Intrauterine pregnancy operation. Medical and surgical treatment of ectopic pregnancy

Other occasions
21.10.2019

When fertilization does not occur according to the natural scenario, such a dangerous pathology as an ectopic pregnancy develops. There are a lot of causes of pathology, so no woman is immune from this disaster. The consequences are deplorable - the slightest delay threatens not only the health, but also the life of a woman, so the treatment is predominantly surgical.

Treatment of an ectopic pregnancy is possible without surgery, when the fetal egg is disposed of with the help of medical intervention. However, getting out of an unpleasant situation in this way is obtained in rare cases, when the gestational age is very short and there are no symptoms that complicate the situation of the pregnant woman.

The method of treatment is also affected by the localization of the fetal egg. For example, if the embryo is attached to the cervix, which happens extremely rarely, then there is hope to get rid of an ectopic pregnancy without surgery. However, if, by some coincidence, the embryo lingered in the fallopian tube or abdominal cavity, the problem will be solved on the operating table. The sooner the surgical intervention occurs, the greater the chance that there will be no negative consequences of this violation for the patient.

How does an ectopic pregnancy manifest?

Offhand to assume that pregnancy is developing incorrectly is quite difficult. However, there are a number of symptoms, with the appearance of which a pregnant woman should at least make an unscheduled visit to the gynecologist. Here are some warning signs of deviation:

  • prolonged menstruation;
  • menstruation does not begin on a calendar date, while they are very plentiful;
  • after the established conception, spotting appears;
  • often dizzy;
  • blood pressure is lowered;
  • pale skin;
  • from time to time there is a pre-fainting state.

If you deliberately drag out time in the hope that your health will improve, sooner or later the fallopian tube will burst, which will entail significant blood loss and the development of hemorrhagic shock. Such complications lead to the death of the patient, so timely surgical intervention is often the only correct treatment tactic.

Contraindications for abdominal surgery in ectopic pregnancy

Surgical treatment of pathology is impossible if the patient has at least one of the following diagnoses:

  • coma;
  • diseases of the cardiovascular system;
  • dysfunction of the respiratory system;
  • hernia of the anterior abdominal wall.

Most often, with an ectopic pregnancy, laparoscopic surgery is preferred. This happens when the following factors are present:

  • profuse hemorrhage in the abdominal cavity;
  • the formation of adhesions on the internal organs;
  • scars and scars after operations in the past;
  • large body weight of the patient.

However, laparoscopy also has its contraindications. An operation of this kind is not performed if a woman has been diagnosed with peritonitis or any disease of an infectious nature, since there is always a high risk of developing consequences that are dangerous to the patient's health. Other contraindications for surgery are the presence of a malignant tumor or a large fetus. In such cases, instead of laparoscopy, a laparotomy is done, in which doctors gain access to the organs of the abdominal cavity and small pelvis through a dissected anterior wall of the abdomen.

If it is necessary to remove the embryo that was implanted in the cervix, the cervix is ​​blocked with a circular suture and its cavity is scraped out (the suture is applied so as not to damage the uterus). Scraping is sometimes done for the purpose of diagnosis, when obvious signs of pregnancy are present, but the ultrasound machine did not detect a fetal egg.

How is the preparation for surgery for an ectopic pregnancy

Surgical treatment of pathological pregnancy is preceded by careful diagnostic preparation:

  1. Examination on a gynecological chair - the doctor will make sure that the size of the uterus does not correspond to the expected gestational age. In addition, it is often possible to detect and feel a seal in the area where the fetal egg has attached.
  2. A clinical blood test during an ectopic pregnancy reflects the following picture: hemoglobin, hematocrit and red blood cells are lowered. The content of leukocytes and the level of ESR are increased. The concentration of hCG is low and does not correspond to the expected gestational age.
  3. Vaginal ultrasound will help assess the condition of the internal reproductive organs and clarify the place of implantation of the embryo.

If the clinical symptoms of the pathology are mild, no diagnostic method will fully guarantee the presence of an ectopic pregnancy. In this case, the patient is admitted to the hospital to continuously monitor the performance and dynamics of chorionic gonadotropin. When the level of the hormone begins to systematically decrease, a diagnostic laparoscopy will be performed.

The operation, which is performed under general anesthesia, allows you to finally confirm or refute the presence of pathology. How long laparoscopic surgery lasts for an ectopic pregnancy depends on the duration of diagnostic manipulations and the condition of the patient, but on average this is a period of 15 to 60 minutes.

What is the operation for an ectopic pregnancy?

Currently, several methods of surgical treatment of ectopic pregnancy are practiced in the field of gynecology and obstetrics. In terms of specificity and duration, they differ significantly. How the patient is operated on depends on her well-being, the course of the pathology and the technical support of the medical institution. Most often resort to laparotomy (abdominal surgery) and laparoscopy.

Laparotomy began to be used even before the invention of laparoscopy. During surgery, the fetal egg is cut out, capturing in some cases the fallopian tube or ovary. Despite the great popularity of laparoscopy, abdominal operations to eliminate ectopic pregnancy are still carried out. Most often, surgical intervention of this kind is resorted to in the following cases:

  • the medical institution does not have modern equipment for laparoscopy;
  • there is no specialist competent in the issue of laparoscopic surgery;
  • the woman is in critical condition, which can lead to death.

