Ectopic Pregnancy Surgery: Everything You Need to Know

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Ectopic pregnancy surgery involves removing a pregnancy that has begun developing outside of a woman's uterus.

In the vast majority of cases, ectopic pregnancies occur within one of the fallopian tubes. These narrow tubes connect a woman's ovaries to her uterus. Less commonly, a fertilized egg may begin developing within a woman's cervix, ovary, abdomen, or prior cesarean scar.

Since pregnancies that grow outside of the uterus cannot develop normally, and because they can cause the organ they are developing in to break open (rupture), medical or surgical treatment is required as soon as possible after diagnosis.

While the overall management of any ectopic pregnancy is similar, this article focuses on the surgical treatment of ectopic pregnancies that develop within the fallopian tube.

What Is Ectopic Pregnancy Surgery?

Ectopic pregnancy surgery is performed under general anesthesia by an obstetrician-gynecologist (OB/GYN). The surgery is usually scheduled but may be performed due to an emergency.

During ectopic pregnancy surgery, the surgeon will perform one of these procedures:

  • Salpingectomy: Pregnancy tissue is removed along with part or all of the fallopian tube
  • Salpingostomy: Pregnancy tissue is removed and fallopian tube is repaired

The decision depends on a number of factors, including the condition of the tube, the size of the ectopic pregnancy, whether any bleeding is present, and surgeon comfort/preference.

Specifically, a salpingectomy rather than a salpingostomy is indicated in the following cases:

  • A ruptured or extensively damaged fallopian tube
  • A large ectopic pregnancy
  • Uncontrolled bleeding

Another factor taken into consideration when deciding between the two surgeries is whether the patient desires to have any more children in the future.

As an example, a patient may opt for a salpingectomy if she is finished having children and wants permanent sterilization. In this case, the surgeon can remove both fallopian tubes during the same surgery—what's known as a bilateral salpingectomy.

Women who are planning in vitro fertilization (IVF) for future pregnancies may also choose salpingectomy.

On the other hand, preserving the fallopian tube would be important for women who desire children (not through IVF) and whose other fallopian tube is absent or damaged.

Whether a patient undergoes a salpingectomy or salpingostomy, future fertility outcomes are similar, assuming the woman's other fallopian tube is healthy.

Surgical Approaches

Ectopic pregnancy surgery may be performed in one of two ways:

  • With a laparotomy, a large incision is made in the skin of the abdomen to remove the pregnancy tissue. A one to five-night hospital stay is required afterward.
  • With laparoscopic surgery, thin surgical tools (one of which has a camera attached to it) are inserted through multiple skin incisions in the abdomen to perform the same operation. The patient can go home the same day as the surgery.

Compared with a laparotomy, laparoscopic surgery is safer and allows for a faster recovery. Laparoscopy is the preferred or "gold standard" surgical treatment for ectopic pregnancies because of this.

That said, laparotomy may be required in emergency situations, like if a patient has significant amounts of internal bleeding or if large amounts of scar tissue are present within the patient's abdomen.

Contraindications

Certain medical conditions, like underlying heart or lung disease, may increase a patient's risk for complications during surgery. The pros/cons of surgery in these cases must be weighed carefully before proceeding.

Potential Risks

In addition to the general risks of surgery (e.g., infection, bleeding, and problems with anesthesia), risks associated with ectopic pregnancy surgery include:

  • Scar tissue (adhesion) formation
  • Injury to nearby organs, such as the bladder or intestines

Retained pregnancy tissue is another risk of ectopic pregnancy surgery; although, this complication is really only a concern in women undergoing salpingostomy.

Purpose of Ectopic Pregnancy Surgery

The purpose of ectopic pregnancy surgery is to remove the developing embryo before it grows too large and causes potentially life-threatening complications like internal bleeding or sepsis.

Ectopic pregnancy surgery is really a last resort option, though. Medical management of ectopic pregnancy with methotrexate is generally considered the first-choice treatment.

Indications for ectopic pregnancy surgery include:

  • Patient's vital signs are unstable (e.g., low blood pressure and high heart rate)
  • Suspicion of a ruptured fallopian tube
  • Patient cannot take or has failed treatment with methotrexate

While not a complete list, some reasons women cannot take methotrexate include:

  • Breastfeeding
  • Sensitivity to methotrexate
  • Kidney disease or chronic liver disease
  • Inability or unwillingness to return for follow-up visits after taking methotrexate

Pre-Surgery Testing

An ectopic pregnancy is diagnosed with a transvaginal ultrasound and a blood measurement of the pregnancy hormone, human chorionic gonadotropin (hCG).

