Laparoscopic management of ectopic pregnancy in the presence of a significant haemoperitoneum

Abstract

To assess the trend in the use of operative laparoscopy in the management of patients with ruptured ectopic pregnancy and significant haemoperitoneum. Four-year prospective observational study of the operative management of women with ruptured ectopic pregnancy and significant haemoperitoneum at the Whipps Cross University Hospital from January 2003 to December 2006. The inclusion criteria were patients with a clinical or laparoscopic assessment of significant haemoperitoneum (>800 ml). The amount of haemoperitoneum was determined at surgery. The blood loss ranged from 800 to 3,500 ml. The laparoscopic approach in this specific clinical scenario increased from 40% in 2003 to 100% in 2006. In 2003 there were five patients, two (40%) were treated by laparoscopy, one (20%) was converted from laparoscopy to laparotomy and two (40%) had laparotomy. In 2004 there were six patients, five (85%) underwent laparoscopic management and one (15%) had laparotomy. In 2005 we had 14 patients, ten (72%) had laparoscopic management, 2 (14%) were converted to laparotomy and 2 (14%) had laparotomies. There were 12 patients in 2006 and all (100%) were treated by laparoscopy. Our study demonstrates that with highly skilled anaesthetic and surgical teams, operative laparoscopy with its recognized advantages over laparotomy and is feasible in women with ruptured ectopic pregnancy and significant haemoperitoneum.