TITLE:
Tubal Pregnancy with Acute Bleeding Treated by Laparoscopic Surgery: Tips and Case Presentation
AUTHORS:
Sugiko Oishi, Keiko Mekaru, Maho Miyagi, Kozue Akamine, Chiaki Heshiki, Yoichi Aoki
KEYWORDS:
Tubal Pregnancy, Acute Bleeding, Laparoscopic Surgery
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.1,
January
8,
2020
ABSTRACT: Laparoscopic surgery is the standard surgical approach for ectopic
pregnancy. However, some surgeons prefer laparotomy for patients with acute
bleeding. We evaluated four cases of tubal pregnancy with massive
hemoperitoneum (>800 ml) and performed laparoscopic surgery. The patient age
ranged from 20 to 37 years, and the gestational age ranged from 5 to 8 weeks.
All cases were hemodynamically unstable. Two cases had hemoperitoneum of
>2000 mL, which was caused by the rupture of the left isthmus tube. In three
cases, surgery could be started within approximately 30 min, and in one case,
the start time extended owing to difficulty in anesthesia introduction.
Moreover, in three cases, the target lesion was reached within 7 min, and the
lesion was excised in approximately 20 min from the start of insufflation, and
in one case with a lesion exceeding 7 cm, the time extended. All patients were
safely treated via laparoscopic surgery. To initiate surgery without
deterioration of the hemodynamic condition, blood transfusion can be started
simultaneously with preparation for laparoscopic surgery. Lifting the lesion with
a pair of forceps can help immediately stop bleeding, even if it is difficult
to secure the visual field owing to massive bleeding. When there is difficulty in anesthesia or a large pregnancy lesion, care should be taken to avoid an
increase in the amount of bleeding associated with extension of the
perioperative period.