Laparoscopic Approach for the Management of Ectopic Pregnancy in a District Level Hospital, Cox's Bazar

Abstract

Introduction: An ectopic pregnancy occurs when a fertilized egg implants and grows outside of the uterine cavity. Ectopic pregnancy usually occurs as a result of delay or prevention in the passage of the blastocyst to the uterine cavity resulting in its premature implantation in the extrauterine tissues. It usually occurs in 2% of all pregnancies and is a major cause of maternal morbidity and mortality when misdiagnosed or left untreated and subsequent successful pregnancy is less than 50% of patients. About 95% of ectopic pregnancies originate in the tubes. Infrequently, it affects the ovary, the bicornuate uterus, and the cervix. The diagnosis of ectopic pregnancy has been performed using laparoscopy. Additionally, it is widely used for the surgical treatment of ectopic pregnancy. The benefit of laparoscopy for ectopic pregnancy over laparotomy is well-known. Laparoscopic surgery has been widely adopted and new technical innovations, procedures, and evidence-based knowledge are persistently emerging. The laparoscopic advantage over open surgery has also been confirmed in different fields. It is associated with shorter operative time, less intraoperative blood loss, reduce postoperative pain, less analgesic requirement, a shorter hospital stay, faster recovery, cost- effectiveness, and lower rate of postoperative complications. This study aimed to compare the outcome of laparoscopic management with laparotomy in the management of ectopic pregnancy. Methods: This was a prospective cross-sectional study that was carried out in a district level hospital at Cox's Bazar. This study was conducted from May 2020 to May 2022. A total of 59 subjects were selected for the study as per inclusion criteria. Result: Among 59 respondents, most of the subjects were of the 15-25 years age group which constituted 81.36%, followed by 13.56% of the 26-35 years age group, and the rest 5.08% were of >35 years age group. Laparoscopy was done on 40 (67.20%) patients and laparotomy was done on 19 (32.80%) patients. Approximately, 25% of laparoscopy patients and 52% of laparotomy patients had prior surgery. Prior ectopic surgery was performed on around 8.47% of laparoscopy patients and 13.55% of laparotomy patients. Regarding the comparison of laparoscopy and laparotomy procedure, total blood loss was less (30-50ml) in laparoscopy and more (≥60ml) in the laparotomy procedure. Hospital stay was also less (1-2 days) in laparoscopy and more (≥3 days) in laparotomy, duration of operation was shorter (20-30min) in laparotomy and comparatively longer (30- 60 min) in laparoscopy. Previous surgery was done on 25% and 52.17% patients who underwent laparoscopy and laparotomy respectively. Previous ectopic pregnancy was diagnosed on 8.33% and 47.83% of laparoscopy and laparotomy patients respectively. Moreover, previous PID was found in 5.55% patients who underwent laparoscopy and none who underwent laparotomy. 2.77% of patients who underwent laparoscopy had a history endometriosis. Recovery to normal activity was early in laparoscopy and late in laparotomy. Moreover, 27 (67.5%) patients conceived among 40 who underwent laparoscopy, and 3 (15.78%) patients conceived among 19 who underwent laparotomy. Conclusion: The management of ectopic pregnancy with laparoscopy may be the most helpful operation with the highest possible level of safety and effectiveness. Laparoscopy has both a diagnostic & therapeutic role in ectopic pregnancy. Laparoscopy is feasible and safer than laparotomy in surgical management of ectopic pregnancy.