Laparoscopic Management of a Second Trimester Tubal Ectopic Pregnancy

Abstract

Study Objective To demonstrate the safe laparoscopic management of a tubal ectopic pregnancy presenting at an advanced gestational age. Design Narrated video tutorial for safe laparoscopic management of this rare presentation. Setting Ectopic pregnancy most often occurs within the fallopian tube commonly presenting as vaginal bleeding and abdominal or pelvic pain during the first trimester. Second-trimester tubal ectopic pregnancies are extremely rare and carry a significantly higher level of maternal morbidity and mortality compared to first-trimester presentation. Second-trimester tubal ectopic pregnancies are challenging to diagnose by ultrasound alone and may appear as peritoneal or ovarian ectopics. A high degree of suspicion must be maintained to ensure the best maternal outcomes. Patients or Participants We present a case of a bleeding tubal ectopic pregnancy diagnosed at 13 weeks and 4 days at an academic tertiary care hospital. Interventions A laparoscopic approach to manage a tubal ectopic pregnancy at 13 weeks and 4 days gestational age. Measurements and Main Results Laparoscopic approach was utilized with several key steps: 1. Confirmation of the tubal location of the ectopic pregnancy 2. Sequential cuts through the mesosalpinx minimizing injury to the adjacent ovary while limiting intraoperative blood loss 3. Specimen containment and umbilical extraction Conclusion Advanced gestational age tubal ectopic pregnancy represents an extremely rare clinical situation that requires the surgeons appreciation for the potential for massive maternal bleeding. Ultrasound diagnosis alone can be very challenging and thus high clinical suspicion should be maintained and appropriate preoperative planning is crucial.