With laparotomy, the removal of the fetal egg is performed in several ways.

Milking operation for ectopic pregnancy

The method is used only in tubal pregnancy in order to preserve the organ. The fetal egg is squeezed out of the fallopian tube without cutting it. This method of removing the embryo is considered sparing. If the patient falls into the hands of a competent doctor, her reproductive function will remain at the same level and the likelihood of another normal pregnancy is very high.

However, in Russia, milking, as they say, did not take root, since there is always a risk that the fetal egg will not be completely removed. Moreover, there are strict requirements for the operation: the embryo must be located close enough to the exit from the tube and there should be no threat of its rupture.

Let us briefly describe how the milking operation is carried out with an ectopic pregnancy:

  1. The doctor gets access to the place of attachment of the fetal egg through an incision.
  2. The place above the implantation area is clamped with special staples.
  3. The embryo is extruded towards the end of the tube.
  4. After the extraction of the fetal egg, measures are taken to stop bleeding, sanitize the cavity and suture the incision.

Within 1 month after the operation, the reproductive function of the female body is fully restored.

Tubotomy surgery for ectopic pregnancy

The method involves the removal of the fetal egg along with a fragment of the fallopian tube through an incision. Such a surgical operation is possible only in the early stages of an ectopic pregnancy, when the size of the embryo is no more than 4 cm and there is no threat of rupture of the tube.

Let's find out how a tubotomy operation is performed for an ectopic pregnancy:

  1. An incision is made in the surgical area.
  2. On each side of the fetal egg, the fallopian tube is fixed with clamps.
  3. The part of the tube where implantation occurred is cut off.
  4. Bleeding is stopped by electro- or laser coagulation.
  5. Both ends of the remaining pipe are joined end-to-end and thus tightly stitched together.
  6. The peritoneum is sutured.

If the operation is carried out carefully, in compliance with all safety measures, the patient may not worry about the formation of adhesions and blockage of the fallopian tube.

Tubectomy for ectopic pregnancy

With this method of laparotomy, the abdomen is cut across, and then the fallopian tube with the fetal egg is removed. However, if the situation requires emergency measures or the surgeon is not qualified in this matter, a median laparotomy is performed. The anterior wall of the abdominal cavity is cut vertically (from the umbilical region to the pubic bone).

Cavity removal of the fallopian tube is carried out in this order:

  1. After dissection of the abdomen, the uterus, together with the ovaries, is brought out by hand into the zone of normal visibility for the surgeon.
  2. Bleeding is stopped with clamps.
  3. The "pregnant" fallopian tube is clamped.
  4. The organ is cut off and removed from the abdominal space.
  5. The abdominal cavity is cleaned of blood clots and sutured.

After such an operation to eliminate an ectopic pregnancy, the chances of getting pregnant again are different for all patients. So, if the tubectomy was unilateral, the woman still has the hope of becoming pregnant naturally, despite the fact that her fertility is reduced by half. With bilateral tubectomy, it will no longer be possible to become parents in the classical way, however, spouses can always use the services of reproductive medicine, in particular IVF. The procedure can be performed 6 to 12 months after the tubectomy.

Laparoscopy for ectopic pregnancy

Laparoscopic surgery is a modern and currently the best option for the treatment of ectopic pregnancy. Laparoscopy is a painless and less traumatic method of surgical intervention.

During the operation, the surgeon pierces the abdominal cavity for the introduction of a special instrument with which the ovum will be removed from the fallopian tube. What happens inside the abdominal space is monitored by an ultrasound machine through the laparoscope. Whether it is worth protecting the fallopian tube, the doctor decides right during the operation. Here are some factors that can influence a positive decision of a specialist:

  • the gestation period is not long;
  • there are no pronounced damage to the fallopian tube.

Under such conditions, the surgeon makes 3 miniature incisions (about 1 cm) for laparoscopic tubes and a laparoscope to remove the fetus. After such an operation to remove an ectopic pregnancy, rehabilitation does not take much time and the functions of the woman's reproductive system are fully preserved. If the size of the embryo is so large that the fallopian tube is injured because of this, part of the organ or the entire organ is excised.

In general, if we consider laparoscopy as a way to treat a pregnancy that has begun to develop outside the uterus, you can see several significant advantages of this method compared to the rest:

  • the risk of large blood loss is excluded;
  • after the operation, the patient recovers quickly;
  • complications after this surgical intervention are very rare;
  • there are no scars after laparoscopy.

The time of the operation to remove an ectopic pregnancy depends on the severity of the pathology, the degree of damage to the fallopian tube, as well as on the health indicators of the patient herself. If there are no concomitant complications, the duration of the surgical intervention is just over a quarter of an hour. In the presence of certain negative factors, the procedure is within the framework of 30 minutes to 1 hour.

Absolutely with all the above methods of surgical treatment of ectopic pregnancy after surgery, the following undesirable consequences may occur:

  • high temperature and inflammation in the wound area;
  • bleeding;
  • formation of adhesions.

The successful outcome of such operations largely depends on the experience and skill of the surgeon.

Recovery after surgery to remove an ectopic pregnancy

In the postoperative period, a woman has many questions: what needs to be done in order to recover faster, how long will she have to stay in the hospital, when can sexual relations be resumed with her soulmate, and, most importantly, when should we return to planning a baby? When answering such questions, one should always take into account the complexity of the operation that the patient underwent.

