Surgery for ruptured ectopic pregnancy

The article was professionally consulted by MSc, Dr. Trinh Thi Thanh Huyen - Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital

A ruptured ectopic pregnancy is a common obstetric emergency, occurring anytime, and is very dangerous because it can cause rapid death of the patient. Ectopic pregnancy in general and ruptured ectopic pregnancy in particular need to be diagnosed and treated promptly.

An ectopic pregnancy is an abnormality in the implantation position of the fetus, the gestational sac will not be located in the uterine cavity but implant in other locations such as the fallopian tubes, ovaries, cervix, abdomen, etc. ... The clinical rate of ectopic pregnancy is assessed at an average level, about 5 to 10 cases per 1000 pregnant women. A ruptured ectopic pregnancy is the most feared complication because it causes a lot of blood loss, which can easily lead to shock and threaten the patient's life.
People who have had an ectopic pregnancy have a high risk of having an ectopic pregnancy in subsequent pregnancies. It is recommended that women of reproductive age should pay attention to abnormal symptoms such as menstrual irregularities, missed periods, need to know how to take a pregnancy test and seek medical attention for examination and detection. Early signs of ectopic pregnancy if any.
Women with ectopic pregnancy are selected for treatment by one of two methods: conservative medical treatment and ectopic cesarean section. The treatment of ectopic pregnancy is decided based on many different factors, the most important being the clinical presentation of the patient.

Ectopic pregnancy is the result of many causes, mainly diseases related to obstetrics and gynecology such as salpingitis, pelvic infection, interventions and surgery related to fallopian tubes and uterus. , history of multiple abortions, ovarian cysts,...

A case of an ectopic pregnancy that hasn't ruptured often has clinical manifestations such as:
Abdominal pain: This is the most common symptom in women with an ectopic pregnancy. Patients suddenly have dull abdominal pain in the lower abdomen or one side of the pelvis corresponding to the position of the fetus's implantation, there may be a throbbing sensation. Missed period: A missed period or missed period is a sign of pregnancy. Irregular vaginal bleeding, also known as heavy bleeding: Blood coming out of the vagina is not usually related to your period. Blood is red, bruised, small amount and does not clot. However, in rare cases, symptoms of vaginal bleeding can appear a few days before the menstrual cycle and last long, making the patient confused with a normal menstrual cycle and not think she is pregnant. This creates a trap that delays the diagnosis of ectopic pregnancy and increases the complication rate of ruptured ectopic pregnancy. An ectopic pregnancy can progress to a cystic hematoma. When the ectopic pregnancy ruptures causing oozing bleeding, the blood collects in the posterior sacrum, the lowest position in the abdomen. The ruptured gestational sac will be covered by intestinal loops and omentum in the abdomen to form a cyst, so it is called a cyst wall hematoma. In this situation, the patient often has other accompanying symptoms such as the feeling of wanting to defecate, the urge to urinate, the urge to urinate, and the frequency of urination. Symptoms of abdominal pain and bleeding often persist for a longer time.
The most serious complication is a ruptured ectopic pregnancy causing a lot of blood loss. The patient's general condition is affected with pallor, fatigue, feeling of lightheadedness, fainting, pale skin and mucous membranes, rapid and light pulse, low blood pressure with the risk of progressing to hemorrhagic shock and possibly death. death if not detected and treated promptly.

The diagnosis of ectopic pregnancy is established based on a combination of clinical and laboratory data. A typical case of ectopic pregnancy presents with the classic triad including: missed period, abdominal pain and vaginal bleeding. However, in order to accurately diagnose and detect complications of ruptured ectopic pregnancy, doctors need the help of paraclinical means such as:
Quantification of beta-HCG: Increased beta-HCG levels Elevation helps diagnose a pregnancy, not an ectopic pregnancy. Abdominal or transvaginal ultrasound: Ultrasound helps to detect gestational sac located in an abnormal position or shows an empty uterus in the context of elevated beta-HCG levels, which is highly suggestive for the diagnosis of pregnancy. ectopic. The image of the gestational sac outside the uterus is not easy to see. In many cases, the sonographer may show a posterior sac that is indirectly suggestive of a ruptured ectopic pregnancy. Laparoscopy: A modern means of both diagnosis and treatment of ectopic pregnancy. This is the gold standard with 100% accuracy for diagnosing ectopic pregnancy.

Ectopic pregnancy is a necessary treatment in cases of ruptured ectopic pregnancy. Today, laparoscopic ectopic pregnancy is gradually overtaking the traditional open surgery method because of many advantages such as:
Quick surgery time Patients only need a short hospital stay Less pain and quick recovery High aesthetics because minimally invasive, does not leave large scars on the abdomen like conventional open surgery Do not use too much drugs Low treatment cost Open ectopic pregnancy is indicated for severe cases requiring Rapid cessation of intra-abdominal bleeding or the presence of large pelvic adhesions that make laparoscopic surgery difficult.