The effect on subsequent fertility and the likelihood of recurrence of an ectopic pregnancy in the operated tube has not been studied.

Postoperative adhesions and obstruction of the operated tube can cause repeated ectopic pregnancy and infertility. Adhesions recur after they are separated during surgery or are a result of the surgery itself.

Prevention of adhesions is carried out intraoperatively and in the postoperative period. The procedure must end with washing the abdominal cavity to evacuate blood and clots. To prevent the formation of postoperative adhesions, a wide variety of methods have been proposed: the introduction into the abdominal cavity of colloid and crystalloid solutions, various medicines, heparin, application of anti-adhesive barriers and fibrin glue, dynamic laparoscopy, etc.

The simplest, most accessible and safest method of preventing adhesions is the injection of Ringer's solution into the abdominal cavity in an amount of 500-1000 ml to create a hydroflotation effect. If during organ-preserving surgery a large number of adhesions were separated, sanitizing dynamic laparoscopy is desirable in the early postoperative period. Frequent repeated separation of the developing loose adhesions (after 24-48 hours) allows the processes of peritoneal regeneration to prevail over the processes of adhesion in the area of wound surfaces.

In this case, the peritoneum heals by primary intention without the formation of adhesions. Dynamic laparoscopy is especially indicated in case of suspected chorion persistence, as it allows you to visually monitor the condition of the fallopian tube and, if necessary, sanitize its cavity or perform local administration of methotrexate.

G.M. Savelyeva

Surgery for an ectopic pregnancy is a necessity that will help save a woman’s life. This diagnosis is not made very rarely. According to statistics, 5% of pregnant women experience an ectopic pregnancy. Such a conception has no chance of successful continuation. Moreover, the sooner this problem is diagnosed and solved, the better it is for the woman. Let us consider the features of the operation, the rehabilitation period and the consequences of such an intervention.

Features of surgery

Surgery for an ectopic pregnancy is a chance to preserve the appendages. Sometimes the patient’s life is at stake. To eliminate the problem, the following type of surgical intervention is indicated:

Laparoscopy

Surgery to remove an ectopic pregnancy is sometimes performed using laparoscopy. It involves the use of an image enlarged in size, as well as small tools.

This method is the least traumatic. It allows you to maintain the integrity of the pipe. It is simply carefully cut open and the fertilized egg is removed.

After laparoscopy, it is necessary to cauterize the areas of all bleeding vessels. And the functionality of the fallopian tube will be preserved. It should be noted that sometimes even the use of this gentle intervention cannot protect the fallopian tube. This happens if a woman experiences repeated symptoms of pregnancy pathology.

What is the duration of the operation for an ectopic pregnancy? The time will depend on the complexity of the intervention. The minimum operation time is 15 to 20 minutes. But if the situation is more serious, it may take 30 minutes to an hour.

Is it possible to do without surgery?

Surgery for early ectopic pregnancy is not always indicated. Modern medicine in some cases makes it possible to do without surgery. It is practiced to use drugs that prevent cell division of the fertilized egg, stopping its growth and development. The result of taking this medicine is complete resorption of the fertilized egg.

When is extrusion indicated?

The use of this method is also practiced as an alternative to abortion, even if the pregnancy develops in the uterus. But for this, the period of fetal development should not exceed three weeks. According to many experts, the use of alternative methods, such as medications, protects women from surgical injuries. But it is important to note that taking the drug is allowed only as prescribed by a doctor. Self-medication is dangerous! Sometimes an integrated approach is practiced, combining the use of a hormonal drug and surgical intervention. After tablets, squeezing is used.

Features of the rehabilitation period

Regardless of the type of intervention chosen, the consequences of surgery for an ectopic pregnancy can be serious. If you do not take the rehabilitation period seriously, problems may arise. It is important to put yourself in order so that the woman’s reproductive system is not damaged.

The doctor will necessarily prescribe medication in combination with a set of physiotherapeutic procedures. Moreover, the complex is prescribed even when one pipe is removed, since in this case the second one also requires treatment. It will take a lot of time to improve the condition.

Protect yourself!

Pay attention to the need to take contraceptives so that the situation does not happen again. You need to refrain from pregnancy after surgery for six months, no less.

