Preservation of the fallopian tubes in women with ectopic pregnancy

The article was professionally consulted by Specialist Doctor I Le Thi Phuong - Department of Obstetrics and Gynecology - Vinmec Ha Long International Hospital. Dr. Le Thi Phuong has 29 years of experience in the field of obstetrics and gynecology.

Ectopic pregnancy is detected in time when there are no signs of threatened rupture. The main purpose of the method is to maintain fertility for women who still wish to have children.

An ectopic pregnancy is a case where the fertilized egg does not move down to implant in the uterus, but implants and develops outside the uterus (fallopian tubes, ovaries, cervix, even inside the uterus). Abdominal).
Organs containing ectopic pregnancy are defined as follows:
More than 95% of ectopic pregnancies occur in the fallopian tubes (tubal, ambulatory, isthmus, or tubal interstitium) 5% In the remaining cases, the fetus attaches and develops in other locations such as the ovary, abdominal cavity, cervix or previous surgical scar. Bilateral ectopic pregnancy is rare, accounting for about 1 in 200,000 pregnancies. Multiple pregnancies with one pregnancy implanting in a normal uterine cavity and the other in an ectopic position, 1 in 30,000 pregnancies.

Indications for tubal-conserving surgery in ectopic pregnancy is indicated for women with a confirmed diagnosis of ectopic pregnancy but no signs of threat of rupture, who wish to keep the fallopian tubes because they still need it. fertility demand. The patient has a fetal mass that is not too large, nests in the position of the ball or the tube of the uterus.
Do not preserve the fallopian tubes for women who have ruptured or show signs of tubal rupture; large fetal mass that feels firmly attached to the tubal wall and is less mobile or ectopic pregnancy with cystic hematoma; Women do not need conservative treatment and some cases have conservative indications, but during surgery, the prognostication of the fallopian tubes is not able to pass, and normal physiology cannot be guaranteed.

There are two methods applied in ectopic pregnancy surgery: open surgery and laparoscopic surgery. Although the form is different, the treatment method is the same. Specifically as follows:
First, the doctor will perform an abdominal surgery or with laparoscopic equipment. After surgery, the doctor will check the location of the pregnancy mass, determine the extent of damage to the fallopian tubes, examine and evaluate the ovaries on both sides and the uterus to determine the rate of pregnancy. pregnancy next time. Especially check the lateral fallopian tube without fetal mass, if abnormality is detected, then surgery to preserve the fallopian tube is indicated to ensure fertility.
Treatment of the lateral fallopian tube with fetal mass If the fetal mass is in the bulb of the fallopian tube: Conduct a tubal incision in the area without blood vessels, gently scrape the fetal tissues and placenta, sew the hemostasis and leave the window hole. . If the fetus is in the tubules: Carry out a plus-shaped incision to get the baby and organize the placenta, then suture the tubules upside down. Then proceed to release and cut the hose ligaments, or tassels (if any). Find and treat other possible causes of an ectopic pregnancy to reduce the risk in future pregnancies.
Treatment of the lateral tubule without fetal mass If there is an abnormality in the bulb of the tube: Proceed to cut and release the attached ligaments and tissues or inject fluid, pus, blood (if any) and then suture to leave the window. If there is an abnormality in the proboscis: Make an incision and inject a plus sign to remove all the fluid, pus, and then sew the speaker upside down. Next, the patient will be prescribed a Beta HCG test to determine the levels of a pregnancy hormone secreted by the placenta. Based on that, decide on dose, duration of consolidation treatment with cytotoxic methotrexate, intramuscular dose.
Patient continues to be monitored and tested. After surgery, a woman should not have sex too soon, have sex not to get pregnant. From the 3rd to 5th day in the first menstrual period after surgery, the patient comes to the hospital for a scan to re-check the fallopian tubes. If the patient has semi-obstruction or blocked fallopian tubes, continue to go to the hospital for treatment, avoid early pregnancy, prevent ectopic pregnancy again.

Currently, there is no way to prevent an ectopic pregnancy from recurring. A woman can only take preventive measures to minimize recurrence of ectopic pregnancy, including:
Early treatment of diseases or infections in the reproductive organs such as adhesions of the fallopian tubes , congenital abnormalities in the structure of the fallopian tubes, Chlamydia infections, endometriosis, gynecological infections. Use safe birth control for 6 months - 1 year after surgery when your body is ready to have a baby. For women who have become pregnant again after an ectopic pregnancy, it is necessary to have regular health checks to determine the exact location of the pregnancy mass and other abnormalities (if any). Prenatal screening helps pregnant women detect early pregnancy complications for timely intervention. Faculty of Fetal Medicine - Vinmec International General Hospital is the first unit in the North to deploy a one-stop prenatal clinic (OSCAR) providing a comprehensive screening package for pregnant women at 12 weeks. The clinic gives quick results on the same day of examination and screening.
Faculty of Fetal Medicine has successfully implemented advanced prenatal screening methods, helping to screen for complications for pregnant women; Timely detection and intervention of some abnormalities in the fetus such as ectopic pregnancy from very early weeks of pregnancy.