What to do in case of ectopic pregnancy?

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor II Pham Thi Tuyet Mai - Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.
Ectopic pregnancy if not detected and treated promptly will lead to rupture causing massive bleeding in the abdomen, which can lead to death if not treated promptly.

1. How to detect ectopic pregnancy?

When you have an ectopic pregnancy, you may first experience symptoms similar to a normal pregnancy, such as missed periods, breast tenderness, or abdominal pain. After that, the patient will have other signs such as:
Abnormal vaginal bleeding: The patient may have bleeding before the menstrual period and it lasts so long that she does not think she is pregnant, or sometimes it stops when it is not called. bleeding. The bleeding is usually black in color and does not clot in small amounts. Abdominal pain: It can be difficult to distinguish between normal pregnancy and ectopic pregnancy symptoms in the early stages. During an ectopic pregnancy, the patient presents with pain in the lower abdomen, unilateral pain, dull pain and sometimes sharp pain. As an ectopic pregnancy develops, more severe symptoms may develop. Especially in the case of ruptured fetal mass, the patient will have sudden manifestations of severe abdominal pain, dizziness or fainting. When detecting abnormal symptoms as above, women need to quickly go to specialized medical facilities for examination and examination for timely treatment.

When a patient is suspected of having an ectopic pregnancy, the doctor can use some of the following tests to make an accurate diagnosis, which are:
Quantitative blood test for βhCG: this test helps diagnose whether there is an ectopic pregnancy. pregnant or not, but it is not possible to know if the pregnancy is in the uterus or not. Ultrasound: On the ultrasound image, there is no gestational sac in the uterus. In some cases, a tumor can be seen in the parauterine area with mixed echo. Or sometimes a gestational sac is seen in the fallopian tube, this case can always be diagnosed as an ectopic pregnancy. However, this image is very difficult to see. When an ectopic pregnancy ruptures, there will be blood in the abdomen, in the same region on ultrasound. Laparoscopy: This is a modern method to quickly and accurately diagnose 100% of cases of ectopic pregnancy.

2. What to do with ectopic pregnancy?

The normal process of pregnancy is that after the fertilized egg moves into the uterus to implant and develop until the day of delivery. When the egg is fertilized but does not move to the uterus but implants in another location such as the fallopian tube, abdomen, ... it will be called an ectopic pregnancy. When the fetal mass develops in these abnormal locations, to some extent it will rupture causing danger to the mother.
Therefore, the ectopic pregnancy cannot be delivered, nor can the fetus be pushed into the uterus. Therefore, treatment is needed to remove the ectopic pregnancy. The earlier an ectopic pregnancy is detected, the easier it is to treat. The choice of treatment will depend on whether the ectopic pregnancy has ruptured and how large it is.
2.1. Using drugs to treat ectopic pregnancy In case the ectopic pregnancy has not ruptured and is 3cm in diameter, the doctor may inject a drug into the fetal mass to prevent the pregnancy from continuing to grow in the wrong position. mind and self-destruct. Methotrexate is the most common drug used to treat an ectopic pregnancy. This medicine will stop the division of cells, then the fetus will be absorbed by the body after 4-6 weeks. When using this method, the fallopian tube is still preserved. Based on the test results of the patient's βhCG level, the doctor will choose a single-dose regimen or a multi-dose regimen for treatment.
During treatment, the patient will be monitored until βhCG returns to negative. When monitoring, if βhCG is found to increase or decrease as expected, the patient will be supplemented with repeat doses or may undergo surgical intervention depending on each specific case.

This method has the following advantages:
Has a high success rate > 90%. Avoid surgery as well as the complications of anesthesia. Helps preserve fallopian tubes, maintain fertility. Patients can be monitored on an outpatient basis, without requiring hospitalization. However, this method also has the following disadvantages:
The follow-up period lasts from 2 to 6 weeks. There are some cases of treatment failure, patients need to use another dose of medicine. Only use a maximum of 3 doses. Patients may experience some side effects of the drug such as: Nausea, vomiting. Fatigue, loss of appetite. Mouth sores. Vision change. Hair loss. Diarrhea. Increased sensitivity to sunlight. Rare side effects: marrow failure, liver failure, kidney failure. Patients should avoid becoming pregnant after treatment for a minimum of 3 months. The patient needs to be re-examined and monitored until the βhCG level is negative. 2.2. Laparoscopic surgery for ectopic pregnancy

Laparoscopic surgery is applied to cases where the ectopic pregnancy is larger but has not been broken. This method has many advantages such as:
No pain for the patient after surgery. The patient did not have to take many antibiotics. The patient recovered quickly. Patients can return to work and daily activities sooner. Laparoscopic surgery has high aesthetics because it does not leave bad scars on the abdomen, the surgical scars are very small, only about 0.5 - 1cm, very difficult to see if you do not pay attention to observe. Patients only need to stay in the hospital for a very short time, and can be discharged 48 hours after surgery. Low cost of treatment. In cases when the doctor does a clinical examination in combination with tests and ultrasounds but still cannot accurately diagnose an ectopic pregnancy, the doctor can use diagnostic laparoscopy. During laparoscopy, if there is an ectopic pregnancy, it will be treated immediately. If there is no ectopic pregnancy, then in addition to definitely confirming that there is no ectopic pregnancy, the patient is also checked for infection, no tumor, no adhesions,... Therefore Laparoscopy is the method of choice for early and accurate diagnosis and treatment of unruptured ectopic pregnancy.
2.3. Open surgery to treat ectopic pregnancy With cases of ectopic pregnancy that has ruptured, there is too much blood in the abdomen, it is imperative that doctors perform open surgery for treatment. This method has some disadvantages as follows:
Patients may feel pain after surgery. Had to use a lot of antibiotics. Patients are at high risk of abdominal adhesions after surgery. Longer hospital stay compared to laparoscopic surgery. However, because this is an emergency, if surgery is not performed in time, the patient can die due to a lot of blood loss. Therefore, when identifying a patient with a ruptured ectopic pregnancy, an emergency caesarean section should be performed immediately. An ectopic pregnancy is an undesirable condition for all women who are expecting a baby, but For women who do not want to have children, they should use contraception and prevent ectopic pregnancy. If unfortunately encountering this situation, the patient should quickly go to specialized medical facilities as soon as possible for timely treatment.
Laparoscopic ectopic pregnancy surgery at Vinmec with outstanding advantages:
The hospital is equipped with leading modern equipment in Vietnam in the operating room The surgical procedures are performed seriously (before) During surgery, a full review sheet must be carried out before surgery...), regularly have someone urge the inspection, and always update the latest regulatory procedures in the world. The hospital environment is clean, there is no hospital infection, so the patient does not have to be treated with antibiotics after surgery. All information about the pathology and surgical management of ectopic pregnancy is stored in the electronic medical record, easy to look up in cases where it is necessary to retrieve information when it is necessary to treat fertility problems. of the patient. A team of highly qualified and experienced medical professionals. In addition, to reduce complications of ectopic pregnancy, Vinmec offers a comprehensive health care package for couples, pregnant mothers and their unborn babies, including basic pre-marital examination packages, pre-marital examination packages. Advanced staff , maternity package package . Vinmec has a team of experienced doctors in the fields of obstetrics and gynecology, IVF, stem cells, gene technology, capable of synchronously and comprehensively deploying the most advanced assisted reproductive techniques today.
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