Surgical management of tubal ectopic pregnancies

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy outside the cavity of the uterus (womb). In the UK, 1 in 90 pregnancies (just over 1%) is an ectopic pregnancy. Most ectopic pregnancies develop in the fallopian tubes (tubal pregnancy). But in rare cases, they can develop at other sites.

Diagnosis is made based on your symptoms, examination, blood tests and ultrasound scan.

Treatment options vary depending on the type and size of ectopic pregnancy that you have and the results of your tests.

What does surgery involve?

An operation to remove the tubal ectopic pregnancy involves a general anaesthetic. The surgery will either remove the tube containing the ectopic pregnancy (salpingectomy) or just remove the ectopic pregnancy and leave the tube behind (salpingotomy). To reduce the risk of another ectopic pregnancy you will usually be advised to have the tube containing the ectopic removed. Your surgeon will discuss this with you.

The surgery can be done in two ways:

• Laparoscopy (key hole surgery)
• Laparotomy (open surgery)

The type of operation you will have will depend on your wishes or plans for a future pregnancy and what your surgeon finds during the operation. This will be discussed with you. There are risks associated with any operation from surgery itself and from the anaesthetic. These will be discussed with you by your surgeon and anaesthetist.

What happens to my pregnancy remains?

To confirm that you have had an ectopic pregnancy, tissue removed at time of surgery is sent for testing in the laboratory. The healthcare team will discuss with you (and your partner) the options for sensitive disposal of your pregnancy remains and confirm your wishes.

An operation to remove the tubal ectopic pregnancy will involve a general anaesthetic.

The surgery will either remove the tube containing the ectopic pregnancy (salpingectomy) or just remove the ectopic pregnancy and leave the tube behind (salpingotomy). To reduce the risk of another ectopic pregnancy you will usually be advised to have the tube containing the ectopic removed. If you already have only one fallopian tube or the other tube doesn’t look healthy, you may be advised to remove the ectopic pregnancy and leave the tube behind.

The surgery can be done in two ways:

• Laparoscopy (key hole surgery)
• Laparotomy (open surgery)

The type of operation you will have will depend on your wishes or plans for a future pregnancy and what your surgeon finds during the operation. This will be discussed with you. There are risks associated with any operation from surgery itself and anaesthetic. These will be discussed with you by your surgeon and anaesthetist.

On the ward

Official ward visiting times vary for each hospital: 2-7pm for West Middlesex University Hospital and 3-8pm for Chelsea and Westminster Hospital.

You will be reviewed by gynaecology doctors prior to discharge who can answer any questions you have and advise on what to expect in the coming weeks. If you have any concerns during this recovery period, please contact us in EPU for advice or attend A&E if you feel very unwell.

What happens to my dressings?

Dressings will be checked before discharge by nurses on the ward. The plan after will depend on the type of surgery you’ve had:

• Laparoscopy (keyhole surgery) –They can be removed by yourself at home 3 days after discharge.
• Laparotomy (open surgery) – Advice will be provided to you at time of discharge.

What happens to my stitches?

Your stitches are usually dissolvable and do not need to be removed. You will be given instructions if your stitches need to be removed. Please call the gynaecology ward or the EPU if you have any queries.

When should I return to work?

This will depend on the type of surgery you have had and how you recover. If you have had key-hole surgery, you will need 1 week while if you had an open operation, it will be 6 weeks.

What happens next?

Follow up appointments

It is important to attend your follow up appointments. If you have had a salpingotomy, you will be asked to do a hormone blood test in seven days, and this will be repeated until it is negative. If you had a salpingectomy, then you will be asked to do a pregnancy test in three weeks and inform your local EPU of the result.

What about future pregnancies?

The chances of having a successful pregnancy in the future are good. Even if you only have one fallopian tube, your chances of conceiving are not significantly different. However, your overall chance of having another ectopic pregnancy is increased and is about 1 in 7-10 (about 10%) compared with 1 in 90 (just over 1%) in the general UK population. You should call us as soon as you know you are pregnant and you will be offered an early ultrasound scan around 5 weeks to confirm the location of your pregnancy. If you do not want to become pregnant, please see your GP for appropriate contraception advice.

Support

The impact of an ectopic pregnancy is a very personal experience. It might mean coming to terms with the loss of your baby, with the potential impact on future fertility or with the realization that you could have lost your life. Each woman copes in her own way. If you feel you are not coping or getting back to normal, please contact us in your local EPU. 

Patient Advice & Liaison Service (PALS)

If you have concerns or wish to give feedback about services, your care or treatment, you can contact the PALS office in the main atrium or you can complete a feedback form on our website www.chelwest.nhs.uk/pals. We value your opinion and invite you to provide us with feedback.

WMUH: 020 8321 6261; wmpals@chelwest.nhs.uk

C&W: 020 3315 6727; cwpals@chelwest.nhs.uk

Useful contacts

The Ectopic Pregnancy Trust

Tel: 020 7733 2653

Website: www.ectopic.org.uk

The Miscarriage Association

Tel: 019 2420 0799

Website: www.miscarriageassociation.org.uk

Crossway Pregnancy Crisis Centre (Hounslow/Richmond ladies only)

Tel: 020 8892 8483 / 07776 482350

Website: www.crosswaypregnancy.org.uk

West Middlesex University Hospital (Early Pregnancy Unit)

Tel: 020 8321 (6070) or (6506), 07920 020800

The Elizabeth Suite, Chelsea and Westminster Hospital (Early Pregnancy and Acute Gynaecology Unit)

Tel: 020 3315 5070 or 0203 315 5073