Full recovery takes an average of 2 months. Judging by the reviews of doctors, more time is needed to recover from an operation to terminate an ectopic pregnancy if you have to treat concomitant diseases or eliminate complications that have arisen. This takes about 3-4 months.

How long to stay in the hospital after surgery to terminate an ectopic pregnancy

After laparoscopy, a woman remains under the supervision of doctors for 2-3 days, and it will take about 2-3 weeks to recover in general.

Laparotomy is a more traumatic procedure, so rehabilitation will take much longer. So, after the operation, the woman remains in the hospital for a period of 5 to 7 days. At this time, doctors will monitor the patient's well-being, as well as monitor the condition of the sutures after the operation to eliminate the ectopic pregnancy in order to prevent the development of an inflammatory reaction. A woman can count on a full recovery no earlier than 6-7 weeks after the operation.

In general, rehabilitation after termination of an ectopic pregnancy can be divided into 3 stages:

  1. Bed rest. Immediately after the operation, the woman needs to lie down - the body needs a good rest, since the anesthesia was only partially released. In the late afternoon, you can get up on the bed, sit down, and also drink some water.
  2. Treatment in a hospital. For 5-7 days, the medical staff monitors the condition of the patient, who often suffers from pain after an operation to terminate an ectopic pregnancy. This is normal: there is still gas in the abdominal space, which causes discomfort in the abdomen. To neutralize its effect, as well as to prevent the formation of adhesions from the second day after the operation, a woman is recommended to get out of bed and walk a lot. The stitches will be removed on 5-7 days.
  3. Treatment at home. For 2 weeks after discharge, you can not take a bath, only a short shower. Behind the incision area on the abdomen, careful control is necessary: ​​the wound is regularly examined and lubricated with a solution of iodine or manganese.

What to eat after ectopic pregnancy surgery

Dieting and a complete rejection of alcohol is a prerequisite for a quick recovery after surgery to remove the fallopian tube or curettage of the fetal egg. To feel good, food is taken in small portions up to 6 times a day. In the first 10 hours after the operation, when the patient wakes up after anesthesia, only water is allowed, nothing can be eaten.

The next day, a woman should return to eating according to the following algorithm:

  • on the second day after the operation, you can refresh yourself with carefully strained meat broth;
  • after another day, the diet is replenished with liquid cereals and finely grated dishes;
  • in one day it is recommended to eat 1 - 2 meals, since the body is not yet ready to adequately respond to a variety of foods.

In this mode, you need to eat 3 - 4 days. The first few weeks after the operation, you should lean on foods high in vitamin C, while proteins and fats, on the contrary, should be limited.

Observation of the menstrual cycle after surgery to remove an ectopic pregnancy

After such a serious operation as the termination of an ectopic pregnancy, special attention is paid to the restoration of menstruation. This is especially true for couples who have decided not to give up trying to get pregnant again, because conception is possible only with regular menstruation. The first cycle begins, as a rule, after 30 - 40 days. If the discharge after surgery to remove an ectopic pregnancy came after 3 weeks or earlier, then this is most likely not menstruation, but uterine bleeding. You need to immediately seek help from a specialist.

Physical activity can be resumed after 4 weeks, when the first menstruation after surgery has passed.

Important! Even if you are used to taking care of yourself during critical days with tampons, give them up in favor of pads. This hygiene product is recommended to be used for about 6 months after the postponed menstruation.

Sex after surgery to terminate an ectopic pregnancy

During the rehabilitation period, intimate relationships are contraindicated. Only by observing sexual rest, you can count on a complete recovery. You can resume "communication" with your loved one no earlier than 1-1.5 months after surgery. Vaginal and anal sex is possible only if the woman feels well and has no complications.

At first, during intercourse, it is recommended to avoid sudden movements that can cause severe pain to the partner. Using the method of careful trials, you need to choose the positions in which the couple will be most comfortable having sex. Do not forget about contraception, since you can plan the next pregnancy only 4 to 5 months after the previous ectopic one.

Early diagnosis of ectopic pregnancy is of great importance for maintaining the reproductive health of women. The most convenient way to detect pregnancy progressing outside the uterus is laparoscopy. The method guarantees the survey high accuracy and reliability.

The sooner the pathology is detected, the more likely it is to operate on a woman without removing such important organs as the fallopian tubes. But even if one of them cannot be saved, a woman can still hope that she will be able to conceive naturally. The reviews of women who survived an ectopic pregnancy are encouraging: some time after the operation to eliminate the pathology, they became pregnant again and became mothers of wonderful little ones.

An ectopic pregnancy is a pathology that develops as a result of the implantation of an embryo outside the uterine cavity. With an ectopic pregnancy, you almost always have to resort to the help of surgeons. It is extremely important to diagnose the pathology in time and perform the operation, otherwise serious complications are possible.

Modern techniques involve surgical removal through an incision - laparotomy or a minimally invasive operation through a puncture - laparoscopy. A serious advantage of the innovative method of laparoscopic surgery is that with minimal trauma, the recovery time is reduced, and the risk of damage to the reproductive organs is reduced.

