Unfortunately, some women, when planning a long-awaited pregnancy, face life-threatening pathologies. One of them is an ectopic pregnancy, in which the fetus develops outside the uterus. If this happens, an ectopic pregnancy surgery is necessary. So, what are the types of surgeries and their consequences for the health of women?
Ectopic pregnancy is a common pathology that threatens the life of a pregnant woman. Pregnancy is called ectopic if during conception a fertilized egg (zygote) is attached not to the uterine cavity, but outside of it: in the fallopian tube, in one of the ovaries, in the rudimentary horn of the uterus or in the peritoneum. With the development of two fetal eggs, a normal attachment of one egg and a pathological of the second one (heterotopic pregnancy) is possible.
Causes and Risk Factors
The causes of ectopic pregnancy are not known. However, the risk factors include:
- hormonal imbalance;
- use of intrauterine contraceptives (Mirena IUD);
- chronic chlamydial salpingitis;
- tumors or abnormalities of the development of the organs of the reproductive system;
- Adhesive process in the small pelvis due to previous operations, inflammatory diseases or endometriosis;
- artificial insemination (IVF);
- ectopic pregnancy In the past;
Up to three weeks, an ectopic pregnancy symptomatically does not differ from the uterine one. A woman feels normal for the current state of events. There may be drowsiness, increased appetite and increased sensitivity of the nipples. But starting with the 4th week, the pregnant woman should pay special attention to changes in her condition: aching pains in the lower abdomen or atypical bleeding (often of a liquid consistency and dark color) are an alarming sign. This is an urgent reason to contact a specialist.
Precise diagnosis is possible in a gynecological hospital. Diagnosis includes transvaginal ultrasound and blood sampling for the determination of hCG (human chorionic gonadotropin). Diagnostic laparoscopy is also necessary sometimes.
If the ectopic pregnancy has not been diagnosed in time, a tube (or ovary) can be ruptured with a subsequent hemorrhage into the abdominal cavity. The rupture is accompanied by a sharp pain in the lower abdomen (acute abdomen), as well as a pain shock (loss of consciousness, general malaise, problems with pulse and pressure). A woman with such symptoms should be immediately hospitalized.
The method of elimination of ectopic pregnancy is selected depending on the location of the fetal egg, the gestational age, the age and general condition of the patient, as well as the desire to have children in the future.
Ectopic Pregnancy Surgery: Laparoscopy
The most modern approach to surgery in all medical directions is laparoscopy. It is used today in almost all medical institutions, which have the necessary equipment and doctors of high qualification. Due to the laparoscopic method of surgical intervention, it is possible to remove the embryo from the fallopian tube, the entire fallopian tube (if necessary), and stop severe abdominal bleeding. In this case, only a few small incisions are made on the abdomen of a woman. This is the minimum of injuries that allow recover much faster after the ectopic pregnancy surgery.
There are several contraindications to the laparoscopy surgery. They include:
- a severe posthemorrhagic shock;
- problems with the heart or respiratory system;
- the presence of adhesions on the intestine;
- severe blood loss;
- the rupture of the organ in which the pregnancy developed.
If there are no obstacles to a laparoscopic operation, then such an ectopic pregnancy surgery is immediately carried out.
The mechanism of the surgery
First, general or epidural anesthesia is performed.
After this, the surgeon makes 3 punctures in the abdominal cavity. Through one of the punctures, carbon dioxide is injected into the abdominal cavity. Thus, that the doctor has good visibility of the operated organ. In addition, if a specialist detects blood inside, he pumps it out in order to be able to carry out the surgery.
Through another puncture, a laparoscope is inserted into the abdominal cavity of the woman, and through the third, the instrument itself, through which the fetal egg will be removed. As a rule, it is a loop that is pounced on the fallopian tube. It cuts off the tube part together with the fetal egg attached to it. At the same time, a coagulator is inserted into the first puncture through which carbon dioxide was introduced. This cauterizes all the cut off places so that there is no bleeding.
After the main process is completed, the abdominal cavity is carefully inspected. The surgeon removes all blood clots. The abdominal cavity is treated with normal saline and stitches are applied.
If there is an opportunity to save a childbearing function in a woman, then doctors do not remove the fallopian tube, but make an incision on it. This is the so-called tubal uterine abortion. This ectopic pregnancy surgery lasts at least 40 minutes. If complications occur during the procedure, then the surgery can take more time.
