Salpingectomy vs Salpingostomy | Western Sydney University

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

188

Pages:

4
Author:

Mariam A. A.

Salpingectomy vs Salpingostomy Informed Consent I understand this is difficult for you and I would like to explain the findings including management You have done nothing wrong, it is not your fault, this is a medical complication, and we are here to help you. Expectant management is not ideal because the beta hCG levels are over 1500 and too high to resolve spontaneously There is a mass of 25 mm -> for expectant management there should not be one The patient is symptomatic -> hence there is Usually indicated when beta hCG levels are less than 3000 Medical management not ideal in this cause since there is a visible gestational sac -> suggests a structurally developed pregnancy -> hence surgical management is preferred We have two surgical options to manage this Salpingectomy Removal of the affected fallopian tube This is the definitive management Decreases chance of fertility -> especially if the counter lateral FT is impacted Safer it the FT is damaged or bleeding Eliminates the risk of it happening in that same FT again and not need for a close beta hCG level after. Re-occurrence rate is 15% Salpingotomy Incision in the FT to remove the ectopic pregnancy and preserves the FT This is safer it the tube is healthy Involves a linear incision along the antimesenteric border to the FT to remove the ectopic pregnancy Preserves FT There is a risk of persistent pregnancy tissue – 4 to 8% -> will cause a non-declining beta hCG Will need methotrexate for a non-declining beta HCG Will need to monitor beta hCG levels on the 3 rd day, 7 th day and weekly until complete resolution In most patients 2 to 4 weeks However, in some may go up to 6 weeks Post Discharge advice Explain the findings of the diagnosis and what happened in the procedure May experience some plain, bloating or shoulder discomfort from the laparoscopic gas Should improve within a few days May use Panadol or ibuprofen for pain Wound care -> keep dressing clean and dry Watch out for signs on infection -> red, swelling or discharge No heavy lifting, driving or sexual intercourse for 2 weeks or anything strains If desire contraception should try to avoid progestin only pill or IUCD as there are associated with a slightly higher risk of future ectopic pregnancy If get pregnant again – TVUS should be performed at 5 weeks to confirm an intrauterine pregnancy 60% of women how have ectopic pregnancy can have a live birth within the next 3 years But there is a 10-15% chance of ectopic pregnancy happening again If planning next pregnancy -> wait until beta hCG has resolve and one normal menstural cycle has occurred Beta hCG follow up 3 to 4 days post op 7 days post op Weekly until drops to less than 5