This article was professionally reviewed by Le Nhat Nguyen, Dr, MSc – Obstetrician-Gynecologist, Department of Obstetrics and Gynecology, Vinmec Da Nang International Hospital.
Ectopic pregnancy often requires surgery in cases where it is detected late, such as when the uterus ruptures, causing severe bleeding. If the patient does not adhere to the prescribed treatment and doctor's advice after the procedure, complications such as high fever, abdominal pain, and surgical site bleeding may occur, leading to poor wound healing and delayed recovery.
1. What is an ectopic pregnancy?
An ectopic pregnancy occurs when the embryo implants in the wrong location. The proper implantation site for the embryo is the uterine cavity. However, for various reasons, the embryo fails to travel to the uterus and instead implants in other locations, such as the fallopian tubes, ovaries, cervical canal, or other areas within the abdomen—or even outside the peritoneal cavity. It is estimated that 95% of ectopic pregnancies occur in the fallopian tubes (55% in the fimbrial end, 25% in the isthmus, 17% in the ampulla, and only 2% in the interstitial part). The remaining 5% implant and develop in other locations. Improper implantation of the embryo poses significant risks to the mother’s health and, in severe cases, may threaten her life.
2. How is ectopic pregnancy diagnosed?
2.1 Diagnosis based on symptoms
Symptoms that help detect ectopic pregnancy early include:
- Abdominal pain: Pain is located in the lower abdomen, typically dull and sometimes cramping.
- A few days after a missed period, there may be light vaginal bleeding with dark brown blood, sometimes mixed with discharge.
If an ectopic pregnancy has ruptured, the symptoms become severe, requiring the patient to be immediately hospitalized to avoid life-threatening complications. These symptoms include:
- Sudden, severe abdominal pain that causes profuse sweating.
- Acute blood loss symptoms: Pale skin, mucous membranes appearing pale, cold extremities, rapid pulse, and low blood pressure.
2.2 Diagnosis based on laboratory tests and imaging
- Serum βhCG quantification: In over 60% of pregnant women, βhCG levels double every 48 hours. If βhCG levels do not rise accordingly and no intrauterine pregnancy is visible on ultrasound, ectopic pregnancy should be suspected.
- Serum progesterone levels: In ectopic pregnancy, progesterone levels are lower. If serum progesterone is <5 ng/mL, abnormal pregnancy is suspected. Further testing is needed for an accurate diagnosis.
- Transabdominal and transvaginal ultrasound: Abnormal findings include no gestational sac in the uterus, a heterogeneous mass with clear boundaries, and a small size adjacent to the uterus.
- Doppler ultrasound: Signs of a "ring of fire" pattern may appear. In rare cases, larger masses with visible fetal echoes and cardiac activity outside the uterus can be observed.
3. Surgical treatment of ectopic pregnancy
There are two surgical methods for ectopic pregnancy:
- Laparoscopic surgery: This is the preferred method for treating ectopic pregnancies. It has advantages such as smaller incisions, shorter hospital stays, and better cosmetic outcomes. Importantly, it allows for preservation of the fallopian tubes, which is crucial for women who still desire to conceive.
- Open surgery: This is used in cases where the ectopic pregnancy has ruptured, causing excessive blood accumulation in the abdominal cavity, or for other specific reasons.
4. Complications after surgery for ectopic pregnancy
- High fever
High fever may indicate an infection. It can also result from incomplete wound healing or suture failure. If accompanied by symptoms like discomfort, fatigue, or dizziness, medical attention is required immediately.
- Swelling at the surgical site
Swelling with redness, heat, and pain at the surgical site may indicate infection or suture breakdown. This can lead to bleeding and cause severe complications. Proper wound care is essential to prevent infection.
- Severe abdominal pain
Abdominal pain may be caused by incomplete wound healing, swelling, or suture breakdown, which can lead to bleeding and pose a life-threatening risk to the patient.
- Bleeding from the surgical site
Bleeding from the laparoscopic incision is a dangerous complication. Rapid and heavy bleeding can result in the patient’s death. Regular health monitoring is necessary after surgery to detect any abnormalities until full recovery is achieved.
5. Post-operative care for ectopic pregnancy
After surgery, patients need time to rest. Additionally, they must strictly adhere to their doctor’s advice, including:
- Avoid strenuous labor or physical activities.
- Allocate time to rest and relax.
- Maintain a nutritious diet, including a balance of green vegetables, fruits, and foods like eggs, fish, pork, and chicken. Avoid foods that may cause bleeding, such as ginger, aloe vera, green papaya, and seafood.
- Refrain from consuming alcohol or using stimulants.
- Avoid sexual activity until the wound has fully healed.
- Follow the prescribed medication regimen and do not self-medicate.
Prenatal screening is essential to detect pregnancy complications early and allow timely intervention. The Fetal Medicine Department at Vinmec International Hospital is the first in Northern Vietnam to implement a one-stop prenatal clinic (OSCAR), offering comprehensive 12-week screening packages. Results are provided on the same day of the visit.
The department has successfully implemented advanced prenatal screening methods, enabling early detection and intervention for complications like ectopic pregnancy.
Dr. Le Nhat Nguyen has over 20 years of experience in Obstetrics and Gynecology. He previously worked at Gia Dinh People's Hospital in Ho Chi Minh City and specializes in diagnosing and treating obstetric and gynecological conditions. Currently, he is an Obstetrician-Gynecologist at Vinmec Da Nang International Hospital.
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