Surgery for ruptured ectopic pregnancy; Laparotomy and Laparoscopy

Surgery for a ruptured ectopic pregnancy is an emergency procedure aimed at stopping internal bleeding and removing the affected fallopian tube or pregnancy tissue. The most common approach is laparotomy or laparoscopy with salpingectomy.

Here’s a detailed overview of the surgical management:

🛑 Indication for Surgery
Ruptured ectopic pregnancy is a life-threatening condition due to internal hemorrhage.

Surgery is required when:

The patient is hemodynamically unstable.

There is evidence of tubal rupture or hemoperitoneum.

Medical management (e.g., methotrexate) is contraindicated or has failed.

🔧 Surgical Approaches
1. Laparotomy
Open abdominal surgery used in unstable patients or when rapid access is needed.

Preferred when there is massive internal bleeding or poor visualization via laparoscopy.

Procedure typically involves:

Salpingectomy: Removal of the ruptured fallopian tube.

Hemostasis and peritoneal lavage.

2. Laparoscopy
Minimally invasive and preferred in stable patients.

Offers quicker recovery and less postoperative pain.

Can perform:

Salpingectomy: Complete removal of the tube.

Salpingostomy: Removal of pregnancy tissue while preserving the tube (less common in rupture cases).

🩸 Intraoperative Considerations
Blood transfusion may be necessary depending on blood loss.

Inspection of contralateral tube and ovaries to assess future fertility potential.

Histopathological examination of removed tissue confirms diagnosis.

🌱 Postoperative Care
Monitor vital signs and hemoglobin levels.

Serial hCG testing to ensure complete resolution.

Counseling on recurrence risk and future pregnancy planning

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