Endoscopic surgery for ectopic pregnancy -
95,000 - 125,000 rubles

30-60 minutes

(duration of operation)

Why does an ectopic pregnancy develop?

In medical terms, an ectopic pregnancy is called an ectopic pregnancy. Most often, it develops against the background of anatomical and functional changes in the organs of the reproductive system. Risk factors include:

  • Prolonged infectious and inflammatory diseases of the uterus or appendages. As a result of chronic inflammation, adhesions are formed, the structural composition of the mucosa changes, the pipes swell. As a result, the patency of the tubes is disrupted, they lose their functionality, the normal movement of the egg is disrupted after leaving the follicle capsule. The leader in the number of complications of this kind is chlamydia.
  • Tumors of the appendages - lead to mechanical compression of the tubes, as a result - impaired patency.
  • Endometriosis is a disease that affects the lining of the uterus and fallopian tubes.
  • Operations and injuries can lead to a violation of the patency of the pipes due to the development of the adhesive process.
  • Congenital anatomical developmental anomalies.
  • Diseases of the endocrine system.

In more than 90% of cases, a tubal pregnancy develops - it is clear from the name that in this case, the egg begins to develop in the tubes. Less common pathology, localized in the ovaries or abdominal cavity.

The mechanism of development is as follows: the embryo is attached by the outer shell to any organ. Having fixed, it, according to the laid down program, begins to grow. The uterus, unlike other organs, is specially adapted for carrying a pregnancy. Outside the uterus, the development of the embryo is extremely dangerous - the outer shell germinates and merges with the vessels, blood circulation is disturbed. Bleeding occurs, and if untreated, the growth of the embryo leads to a rupture at the site of its attachment.

In some cases, the body tries to get rid of the pregnancy on its own - the chorion exfoliates from the place of attachment. The danger to the body in this case is no less. Therefore, the treatment is to remove the embryo surgically.

An ectopic conception can manifest itself in different ways. Often it is accompanied by symptoms similar to signs of uterine pregnancy. In the early stages of development, an ectopic pregnancy can manifest itself in this way:

  • Bloody discharge from the genital tract appears.
  • There is pain in the lower abdomen.
  • Bowel function is impaired.
  • Pregnancy tests are questionable.

If the fallopian tube ruptures, then intra-abdominal bleeding begins. It is characterized by sharp pain, weakness, low blood pressure and rapid pulse. This condition requires emergency care.

Surgical treatment of ectopic pregnancy

If an ectopic pregnancy is suspected, an operation is prescribed, which is usually carried out as soon as possible. The task of the surgeon is to remove the embryo, restore the normal anatomical structure of the fallopian tube or other organ involved in the development of pregnancy.

As for the method of access, nine operations out of ten are performed by laparoscopic access. This technique is characterized by low invasiveness - the surgeon does not need a wide incision for access. Laparoscopy in ectopic pregnancy requires only three punctures through which a laparoscope with a video camera and manipulator instruments are inserted into the abdominal cavity.

The ability to save the tube depends on its condition at the time of the operation - sometimes a small incision is enough to remove the embryo, and sometimes the tube has to be removed. An organ-preserving operation called tubotomy is an intervention that involves the preservation of the entire complex of reproductive organs and the restoration of reproductive function. The removal of the fallopian tube is a tubectomy. Indications for such an operation are the development of life-threatening bleeding, repeated ectopic pregnancy, and a large embryo size. It is clear that after removal, it is impossible to restore the full functioning of the reproductive system.

Laparotomy is an abdominal operation in which the surgeon makes an incision in the anterior abdominal wall. As a rule, it is carried out in cases where laparoscopy is impossible for any reason. The decision on the operation is made by the attending physician - there are certain indications for both abdominal surgery and laparoscopy.

Laparoscopic surgery for ectopic pregnancy

The operation is performed through 3 punctures in the abdominal wall. This is a full operation, but with minimal trauma. Laparoscopy has wide diagnostic capabilities - the doctor can assess the condition of the uterus and tubes, see the presence of blood in the abdominal cavity. During the operation, the specialist can adjust his actions - for example, refuse to completely remove the pipe if it is possible to save it. A special camera, which is equipped with a laparoscope, allows you to carefully assess the condition of the internal organs without the risk of injury and without incisions. Modern cameras allow you to zoom in for more precise control when manipulating tools.

The choice of anesthesia depends on the expected volume and severity of the operation. There are two main options: general anesthesia and spinal anesthesia. The method of anesthesia is selected after examination by an anesthesiologist based on comprehensive information about the patient's condition.

As for the postoperative period, laparoscopic surgery provides a quick recovery. Since there were no serious injuries, patients do not require the introduction of serious painkillers.

Doctors performing endoscopic surgery for ectopic pregnancy:

Reviews about the doctors providing the service - Surgery for ectopic pregnancy

Came to Svetlana Sergeevna in a terribly neglected state. Previously, the diagnosis was incorrectly made and, accordingly, the treatment was also incorrect. Svetlana Sergeevna immediately unraveled the whole tangle, correctly diagnosed and prescribed treatment. Unfortunately time was lost and had to...

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I want to express my deep gratitude to the DOCTOR with a capital letter - Puzyrev A.N. He had an HSG procedure. After reading reviews on the Internet (girls are taken out on a gurney from a painful shock), I went to the procedure with shaking knees and a sinking heart. But! Everything is so fast, to be honest, I did not understand how ...