Once the diagnosis is made, additional blood tests, like a complete blood count (CBC) or comprehensive metabolic panel (CMP), may be performed to help determine whether methotrexate can be safely administered.

These same blood tests, along with possibly other tests, like an electrocardiogram (ECG), may be used to assess the patient's medical status in preparation for surgery.

How to Prepare

Once you are scheduled for an ectopic pregnancy surgery, your surgeon will give you instructions on how to prepare.

Location

Your operation will take place in a hospital or surgical center.

What to Wear

Wear comfortable, easy-to-remove clothes as you will change into a gown upon arrival.

Avoid wearing makeup, moisturizers, perfume, or nail polish. Leave all valuables, including jewelry, at home.

Food and Drink

Do not eat or drink anything after midnight the evening before your surgery.

Medications

Up to a week before surgery, your surgeon will likely ask you to stop taking medications that increase your risk for bleeding—e.g., nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen).

To help prevent surgical complications, be sure to inform your surgical/anesthesia team of all of the drugs you are taking including prescription and over-the-counter medications, dietary supplements, herbal remedies, and recreational drugs.

What to Bring

Since you may experience vaginal bleeding and abdominal cramping/swelling after surgery, bring a sanitary pad and loose-fitting pants or a large button-down dress to go home in.

Also, bring your driver's license, insurance card, and someone to drive you home after your procedure.

If you are staying overnight in the hospital, pack the following items in your bag or suitcase:

  • Any medical devices you use (e.g., asthma inhaler)
  • Comfortable and loose-fitting clothes to go home in
  • Slip-on shoes or non-skid slippers to walk around in
  • Personal toiletries (e.g., toothbrush and hairbrush)
  • Small personal or comfort items (e.g., book and cell phone charger)

Pre-Op Lifestyle Changes

Stop smoking as soon as possible prior to surgery. Smoking increases your risk for complications, including breathing and wound healing problems, both during and after the procedure.

What to Expect on the Day of Surgery

On the day of your surgery, you will arrive at the hospital/surgical center and check-in. You may be asked to show your driver's license at this time.

Before the Surgery

After checking in, you will be taken to a surgical holding area where you will change out of your clothes into a hospital gown. A nurse will then review your medication list, record your vitals, and place an intravenous (IV) line for administering fluids and medications into a vein in your hand or arm.

Your surgeon will come to greet you and briefly review the operation with you. You may need to sign a consent form at this time.

Your anesthesiologist will also come to say hello and review the anesthesia process and potential risks involved.

From there, you will be walked or wheeled on a gurney into the operating room.

During the Surgery

Upon entering the operating room, the surgical team will transfer you onto a table.

The anesthesiologist will then administer inhaled or intravenous medication to put you to sleep. You will not remember anything that occurs during the surgery after this point.

Next, a breathing tube called an endotracheal tube will be inserted into your windpipe. This tube is connected to a ventilator that takes control of your breathing during the operation.

Ectopic pregnancy surgery takes around 45 to 90 minutes to complete and generally proceeds in the following fashion:

  • Incision: The surgeon will make one or more incisions over the abdomen. The size and number of incisions depend on whether a laparotomy (large, single incision) or laparoscopy (small, multiple incisions) is being performed.
  • Visualization: The fallopian tube containing the ectopic pregnancy will be visualized through the incision site(s). Carbon dioxide gas may be pumped into the abdomen to help make it easier for the surgeon to see everything.
  • Salpingectomy: The fallopian tube containing the ectopic pregnancy will be partially or totally removed using various surgical instruments (e.g., clamps, grasping forceps, scissors, and/or a device that releases heat).
  • Salpingostomy: Alternatively, an incision will be made within the tube overlying the ectopic pregnancy. The pregnancy tissue will be released from the tube using a special tool called a suction-irrigator. With laparoscopy surgery, the tissue will be placed in a pouch and removed from the abdomen. The incision site within the tube will be left to heal on its own.
  • Closure: The abdominal incision site(s) will be closed with stitches or surgical glue or tape and covered with a dressing.
  • Pathology review: The removed tissue may be sent off to a pathology laboratory to confirm the diagnosis of a tubal pregnancy.
  • Prep for recovery: The breathing tube will be removed and you will be taken to a recovery room.

