The EPT

What is surgical management?

This means performing an operation to remove the ectopic pregnancy and will involve a general anaesthetic. Surgery to remove the ectopic pregnancy is the most well-established form of treatment.

When is surgery most appropriate?

Your doctors have considered carefully the best way to manage you. Because the hormone being made by the pregnancy (beta hCG) is high, the doctors cannot consider less invasive treatments for you because your health may be at risk. If an ultrasound scan has been performed, whilst not showing a pregnancy in your uterus, it may have shown that there is bleeding into your abdomen. Surgery may also be performed if expectant management or medical management have failed.

What will surgery involve?

Traditionally, surgery involved Laparotomy (open cut) on the lower abdomen. This is occasionally used if there is heavy internal bleeding/rupture or a lot of scar tissue. This will be performed in an emergency situation. If there is extensive bleeding, a blood transfusion may need to be given. Otherwise you will be operated on using a technique called laparoscopy (keyhole surgery). This involves inserting a camera through the navel (belly button) and inserting instruments through two small cuts in the lower abdomen.  A small amount of gas is put into your abdominal cavity to inflate it to enable the surgeon to see inside the abdomen. Both techniques will enable the surgeon to examine the abdominal cavity and determine the next course of action.

How will the ectopic pregnancy be treated?

There are two courses of action for the surgeon and the one chosen will depend upon the damage to the affected tube and the condition of the other tube. If there is a lot of damage or bleeding, the affected tube will be removed. This is called a salpingectomy. However, if the damage is minimal, then the ectopic can be removed from the tube by making a small cut, leaving the tube intact. This is called a salpingotomy. This entails a very small risk that some of the pregnancy remains in the tube. You will be advised to have weekly blood tests to monitor hCG levels as they decrease and the pregnancy is fully resolved. In a very small number of cases, treatment with a drug called methotrexate may be required, or a further operation needed if the hCG levels are not decreasing.

How will I feel after the surgery?

Most women experience pain during the first 1-2 weeks after surgery which can be treated with painkillers. If you have had a laparoscopy, you are likely to feel bloated for the first week, with pain similar to trapped wind. This is due to the gas which is used during the surgery. You will feel tired, particularly if you lost a lot of blood during the procedure. If you had to have a blood transfusion, you may be offered iron tablets. No follow-up is needed. Some hospitals ask you to return for an outpatient appointment about 6 weeks after surgery to ensure that your tummy has healed properly, but not all do. If you are not offered a follow-up appointment, your GP would probably like to see you at around 6 weeks, or before you return to work, to undertake a post – operative check to make sure that you are healing well.

How long will I stay in hospital?

This depends upon the operation you had. For a laparoscopy it is 1-2 days and for a laparotomy it is 3-5 days. When you are discharged, the ward staff will give you all the necessary advice on aftercare, exercise and diet. Stitches are usually dissolvable and should dissolve completely after 1 week.

What can I do to help me recover from the surgery?

In the first days after surgery it is important to try to keep moving gently. Make sure you walk around regularly and increase the short distances you walk as each day passes. Your nurses will tell you anything you need to know about managing your wound sites, for example, if the stitches are dissolvable or if you need to return to have them removed and when. You need to keep your wound site clean. You can shower regularly and you can safely take a bath 48 hours after the operation unless you have been told otherwise. It’s a good idea to make sure you have someone with you in the house when you first take a bath in case you need help to get out again. You should not do any heavy lifting or vigorous housework for around 2 weeks and should only undertake gentle exercise such as walking, and possibly gentle swimming, once the wound sites on the skin have healed. The staff at the hospital should also advise you about pelvic floor (Kegel) exercises, as these can greatly help you to recover your normal tummy and bladder tone in the weeks to come. In the first few days it’s important to take the painkillers that have been prescribed for you, as they will help you to manage your pain and feel more comfortable after an operation.

How will my doctors keep me monitored?

If you had a salpingotomy, or if there was any doubt that all of the placental tissue was removed, your doctors will usually test your hCG levels to ensure that they are dropping. In this instance, it may be necessary to check your blood hCG levels again after a week, and possibly beyond.