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FAQ

What preparation is needed for the operation?

Given that the diagnosis is usually established when clinical symptoms appear, the decision to operate is made urgently. The scope of the examination before the operation is standard, and it can be performed in our clinic:

  • standard laboratory examination
  • ECG
  • x-ray examination of the chest cavity
  • swabs for flora

Ectopic pregnancy, in which the fetal egg is fixed somewhere outside the uterine body, is quite common today. Usually, the egg is implanted in one of the fallopian tubes, much less often (≈1-2%) - in the abdominal cavity, cervix or ovary. Untimely detected pathological gestation often leads to death, so early diagnosis and treatment are a vital factor in such clinical cases. A timely operation for an ectopic pregnancy will help save a woman's life and preserve reproductive opportunities.

At the slightest suspicious symptoms, seek immediate medical attention

Ectopic gestation occurs under the influence of a group of provoking factors, and not for any one reason. First of all, this pathology leads to:

  • Chronic inflammatory pathologies of the genital organs;
  • Artificial insemination;
  • Adhesive processes that develop in the reproductive system of a woman as a result of laparoscopic, abdominal operations;
  • Due to prolonged wearing of the intrauterine device;
  • Against the background of hormonal disorders;
  • Tumor processes in reproductive structures;
  • Abnormally developed uterus, congenital pathologies, etc.;
  • Underdevelopment, too long or tortuous fallopian tubes, which prevents the egg from reaching the uterine body and fully implanting;
  • Frequent abortions;
  • Adenomyosis or endometriosis, etc.

According to statistics, ectopic conception takes about 1.5% of the total number of all pregnancies and very often leads to rupture of the fallopian tubes.

The first signs of an ectopic

The first signs of ectopic conception that occur in the early stages are almost impossible to distinguish from the early symptoms of normal gestation, which greatly complicates the timely detection of pathology. The patient also notes the absence of menstruation, and the pregnancy test shows two strips. Even signs such as malaise, drowsiness or breast swelling are also present in the patient, as if the pregnancy is developing according to a normal scenario.

Severe weakness is often a dangerous sign

An important diagnostic symptom is the absence of a fetal egg inside the uterus on ultrasound images. A qualified doctor will be able to identify a fetal egg implanted in the lumen of the cervical canal or fallopian tube already in the early stages. Signs like painful sensations will help to suspect a pathology. They are aching, dull, similar to menstruation pains, maybe a little stronger. Soreness is concentrated over the pubic joint and may indicate a tubal rupture and bleeding.

Also, signs of ectomy gestation may appear in bloody vaginal discharge. With a tubal rupture, patients develop signs of peritonitis and acute blood loss, such as a rapid pulse, loss of consciousness or a sharp drop in blood pressure, severe pain on palpation of the abdomen, etc. If ectopic gestation is not detected in the early stages, then for a woman it is dangerous for the development of fatal complications.

Why surgery is inevitable

The procedure for removing an ectopic pregnancy is rarely without surgery. According to statistics, pathology is detected only when the patient has acute pain in the abdomen, spotting, etc. It is these symptoms that manifest the consequences of a dead fetus that has left the ovary or tube. According to statistics, almost all cases of WB are associated with implantation of the ovum in the fallopian tubes.

In any case, if the pathology was not detected in the early stages, then it will not be possible to eliminate it only with the help of medical methods. The patient has profuse blood loss, leading to the development of hemorrhagic shock. If doctors do not take urgent measures, then the girl will die. Therefore, it is absolutely impossible to refuse hospitalization, hoping that the pathological symptoms will go away on their own.

Even a slight release of blood into the peritoneum provokes the development of an infectious process, which leads to peritonitis. Therefore, in an ectopic pregnancy, removal of the tube or extraction of the fetal egg is considered an inevitable operation.

Types of surgical treatment

When a woman is informed that she has an ectopic and urgently needs to be operated on, one of the first questions that arise in the patient is: how is the operation going? Interventions for ectopic conception are abdominal or minimally invasive. Abdominal surgery is performed laparotomically, while the patient is cut into tissues on the anterior wall of the peritoneum.

Minimally invasive interventions are performed using specialized laparoscopic and endoscopic equipment through small punctures in the abdominal wall. Minimally invasive techniques are used more often, because the removal of the tube during an ectopic pregnancy in a similar way allows you to carry out the necessary surgical procedures without any complications.

Only a doctor will be able to establish the presence of indications for a certain type of intervention, determine the amount of removal in accordance with the data obtained after the examination, the patient's condition and taking into account the risk of possible complications. Therefore, before the operation, it is necessary to undergo a competent examination.

Laparotomy is performed under general anesthesia through a large vertical incision in the lower abdomen. The main indications for such an invasive and traumatic intervention are conditions such as a tubal rupture, adhesive pathology, profuse and intractable bleeding, or the presence of a real threat to the patient's life.

Another method for removing an ectopic pregnancy is laparoscopic surgery. Compared to laparotomy, it is not associated with large surgical incisions in the peritoneum, does not require long-term anesthesia and does not require long rehabilitation.