But in any case, after this ectopic pregnancy surgery, a woman will need one more surgery. This is a plastic surgery in order to restore the integrity of the genital organ.
Ectopic Pregnancy Surgery: Abdominal Operation
The abdominal operation, despite all the cons of this surgical method, is used today as often as laparoscopy. Most often this happens if a woman has the following indications:
- she does not plan to become a mother in the future;
- when there are severe adhesions on the fallopian tube;
- if in the past a woman went through operations on the fallopian tubes several times;
- if earlier a woman has already had an ectopic pregnancy.
The Mechanism of Ectopic Pregnancy Surgery: Abdominal Operation
To begin with, the doctor must decide which abdominal incision he will make. If the situation is not very critical, the surgeon usually makes the transverse incision in the pubic region. If emergency surgery is required, the surgeon most often makes a mid-incision. It heals much longer, but in the course of the operation the doctor has the opportunity to perform all necessary manipulations in a qualitative and correct manner.
Then the anesthesiologist gives the patient anesthesia. As a rule, it is always general anesthesia.
Then the surgeon makes an incision, creates access to the uterus and fallopian tubes.
If bleeding takes place, the doctor needs to stop it. Thus, he performs all the necessary manipulations with the help of medical clamps.
After this, the surgeon removes the uterine tube or the fetal egg.
Then, all organs that have been operated are sutured. The doctor carefully examines the abdominal cavity, so that there are no blood clots or medical supplies left inside. Then, the surgeon applies the normal saline on the abdominal cavity, and sutures it.
The time of ectopic pregnancy surgery may be different. The length of the procedure depends on how critical the situation is. Every ectopic pregnancy surgery is quite complicated. It belongs to the number of risky surgical interventions. The recovery of a woman after ectopic pregnancy surgery takes a long period of time. Because not only internal seams, but also a large external suture should heal. It also requires care.
Other Types of Ectopic Pregnancy Surgery
Surgical treatment for tubal ectopic pregnancy can be produced by several different methods of interruption and removal of pathology:
The procedure is performed in the case of detachment of the fetal egg. It is simply squeezed out of the fallopian tube, while retaining it. The use of this method is performed when the non-developing embryo is located near the exit from the tube. That is, the stopping of development with the detachment of the fetal egg and its location is crucial.
The surgery is performed in cases when expression operation is impossible. The surgeon cuts the fallopian tube at the place of attachment of the fetal egg. Then he removes its elements and sutures the tube. If the embryo is too large by the time of surgery, it is removed together with the part of the fallopian tube. Tubotomy allows preserving the uterine tube, as an organ that is able to perform its function fully. The possibility of becoming pregnant in the future is preserved, although it is decreasing.
Tubectomy is the surgical removal of the tube. The operation is performed when it is impossible to save the uterine tube. Thus, it is completely removed together with an ectopic pregnancy. Most often, tubectomy is performed in case of repeated pregnancy outside the uterine cavity. In emergency cases, it is possible to remove the ovary, when there is a need to save a woman’s life.
Possible Consequences of Ectopic Pregnancy Surgery
Regardless of what operation is performed for a woman with an ectopic pregnancy, it is always unsafe. According to medical statistics, surgical intervention in pelvic organs always entails many different negative consequences. The main of them are the following:
If an ectopic pregnancy surgery was performed in the early stages, then no terrible consequences will occur. With proper treatment and a full rehabilitation course a woman can have children in the future.
At the same time, even, if one of the fallopian tubes was removed, a woman can still get pregnant, as the other one remains untouched. If an ectopic pregnancy has occurred in a woman who is more than 35 years old, then she has a physiological decline in fertility. So, after the operation she can become infertile.
If tubal abortion was performed, as a result of which the tube was saved, but an incision was made on it, there is a very high probability that the next egg will be attached again in the fallopian tube, and not in the uterine cavity. Therefore, doctors advise women who have gone through such an operation not to risk and think about the IVF procedure.
Sometimes a woman doesn’t have to go through an ectopic pregnancy surgery. She can take a special drug, which stops the development of the fetus. As a result, it dies, dissolves and comes out as a bleeding with clots from the vagina. Complications after such a procedure are less dangerous. But only if it was done in time.
The most important and dangerous complication that can occur after an ectopic pregnancy surgery is infertility. Therefore, a woman needs to undergo a comprehensive examination and treatment after such a procedure, so that the ectopic pregnancy does not happen again.