Laparoscopic Tx okay for ectopic pregnancy, shock.(Obstetrics)

SAN DIEGO -- Laparoscopic management for ectopic pregnancy was safely undertaken in 12 women who were in shock, Mark Erian, M.D., reported at an international congress of the Society of Laparoendoscopic Surgeons.

He reviewed records of 12 patients with clinical hypovolemic shock due to a ruptured fallopian tube ectopic pregnancy who were treated laparoscopically in one gynecology unit where minimally invasive surgery is the norm. All patients survived and were successfully treated, said Dr. Erian of Royal Brisbane and Women's Hospital, Brisbane, Australia.

The report of the 12 cases was coauthored by Glenda McLaren, M.D., of the University of Queensland, which is in Brisbane.

Laparoscopic management is the mainstay for women with ectopic pregnancy who are not in shock, and it should still be even when shock occurs, Dr. Erian said. His unit has successfully treated an additional 5 cases of ectopic pregnancy in women with hypovolemic shock since the original series of 12 cases, he added.

The original 12 cases were seen over a period of approximately 4 years, the researchers said. Such cases are relatively rare. Some of these patients had been airlifted by helicopter to the hospital from other parts of Australia.

The patients had a mean age of 21 years (ranging from 15 to 43 years), and all had been amenorrheic for a mean of 7 weeks except two patients for whom the latest normal menstrual period was unknown. Serum [beta]-HCG measurements showed a mean value of 4,850 IU/L. Symptoms and findings of a pelvic examination usually pointed to ectopic pregnancy. Preoperative ultrasound scans showed no intrauterine gestations or excessive peritoneal fluid, and usually showed an adnexal mass with heterogenic echogenicity.

Urgent resuscitation measures, including blood transfusion, ...