Operation progress

The duration and stages of surgical intervention depends on which technique is used to remove the WB. If the patient is noticeably pale, the bleeding bothers her for a long time and there is a pronounced hyperthermic reaction, then the patient is urgently removed the fallopian tube through laparotomy. If the ectopic conception is detected in a timely manner, then a planned surgical laparoscopic intervention is prescribed.

The operation can be performed organ-preserving or with the removal of any structures.

  • If ectopic conception is detected in the early stages and fetal detachment has not yet occurred, then the egg is squeezed out of the tubal lumen or an incision is made on the wall and the fetus is removed, and the wounds are sutured. Extrusion is considered a traumatic method with a high risk of leaving fetal tissues inside the tube.
  • If the egg has already been aborted, then a resection or ectomy of the tube is indicated.
  • If the fetal egg was implanted to the ovary, then its removal is indicated.
  • When the fetus is attached to the uterine cervix, removal is carried out by scraping the uterus. In other forms of ectopic pregnancy, curettage is not a mandatory measure.
  • Curettage is also performed if the doctor suspects the presence of tumor formations.

How long the operation lasts depends on its type and the amount of manipulations performed. Laparoscopic intervention takes less than an hour, abdominal surgery will take a little longer.

Possible Complications

Any drugs should be taken under the supervision of specialists

Any intervention can lead to a number of different complications. During laparoscopic surgery, there is a risk of intraorganic damage during the puncture process. The less traumatic damage will be caused during the intervention, the less adverse consequences may occur after the operation. If the operation is laparoscopic and the girl has the tube removed along with the fetal egg, then in the future the probability of conceiving a child for this patient is halved, but the risk of recurrence of an ectopic in the same tube is also reduced.

After surgery, a woman may also experience bleeding or post-operative inflammation. But these complications usually occur in patients who were operated on by an insufficiently experienced surgeon. Such a condition and an operation after it never pass without a trace, but if a girl strictly follows all medical recommendations, then in the future she will be able to successfully conceive a baby with one tube.

Rehabilitation and recovery period

At first, in the first 24 hours, the woman after the operation needs to lie down, because it takes time to move away from anesthesia. But by the evening of the first day, you can drink some water, turn around, sit down. From the second day, you need to be active through pain, which in the future will save you from the adhesive process, eliminate the need for scraping and create the necessary conditions for the absorption of gases. It just remains in the abdomen after laparoscopy, which causes painful discomfort. With the help of short walks, you can get rid of such unpleasant symptoms quickly enough.

About a month after the operation, you will have to undergo a course of diet therapy. Food should be taken low-calorie, vegetable, rich in ascorbic acid, in small portions, fractionally. Fats and proteins should be limited for the time being. Such a diet will help eliminate the manifestation of postoperative discomfort and speed up the rehabilitation and recovery course. You can wash, but only in the first couple of weeks strictly in the shower, and after the procedure, you need to lubricate postoperative wounds with iodine. Physical activity is allowed approximately three weeks after the operation, but sexual rest will have to be observed within a month. Drug therapy is carried out according to medical prescriptions.

Who is not eligible for surgery

Laparoscopic intervention may not be performed in all clinical cases, because the procedure has a number of contraindications.

  1. Laparoscopy is not possible if the girl is unconscious.
  2. Such an intervention is contraindicated if the patient has respiratory or cardiovascular pathologies, abdominal hernia.
  3. Laparoscopy is also not recommended for accumulations in the peritoneum of blood due to massive bleeding (a liter or more).
  4. Contraindications for laparoscopy are adhesive processes, obesity, the presence of scars from previous operations.
  5. It also prevents laparoscopic treatment of ectopic peritonitis, infectious pathologies.
  6. In case of malignant tumors, such operations are not performed, as in the case of cervical localization of fetal fixation.

In each case, when comparing contraindications, the patient's condition, the degree of damage, etc., must be taken into account. For one patient, a specific contraindication is absolute, and for another, it is relative.

Why is it better to choose laparoscopic removal of an ectopic

If a girl was diagnosed with an ectopic early and there is still some time left before the operation, then it is better to opt for laparoscopic treatment, because this approach has many advantages. Firstly, such an operation does not leave scars on the abdomen, minimizes tissue trauma and reduces blood loss to a minimum. Secondly, the laparoscopic approach in ectopic therapy greatly accelerates the recovery of the patient, who can be allowed to go home in a couple of days.

If an ectopic pregnancy is localized in the cervical passage, then curettage is performed, which is more diagnostic and preventive. If bleeding after such a procedure worries for a sufficiently long period, then this indicates the presence of a pathology in the patient.

The detection of ectopic fixation of the fetal egg at the earliest stages of gestation saves a woman from many problems and adverse consequences. In this case, there are all conditions for laparoscopy, and after this operation, the patient has every chance to save both fallopian canals, and not be left with only one tube or without them at all. And having saved the tubes in the future, the patient will be able to freely conceive a child without outside help and reproductive interventions such as ICSI or IVF, etc. In extreme cases, such technologies still give a chance for happy motherhood, especially for those girls who have experienced more than one ectopic and were left completely without tubes.

Surgery for an ectopic pregnancy is a necessity that will help save a woman's life. Such a diagnosis is not so rare. According to statistics, 5% of pregnant women have an ectopic pregnancy. Such a conception has no chance of having a successful continuation. And the sooner this problem is diagnosed and solved, the better it is for a woman. Consider the features of the operation, the rehabilitation period and the consequences of such an intervention.

