Treatment of ectopic pregnancy

1. Debashis Nanda
Roll- 16
Treatment of Ectopic
Pregnancy : Ruptured and Unruptured

3. The type of treatment must be individualized and depends more on clinical
presentation.
Acute :
Principle : Resucitation and laparatomy . ( Rescucitation followed by laparatomy )
a)Anti-shock measures : Ringer’s lactate solution ( Venesection if required )
Blood sample for Hb, blood grouping & cross matching,BT, CT.
Arrange for blood transfusion.
Even if blood is not availabe , laparatomy is done desperately.
Once blood is available, it is transfused after clamping the bleeding vessels.
b)Laparatomy : Indications : 1. patient hemodynamically unstable
2. laparoscopy contraindicated
“Quick in & quick out” 3. evidence of rupture
Chronic :
All cases are to be admitted as emergency.
Patient is kept under observation.
Investigations are done.
Pt. is put up for laparatomy.

4. Management of unruptured tubal pregnancy
•Initial beta-hcg < 1500 IU/L
•Falling hcg titre
•Ectopic mass diameter <4cm
•No fetal heart beat on trans
vaginal sonogra[phy
•No eveidence of bleeding or
rupture on trans vaginal sono
graphy
Beta-hcg follow-up to detect persistent trophoblastic disease
(ectopic pregnancy)
50mg/M2
intramuscularly • Linear
salpingotomy
• Segmental
resection
• Fimbrial
expression
• Salpingectomy
5 mIU/mL

5. Indications for Medical Management
1. The patient must be haemodynamically stable
2. Serum Hcg < 3000 IU/L
3. Tubal diameter < 4cm without any fetal cardiac activity
4. There should be no intra-abdominal hemorrhage
Indications for Conservative surgery
1. Cases not fulfilling the criteria for medical therapy
2. Cases where beta-Hcg levels are not decreasing despite medi
cal therapy
3. Persistent fetal cardiac activity

6. Management of ruptured ectopic pregnancy
PRINCIPLE: Resuscitation and Laparotomy
•ANTI SHOCK TREATEMENT:
- IV line made patent, crystalloid is started
- Blood sample for Hb, blood grouping & cross matching,
BT, CT
- Folley’s catheterization done
- Colloids for volume replacement
•LAPAROTOMY:
Principle is ‘Quick in and Quick out’
- Rapid exploration of abdominal cavity is done
- Salpingectomy is the definitive surgery (sent for HP study)
- Blood transfusion to be given
- Autotransfusion only when donated blood not available.

8. Abdominal Pregnancy
Once the diagnosis is made , it always favours Urgent laparatomy irrespective of
period of gestation.
The risks of continuing pregnancy are :
1.Catastrophic hemorrhage
2.Fetal death
3.Increased fetal malformation
4.Increased neonaral loss(50%)
URGENT
LAPAROTOMY

9. Ovarian Pregnancy
Rupture is an inevitable phenomenon
Salpingo-oopherectomy is a definite surgery
Ovarian resection could be done when the diagnosis is made early

10. Cornual Pregnancy (The term cornual pregnancy indicates the presence of a pregnancy located with
in the cavity in one of the two upper "horns" of a bicornuate uterus.)
•Termination is inevitable by rupture( b/w 12-20 wks) with massive
intraperitoneal hemorrhage.
•Commonly diagnosed as fibroid or ovarian tumour with pregnancy
•Surgery-removal of rudimental horn
Hysterectomy- if the pedicle is short and the attachment is wide

11. Cervical pregnancy(when the implantation occurs in the cervical canal or below the internal os)
Commonly confused with cervical abortion.
Hysterectomy is often required to stop the bleeding.
An attempt to preserve the uterus may be made by intracervical plugging
Methotrexate therapy has been tried as alternative or adjunct to hysterectomy.
Uterine artery embolisation with gelfoam can control the hemorrhage.

12. Thank You