Laparoscopy For Ectopic Pregnancy Research Articles

Could Laparoscopic Concerns During Coronavirus Pandemic Affect the Care of Women With Pregnancy of Unknown Location/Ectopic Pregnancy?

In the coronavirus pandemic elective surgery has been deferred and therefore emergency surgery for suspected ectopic pregnancy arises as the most commonly performed operation in gynecology. Laparoscopic management has traditionally been the gold standard, however recently concerns have been raised regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dissemination as aerosolized small particles are presumed to escape abdominal cavity. The rationale for this hypothesis is based on cohort studies confirming presence of blood-borne viruses such as human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in the surgical plume, whereas data for airborne viruses such as SARS-CoV-2 are scarce. Remarkably, there is no solid evidence up to date to associate inhalation of pneumoperitoneum viral particles with subsequent disease of theatre staff. Reverse transcription-polymerase chain reaction (RT-PCR) on blood samples of coronavirus disease 2019 (COVID-19)-infected patients presenting with fever, confirmed viremia in only 1% of cases. The viral ribonucleic acid (RNA) was isolated in stool samples in 29% of cases but was not found in urine samples. Therefore, the use of surgical energy devices on genital tract tissues bears little chance of producing aerosolized COVID-19 particles. The optimal surgical approach should be individualized according to a variety of factors: complexity of case and bowel involvement, length of procedure, comorbidities, hospital stay, as well as the surgeon’s familiarity with each approach. When necessary precautions are taken, laparoscopy for ectopic pregnancy appears safe. Operating theatres should meet technical specifications and maintain negative pressure if possible. Only essential personnel equipped with personal protective equipment should be attending theatres. Abdominal pressure should be set under 12 mm Hg and ultrasonic/bipolar device use minimized. Smoke evacuation filtration systems and disposable trocars with insufflation taps can contain surgical smoke. As more information is emerging, trusts will adjust to evolving circumstances with standard operating procedures. Changing established practice may be premature as clinicians should “first do no harm” . J Clin Gynecol Obstet. 2020;9(3):31-36 doi: https://doi.org/10.14740/jcgo657

1806 Tricky and Inexpensive Way to Aspirate Large Hemoperitoneum

Video Objective show a inexpensive, safe and fast way to aspirate large hemoperitoneum during a laparoscopy Setting large amounts of blood in the abdominal cavity delays a lot during a laparoscopy for ectopic pregnancy or an hematic ovarian cyst, using a regular 5mm aspirator Interventions make a small, inexpensive, reversible and safe modification in a regular aspirator hose with scissors Conclusion this reversible and fast modification improve the operation time without harm for the patient during aspiration of large hemoperitoneum

Implications of perihepatic adhesions in women undergoing laparoscopic surgery for ectopic pregnancy

ObjectiveTo establish whether the finding of perihepatic adhesions (PHAs) at laparoscopy for ectopic pregnancy (EP) is associated with poor perioperative and reproductive outcomes. MethodsA retrospective cohort study was undertaken of all cases of EP managed surgically at a teaching hospital in northeast London in 2003–2013. Data for symptoms, reproductive history, ultrasonography findings, blood parameters, and findings at surgery were compared between patients with and without perihepatic adhesions (PHAs) identified at laparoscopy. ResultsAmong 802 women with EP, PHAs were identified during surgery for 60 (7.5%). Compared with women without PHAs, patients with PHAs were significantly more likely to have had previous pelvic inflammatory disease, previous EP, previous tubal surgery, and the finding of abnormal contralateral adnexa or other adhesions during laparoscopy (P≤0.024 for all). They also had higher preoperative hemoglobin concentrations and smaller hemoperitoneum volumes (P≤0.04 for both). ConclusionWomen with PHAs at laparoscopy for EP had lower blood loss than did those without PHAs. The finding of PHAs was associated with an increased rate of recurrent EP, irrespective of a previous history of PID or EP.

P16.19: Intrauterine pregnancy of uncertain viability: what influences outcome of the first trimester?