Features of surgery

Surgery for an ectopic pregnancy is a chance to save the appendages. Sometimes the patient's life is at stake. To fix the problem, this type of surgical intervention is shown:


Laparoscopy

Surgery to remove an ectopic pregnancy is sometimes performed by laparoscopy. It involves the use of an enlarged image as well as small tools.

This method is the least traumatic. It allows you to maintain the integrity of the pipe. It is simply carefully dissected and the fetal egg is taken out.

After laparoscopy, it is required to cauterize areas of all bleeding vessels. And the functionality of the fallopian tube will be preserved. It should be noted that sometimes even the use of this sparing intervention cannot save the fallopian tube. This happens if a woman has repeated phenomena of the pathology of pregnancy.

What is the duration of surgery for an ectopic pregnancy? The time will depend on the complexity of the intervention. The minimum operation time is 15 to 20 minutes. But if the situation is more serious, it may take from 30 minutes to an hour.

Is it possible to do without surgery?

Surgery for an ectopic pregnancy in the early stages is not always indicated. Modern medicine in some cases allows you to do without surgery. The use of drugs that prevent cell division of the fetal egg is practiced, stopping its growth and development. The result of taking this medication is the complete resorption of the fetal egg.

When extrusion is indicated

The use of this method is also practiced as an alternative to abortion, even if the pregnancy develops in the uterus. But for this, the terms of fetal development should not exceed three weeks. According to many experts, the use of alternative methods, such as medication, protects a woman from surgical injuries. But it is important to consider that the drug is allowed only on prescription. Self-medication is dangerous! Sometimes an integrated approach is practiced, combining the use of a hormonal agent and surgery. After the tablets, extrusion is used.

Features of the rehabilitation period

Regardless of the choice of type of intervention, the consequences of surgery for ectopic pregnancy can be serious. If you are not serious about the passage of the rehabilitation period, problems are possible. It is important to put yourself in order so that the woman's reproductive system does not suffer.

The doctor will without fail prescribe medication in combination with a complex of physiotherapy procedures. Moreover, the complex is prescribed even when one pipe is removed, since in this case the second one also requires treatment. It will take a long time to improve the condition.

Protect yourself!

Pay attention to the need to take contraceptives so that the situation does not happen again. It is necessary to refrain from pregnancy after surgery for six months, no less.

After a competent rehabilitation period, a woman has a 60% chance for the subsequent bearing of a healthy child. But there are also 15% of situations when the pathology of pregnancy is repeated. In 25% of cases, a woman will not have children. When using medical methods of rehabilitation, infertility threatens to a lesser extent. A woman can still have children if she turns to the help of alternative methods. But at the same time, the ovaries should remain, and with their full functioning. Then in vitro fertilization will help. If the ovary is removed, there is little chance of getting pregnant.

What could be the consequences

The nature of the consequences after surgery for ectopic pregnancy can be very different. If the fallopian tube ruptures, the consequences can be dire. Damage to arteries and veins may occur. Then there is bleeding, painful sensations, a state of shock.

If bleeding starts, don't waste time. Seek immediate medical attention. In twenty cases out of a hundred, a recurrence of an ectopic pregnancy was recorded. If you do not conduct a correct course of rehabilitation, adhesions may appear. The pelvis and abdominal cavity are at risk. The development of inflammatory processes is characteristic, if you do not pay attention to recovery after surgery.

Infertility can also be a consequence of an ectopic pregnancy. Moreover, this situation is observed in a third of women, especially when one or two tubes have been removed from them.

Description of symptoms in the postoperative period

After surgery to remove an ectopic pregnancy, a woman may feel discomfort for 10 days. It is expressed in the presence of the following symptoms:

  • The abdomen is bloated.
  • There is pain that can only be relieved with pain medication.
  • The woman gets tired quickly.

Such conditions can go away on their own. But sometimes you have to consult a gynecologist. If surgery was performed, it will take two to five days for the woman to be discharged with an improvement in her condition.

Precautions in the postoperative period

During an operation for an ectopic pregnancy, a woman is exposed to trauma. Therefore, after the operation, it is necessary to follow the recommendations similar to those for other interventions on the abdominal cavity:

  • Physical activity is unacceptable, you can not get injured, shake, get bruised.
  • To prevent bleeding, it is forbidden to lift heavy objects.
  • In the case of strip surgery, you will need to wear a bandage so that the wall of the peritoneum is fixed.
  • Remember that moderate physical activity is good for you. In order not to form adhesions, you need to at least roll over on your side. The appointment of therapeutic exercises will also help to effectively restore the body and strengthen the peritoneum.
  • Diet is important. While a woman is lying, she should be limited to light meals, nutritious and vitamin. Do not eat foods that may cause bloating.
  • You can not supercool, in the cold season it is necessary to walk in warm underwear.

Return to full life

After recovery, the woman will want to live a normal life again. But there are recommendations so as not to worsen your health:


Summing up

In the event of an ectopic pregnancy, it is important to act promptly. The shorter the period, the easier and painless the procedures will be. You can do without abdominal surgery. Therefore, if a pregnant woman has bleeding, she experiences pain in the lower abdomen and a deterioration in her general condition, it is important to diagnose. An ectopic pregnancy is dangerous with serious complications in the form of internal bleeding and hemorrhagic shock.

