Extrauterine (ectopic) pregnancy
Treatment of ectopic pregnancy is currently possible through two modalities: surgical intervention and medical management. Both approaches require close clinical supervision in a specialized inpatient setting.
For medical treatment, a cytostatic agent (methotrexate) is used to disrupt cellular division. In order to attempt medical termination of an ectopic pregnancy, strict criteria must be met:
• low serum hCG concentration;
• small size of the ectopic gestational sac without detectable embryonic cardiac activity on ultrasound.
It must be taken into account that cytostatic therapy carries risks of systemic side effects and drug toxicity. Due to variable success rates and the risk of severe complications, I do not utilize medical therapy or local tubal injections during laparoscopy in my current practice.
Year: 2020 Complex surgical case: ectopic pregnancy in tubal stump
A patient was admitted with suspected right-sided ectopic pregnancy. Five years earlier, the left fallopian tube was supposedly removed laparoscopically elsewhere.
Initial surgical plan: evacuation of ectopic pregnancy from the right tube. Laparoscopic exploration revealed ~200 ml of hemoperitoneum with pelvic blood clots. The sigmoid colon was densely adherent to the uterine fundus and left tubal cornu. The left ovary was enclosed in a dense adhesive conglomerate. Right adnexa were fixed to the pelvic sidewall.
Following clot clearance, no ectopic gestation was found in the right tube. Active bleeding originated from the adherent left adnexal region. Adhesiolysis was performed, mobilizing the sigmoid colon and opening the Pouch of Douglas. An ectopic gestational sac was identified adhering to the remaining fimbrial stump of the left tube from the prior surgery. The remnant stump was completely resected together with the gestational tissue. The left ovary was mobilized from adhesions.
Right adnexal adhesions were separated; examination revealed a normal right ovary with a corpus luteum (recent ovulation site). The patient recovered smoothly and was discharged home the next morning.
Year: 2020 Ectopic pregnancy secondary to IUD perforation and displacement
The patient presented with a 1-week history of lower abdominal pain. Medical history: intrauterine device (IUD) insertion 6 months prior, followed by persistent pelvic discomfort.
Ultrasound revealed an empty uterine cavity and free fluid in the rectouterine pouch. Diagnostic CT confirmed extrauterine migration of the IUD into the pouch of Douglas. The patient underwent emergency laparoscopy.
Intraoperatively, a right tubal pregnancy was confirmed; salpingectomy was performed. The displaced IUD was located behind the uterus, encapsulated within the greater omentum, and safely extracted. The patient was discharged home the next day.
Year: 2019 Cornual ectopic pregnancy (interstitial/tubal angle)
A rare and dangerous form of ectopic gestation localized in the interstitial segment of the fallopian tube at the uterine cornu.
Year: 2020 Intramural / cornual ectopic pregnancy with temporary uterine artery clipping
Ectopic development situated in the intramural segment of the tube adjacent to the uterine cavity. To prevent catastrophic intraoperative hemorrhage, temporary bilateral clipping of the uterine arteries was performed prior to complete resection of the ectopic tissue.
Year: 2020 Right tubal pregnancy: organ preservation and fimbrioplasty
Successful evacuation of the tubal ectopic pregnancy with preservation of the fallopian tube and plastic restoration of the fimbrial apparatus (fimbrioplasty).
Year: 2013 Ruptured ectopic pregnancy with hemorrhagic shock
Emergency open surgery performed for tubal rupture with massive intra-abdominal hemorrhage. Urgent Pfannenstiel laparotomy and right salpingectomy.
Year: 2007 Tubal ectopic pregnancy