Objectives: Chlamydia trachomatis is common among young and sexually active people. Most often infections are asymptomatic but have potential long-term consequences for the reproductive health. The pathogenesis of tubal ectopic pregnancy (EP) in the context of chlamydia trachomatis infection is poorly understood. We aimed to study whether chlamydia trachomatis is absent or persists in a latent state in the fallopian tube at the time of laparoscopy for tubal EP. Methods: We examined tissue of the fallopian tubes for the presence of chlamydia trachomatis from women who underwent laparoscopic salpingectomy for EP. Results: Fresh tubal tissue from 16 women with histological confirmation of EP were examined in a hospital setting for the presence of chlamydia trachomatis. The presence of chlamydia trachomatis DNA was confirmed by polymerase chain reaction (PCR) using a commercial test (BD ProbeTecTM ET System) and a real-time enhanced PCR able to detect few copies of the organism. Chlamydial DNA was detected in 0 of the 15 tubal specimens. In 1 case the PCR analysis was not possible for presence of inhibitors. Conclusions: We did not find any evidence of latent infection of chlamydia trachomatis in the fallopian tube at the time of laparoscopy for EP in our study. This suggests that EP can be considered a late complication of the tubal damage resulted from a previous acute chlamydia infection, and that EP may not be related to a latent persistence of chlamydia in the fallopian tube.

P17.01: Yield of invasive diagnostic procedures by indications

Objectives: Chlamydia trachomatis is common among young and sexually active people. Most often infections are asymptomatic but have potential long-term consequences for the reproductive health. The pathogenesis of tubal ectopic pregnancy (EP) in the context of chlamydia trachomatis infection is poorly understood. We aimed to study whether chlamydia trachomatis is absent or persists in a latent state in the fallopian tube at the time of laparoscopy for tubal EP. Methods: We examined tissue of the fallopian tubes for the presence of chlamydia trachomatis from women who underwent laparoscopic salpingectomy for EP. Results: Fresh tubal tissue from 16 women with histological confirmation of EP were examined in a hospital setting for the presence of chlamydia trachomatis. The presence of chlamydia trachomatis DNA was confirmed by polymerase chain reaction (PCR) using a commercial test (BD ProbeTecTM ET System) and a real-time enhanced PCR able to detect few copies of the organism. Chlamydial DNA was detected in 0 of the 15 tubal specimens. In 1 case the PCR analysis was not possible for presence of inhibitors. Conclusions: We did not find any evidence of latent infection of chlamydia trachomatis in the fallopian tube at the time of laparoscopy for EP in our study. This suggests that EP can be considered a late complication of the tubal damage resulted from a previous acute chlamydia infection, and that EP may not be related to a latent persistence of chlamydia in the fallopian tube.

Fertilidad después del tratamiento laparoscópico del embarazo ectópico, en la Clínica del Prado en Medellín, Colombia. Estudio de cohorte

Objetivo: conocer y comparar los índices de fertilidad luego de salpingostomía vs. salpingectomía laparoscópicas en pacientes con embarazo ectópico.Diseño y población: cohorte concurrente de pacientes sometidas a cirugía de embarazo ectópico por laparoscopia en la Unidad de Cirugía Endoscópica Ginecológica, Clínica del Prado, Medellín, Colombia.Metodología: revisión de historias clínicas e interrogatorio telefónico a pacientes que cumplieron criterios de inclusión.Variables principales: tasa global de embarazo intrauterino, tasa acumulada por año de embarazo intrauterino, tasa de recurrencia de ectópico, tasa de persistencia de ectópico.Resultados: 31 pacientes en el grupo de salpingostomía y 14 pacientes en el grupo de salpingectomía. La tasa global de embarazo intrauterino después de salpingostomía fue de 54,8% comparada con 57,1% para salpingectomía (p = 0,88). Se presentaron recurrencias en el 10,5% de las salpingostomías y en el 20% de las salpingectomías (p = 0,77). La tasa de persistencia de ectópico después de manejo conservador fue de 9,6%.Conclusiones: este estudio no demuestra diferencias significativas en los índices reproductivos al comparar salpingostomía vs. salpingectomía laparoscópicas.

Combined Pregnancy

Nine recent cases of coexisting intra- and extrauterine pregnancy at The Mount Sinai Medical Center are presented. The myriad of clinical presentations is exemplified in the postabortal, endometriosis, posttreatment; ovulation induction, and routine "rule-out ectopic" situations. A brief review of the literature follows detailing historical reports of diagnostic inaccuracy and delayed diagnosis. Several studies are cited supporting the difficulty of correctly diagnosing heterotopic pregnancy as well as factors which may predispose to it. The advantages and pitfalls of ultrasonography are mentioned as well as recommendations for early laparoscopic intervention when clinical history and ultrasound are suggestive. Caution is advised in those infertility patients who may undergo "routine" curettage at laparoscopy for ectopic pregnancy and thus, be at risk for inadvertent termination of an otherwise salvageable intrauterine pregnancy. This report further supports several other reviews in noting that the incidence of combined pregnancy may be much greater than formerly appreciated.