A Comparison of Laparotomy And  Laparoscopy as a Modality of Management  For Ectopic Pregnancy

Dr. Patel AR; Dr. Vijetha R; Dr. Aditi choubey; Dr. Pooja DS

Volume : III, Issue : I, January - 2014

A Comparison of Laparotomy And Laparoscopy as a Modality of Management For Ectopic Pregnancy

Dr. Patel Ar, Dr. Vijetha R, Dr. Aditi Choubey, Dr. Pooja Ds

Abstract :

Incidence of Ectopic pregnancy (pregnancy outside the uterine cavity) increased 4 fold from 5/1000 to 20/1000 in last 20 years and in spite of advance in diagnostic technique like Trans-vaginal USG and β-HCG, majority of cases of ectopic pregnancy present as emergency and is still a major cause of maternal mortality, responsible for 9 % of maternal mortality. Laparoscopy, in present time is valuable modality of treatment for ectopic pregnancy which provides ease of confirmation of diagnosis and treatment simultaneously, less operative time and less post-operative complication, so we did a retrospective analysis to evaluate whether �laparoscopy� as a treatment modality for ectopic pregnancy can be applied as a protocol during emergency or not. All the patients with ectopic pregnancy (61 patients) presented to our hospital from July 2009 to May 2013 (4 years) are included in this study and retrospective analysis of all cases done on the basis of patients haemodynamic condition, location and type of ectopic pregnancy, whether ruptured or unruptured, choice of modality of management: Laparoscopy or laparotomy, intra operative, post-operative complication, and need of conversion from laparoscopy to laparotomy. And we found that out of total 61 patients with ectopic pregnancy 58 were tubal pregnancy, and 3 were ovarian ectopic pregnancy. 31 patients (52%) were managed by laparoscopy and 30 patients (48%) by laparotomy. Laparoscopy was Mostly (94%) performed on patient with unruptured tubal pregnancy and who were haemodynamically stable whereas laparotomy was done in patient who were haemodynamically unstable (23/33), and with ovarian pregnancy (3/33). Salpingectomy was the procedure in both routes of surgery. And 4 patients required conversion of laparoscopy to laparotomy due to intra operative complication. 2 patients managed by laparotomy had complication like septicemia and wound infection postoperatively. We conclude that Laparoscopy should be the choice in un-ruptured ectopic pregnancy, whereas degree of shock should govern the route of surgery in patients with ruptured pregnancy.