After the Surgery

In the recovery room, you will slowly wake up from anesthesia. A nurse will monitor your vital signs and help you manage common post-operative symptoms like pain and nausea.

Once you are fully awake and alert, you will be discharged home (if you underwent a laparoscopy) or wheeled to a hospital room (if you underwent a laparotomy).

Recovery

Patients can generally resume normal activities within a week after undergoing laparoscopic ectopic pregnancy surgery. A laparotomy, on the other hand, requires a two to six-week recovery period.

As you recover, you can expect the following:

  • Abdominal soreness and swelling are common after surgery. Continue to use your prescribed pain medication as instructed.
  • You may experience a day or so of mild nausea after surgery. Eating bland, light foods like toast, crackers, and chicken broth can be helpful.
  • You may experience vaginal bleeding for one to four weeks after surgery. As you recover, you may be asked to avoid using tampons to help prevent infection.

Wound Care

Ask your surgeon when you can shower after your surgery. When able to do so, be sure to gently wash your incision site(s) and pat them dry with a clean towel afterward.

Do not apply any powders or lotions to or near your incision site(s).

Apply new dressings over the incision site(s) once they are dry as/if directed by your doctor.

Activity

You will have specific activity guidelines to follow after surgery, such as:

  • Avoid swimming, taking baths, or having sex until your surgeon says it's OK.
  • Avoid driving until you are off all pain medication.
  • Return to work two to six weeks after a laparotomy and one week after a laparoscopy.
  • Avoid vigorous exercise and lifting more than 10 pounds until your incision site(s) are fully healed.

Expect to see your surgeon around one week after surgery. At this appointment, your surgeon will check your incision site(s), remove any non-absorbable stitches, and monitor for complications.

When to Call Your Surgeon

Call your surgeon if you experience any of the following:

  • Fever
  • Signs of surgical site infections like redness, swelling, or abnormal drainage
  • Pain not eased with medication
  • Worsening abdominal swelling
  • Heavy vaginal bleeding with clots or vaginal discharge
  • Lightheadedness or fainting
  • Persistent nausea and vomiting

Long-Term Care

If you underwent a salpingostomy, your doctor will measure your hCG level every week to confirm that it declines to zero. This ensures that there is no pregnancy tissue remaining in the fallopian tube.

If you underwent a salpingectomy and the lap report confirms a tubal pregnancy, you probably will not need a follow-up blood hCG measurement.

If you are interested in having children in the future, talk with your doctor about when it is deemed safe for you to try to conceive again. As of now, there is no data to support waiting a specific time interval before conceiving after ectopic pregnancy surgery.

If you get pregnant again, tell your OB-GYN and be on the lookout for signs and symptoms of an ectopic pregnancy. Since women who have had an ectopic pregnancy are at an increased risk for having another one, your doctor may want to see you sooner than usual to confirm that your pregnancy is growing in your uterus.

Lastly, as for any patient, be certain to see your OB-GYN for your regular well-woman check-ups and preventive care.

Possible Future Surgeries/Therapies

Pregnancy tissue is retained in about 4% to 15% of salpingostomy cases. This may be treated with another surgery or by taking a dose of methotrexate.

Coping

It's normal to experience a rollercoaster of emotions after an ectopic pregnancy. Disbelief or shock at how fast the diagnosis-to-treatment process went, grief over the loss of the pregnancy, and/or anxiety over whether this will happen again in the future are all common and normal reactions.

While joining an online or in-person support group can bring you comfort and emotional guidance, be sure to reach out to your doctor if you find it hard to get back to your daily routine after healing from surgery. You may benefit from talking with a therapist or counselor trained in pregnancy loss.

A Word From Verywell

Undergoing ectopic pregnancy surgery can feel like a whirlwind experience from start to finish. Please take the time you need to rest and care for yourself, both body and mind, after your procedure.

Lastly, if you are worried about your future fertility, try to remain positive—in most cases, the chances of having a successful pregnancy after an ectopic one are high.

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