Surgery will help remove the fetal egg and stop the bleeding. Depending on the complexity of the situation, several types of surgical intervention are determined: from the most gentle extrusion to abdominal surgery. How long does an operation for an ectopic pregnancy take? From fifteen minutes to two hours, depending on the complexity.

After the operation, it is important to take care of yourself and follow the recommendations of the doctors. After all, if you do not take care of high-quality rehabilitation, infertility can develop. The formation of adhesions is also dangerous for a future pregnancy. They can prevent the fertilized egg from moving through the fallopian tubes. Then a recurrence of an ectopic pregnancy is possible.

Sex life after surgery is possible after three weeks. Otherwise, you can bring an infection, the consequences of which will be an inflammatory process.

A woman may have congenital abnormalities in the formation of the fertilization system. Then the fetal egg is not located in the uterus, but in the neck of this organ, abdominal cavity, tube or ovary. The purpose of surgery will also be determined depending on the location of the fetus. The method of laparoscopy has become widespread. This is a relatively gentle intervention using miniature instruments. After their introduction into the area of ​​the abdominal cavity, the fetal egg will be removed through the abdominal opening.

Take care of your health and contact the specialists in a timely manner!

An ectopic pregnancy is a danger that any woman can face. Bad ecology, wrong way of life, various infections often become the appearance of this pathology, and recently it has been observed more and more often. A site for moms, the site wants to warn you, but in no case scare you.

The fact is that most often the treatment of an ectopic pregnancy involves surgery, and our women still have a stereotype: during the operation, the ectopic tube is removed and thus the possibility of having children in the future is excluded. Indeed, before it was the only way to save a woman's life, but now there are other, more benign, options, and the site will tell you about them.

And for more information about whether it is possible to give birth later, read on our website for mothers.

Removal of an ectopic: types of operations

When signs of an ectopic pregnancy appear, the main thing is not to waste time, but to contact a gynecologist in time.

Usually, when the diagnosis of "ectopic pregnancy" is confirmed, the doctor prescribes surgery. Most often, this is the only way out, especially if an ectopic pregnancy leads to rupture of the fallopian tube and large internal bleeding.

Based on the results of the examination, the doctor decides what type of operation is needed - everything is individual here.

Currently, there are two types of operations:

  • laparotomy (with dissection of the lower abdominal wall);
  • laparoscopy (surgery with minimal incisions - microsurgical).

The doctor's choice of this or that operation will depend on the degree of damage to the fallopian tube.

Tube removal in ectopic pregnancy: laparotomy

Laparotomy is considered a very serious operation, it is done only in exceptional cases, when there is a real threat to the life of the patient.

The main indications for its implementation are: rupture of the fallopian tube and large internal blood loss.

The surgeon makes an incision along the anterior abdominal wall, the operation is performed under general anesthesia. The result of the operation is the removal of an ectopic pregnancy along with the fallopian tube.

Removal of an ectopic pregnancy laparoscopically

An alternative to laparotomy is laparoscopy, a microsurgical operation. Laparoscopy is considered an effective and painless operation, after which a woman is able to give birth to a child.

Laparoscopy is performed under general anesthesia, during which three small incisions are made to the woman, leaving no scars or scars.

Using a special video camera inserted inside, the surgeon examines the pelvic organs and easily distinguishes an ectopic pregnancy from endometriosis or ovarian cysts, which are very similar in their symptoms. If the doctor confirms the initial diagnosis - an ectopic pregnancy, then the examination stage immediately proceeds to the operational stage, during which the doctor removes the embryo that has attached to the tube.

During laparoscopy, the surgeon can assess the condition of the woman's appendages and, if necessary, remove adhesions and restore the patency of the tube.

Surgery to remove an ectopic pregnancy: recovery

If you had to go through an operation to remove an ectopic pregnancy, then you need to undergo a series of restorative measures:

  1. Standard postoperative treatment in the hospital.
  2. Therapeutic procedures that prevent the formation of adhesions and scars at the suturing sites.
  3. If necessary, relief of inflammation in the second fallopian tube.
  4. After 8 weeks - ultrasound treatment and inductothermia.
  5. Reception of biostimulants and proteolytic enzymes.
  6. It is advisable to take a course of physiotherapeutic procedures with therapeutic mud and ozocerite.

Rehabilitation after surgery to remove an ectopic pregnancy lasts six months. It helps a woman to restore the normal functioning of the reproductive organs.

But during this period, a new pregnancy cannot be allowed, because there is a possibility that it will also be ectopic - so you need to remember about contraception.

And in conclusion: yes, any operation is not a very pleasant thing, but, unfortunately, with the diagnosis of “ectopic pregnancy”, there is no other way out yet, and you will have to put up with it.

In no case do not try to be treated with the help of folk remedies - it is deadly. Remember: the sooner you see a doctor, the sooner you will be scheduled for surgery and, perhaps, it will be gentle, aimed at preserving the fallopian tube.

If you take care of your health and follow all medical recommendations, then an ectopic pregnancy, surgery, removal of the tube will not be the final verdict on infertility for you, but will leave hope that in the future you will be able to conceive, endure and give birth to a completely healthy child.