Ectopic Pregnancy: How can an ectopic pregnancy be treated?

At one time, when an ectopic pregnancy was suspected, a laparotomy (open operation into the abdomen) was required and the Fallopian tube with the ectopic pregnancy was removed (salpingectomy). It was thought that it was inappropriate to conserve the damaged tube as another ectopic pregnancy was likely to be the result. We have learned that if the diagnosis is made relatively early, it may be possible to open the tube and remove the ectopic pregnancy (salpingostomy) with a reasonable chance that the conserved tube will function correctly in the future. The latest advice is that salpingostomy should be used if the other tube has been removed or is unhealthy.

Some gynaecologists are able to undertake these operations at laparoscopy (minimally invasive surgery). Several incisions to insert the instruments are required. Although it is claimed that minimally invasive surgery reduces the postoperative recovery time, we have found that with small laparotomy incisions, the benefits of the laparoscopic route may not be as great as originally envisaged.

There is currently interest in treating ectopic pregnancies medically rather than surgically. Drugs such as methotrexate are administered, which stop the pregnancy from developing further and then nature takes over. This may prove effective in some situations but the exact place of this approach has not yet been defined.

A thirty-three year old lady presented with lower abdominal pain. She had a slightly irregular menstrual cycle and had been trying to conceive for a few months. Two weeks before consultation she had a normal period. She was prone to constipation for which she was taking lactulose. She had recently commenced a course of antibiotics. Her BMI (Q9.8 ) was 32. She was experiencing hirsutism and difficulty keeping her weight down. There were no problems on pelvic examination. Investigations were initiated. Ultrasound showed a 5cm cyst in the left ovary and a 5.5 cm cyst on the right. One week later she felt unwell and a pregnancy test proved positive. The patient had not been sexually active since the last period. A further ultrasound showed no change in the cyst on the right but adjacent to it was another structure measuring 4.6 x 1.9 cm. The cyst on the left was no longer present. There was no sign of a pregnancy in the uterus.

We proceeded to mini-laparotomy and confirmed a right-sided ectopic pregnancy. The left ovary appeared polycystic and we took the opportunity of ovarian drilling. This case is interesting for several reasons. It shows that a period-like bleed can occur in early pregnancy. The 5cm cyst on the left disappeared spontaneously.

The patient was home on the third post-operative day and within three weeks she had made a complete recovery. Within a short time she reported that her weight problem and excess hair production were improving following surgery with ovarian drilling(ovarian drilling ).

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

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