After competent completion of the rehabilitation period, a woman has a 60% chance of subsequently bearing a healthy child. But there are also 15% of situations where the pathology of pregnancy recurs. In 25% of cases, the woman will not have children. When using medicinal methods of rehabilitation, infertility threatens to a lesser extent. A woman can still have children if she turns to alternative methods. But at the same time, the ovaries should remain, and with their full functioning. Then in vitro fertilization will help. If you have your ovary removed, you have little chance of getting pregnant.

What could be the consequences?

The nature of the consequences after surgery for ectopic pregnancy can be very different. If the fallopian tube ruptures, the consequences can be dire. Damage to arteries and veins may occur. Then bleeding occurs, painful sensations, and a state of shock appear.

If bleeding starts, do not waste time. Contact your doctor immediately. In twenty cases out of a hundred, a recurrence of ectopic pregnancy was recorded. If you do not carry out the correct course of rehabilitation, adhesions may appear. The pelvis and abdominal cavity are at risk. The development of inflammatory processes is typical if you do not pay attention to recovery after surgery.

The consequences of an ectopic pregnancy can also be infertility. Moreover, this situation is observed in a third of women, especially when one or two tubes were removed.

Description of symptoms in the postoperative period

After surgery to remove an ectopic pregnancy, a woman may feel discomfort for 10 days. It is expressed in the presence of the following symptoms:

The stomach is bloated.
There is pain that can only be relieved with painkillers.
The woman gets tired quickly.

Such conditions can go away on their own. But sometimes you have to consult a gynecologist. If surgery was performed, it will take two to five days before the woman can be discharged with an improvement in her condition.

Precautions during the postoperative period

During surgery for an ectopic pregnancy, a woman is exposed to traumatic effects. Therefore, after surgery, you should follow recommendations similar to those for other abdominal interventions:

Physical activity is unacceptable, you cannot get injured, shake, or get bruises.
To prevent bleeding, do not lift heavy objects.
In the case of a strip operation, you will need to wear a bandage so that the peritoneal wall is fixed.
Don't forget that moderate physical activity is beneficial. To prevent adhesions from forming, you need to at least turn over on your side. Prescribing therapeutic exercises will also help to effectively restore the body and strengthen the peritoneum.
Diet is important. While a woman is lying down, she should limit herself to light, nutritious and vitamin-rich meals. You should not eat foods that may cause bloating.
You should not overcool; in the cold season you must wear warm underwear.

Return to a full life

After recovery, the woman will want to live a normal life again. But there are recommendations to avoid deteriorating your health:

Let's sum it up

In the event of an ectopic pregnancy, it is important to act promptly. The shorter the period, the simpler and more painless the procedures will be. You can do without abdominal surgery. Therefore, if a pregnant woman experiences bleeding, experiences pain in the lower abdomen and a deterioration in her general condition, it is important to conduct a diagnosis. Ectopic pregnancy is dangerous due to serious complications such as internal bleeding and hemorrhagic shock.

Surgery will help remove the fertilized egg and stop the bleeding. Depending on the complexity of the situation, several types of surgical intervention are determined: from the most gentle extrusion to abdominal surgery. How long does surgery take for an ectopic pregnancy? From fifteen minutes to two hours depending on the complexity.

After surgery, it is important to take care of yourself and follow the recommendations of doctors. After all, if you do not take care of quality rehabilitation, infertility may develop. Also dangerous for future pregnancy formation of adhesions. They can prevent the fertilized egg from moving through the fallopian tubes. Then a recurrence of the ectopic pregnancy is possible.

Sexual activity after surgery is possible after three weeks. Otherwise, you can get an infection, the consequences of which will be an inflammatory process.

A woman may have congenital abnormalities in the formation of the fertilization system. Then the fertilized egg is not located in the uterus, but in the cervix of this organ, the abdominal cavity, tube or ovary. The purpose of surgical intervention will be determined depending on the location of the fetus. The method of laparoscopy has become widespread. This is a relatively gentle intervention using miniature instruments. After their introduction into the zone abdominal cavity the fertilized egg will be removed through the abdominal opening.

Take care of your health and contact specialists in a timely manner!