Ectopic Pregnancy

Ectopic

However, in certain cases the tube may be slit on top of the ectopic pregnancy which can be removed without damaging the whole tube (salpingostomy). In such cases, there is 5-10% risk of persistent ectopic with viable chorionic villi continuing to grow. The hCG level will stay high, and patients may become symptomatic again within 10 days after surgery. This may lead to subsequent rupture of the tube, unless treatment with methotrexate is given or salpingectomy is performed.Please click on the following link to see an ectopic pregnancy being removed laparoscopically:http://www.youtube.com/watch?v=qOgJrcWHOUAMethotrexate is an anti metabolite which is usually used for treating some forms of cancer. It inhibits rapidly growing cells, hence used to block the growth of ectopic trophoblasts. It is usually used for small ectopic pregnancies less than 3-4 cm in diameter, in haemodynamically stable patients who have no significant intra-abdominal haemorrhage. Depending on the selection criteria more than 70% of medically treated ectopic pregnancies resolve, with confirmed tubal patency in 70% of the cases. Furthermore, they have a similar recurrence of ectopic pregnancies as compared to conservative surgery. The usual dose is 50 mg per square metre intramuscularly, though direct injection into the ectopic site is used frequently. Strict follow up of these patients is necessary for a long time till the hCG level returns back to the non pregnant level. However, there might be an initial transient rise in the level of hCG, as well as lower abdominal pain. Furthermore, it is also important to note that a mass may be seen at the ectopic site with transvaginal scanning for many months following medical treatment.


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