Operative laparoscopy for management of ectopic pregnancy in patients with hypovolemic shock.

STUDY

OBJECTIVE

To determine the safety of operative laparoscopy in the management of ectopic pregnancy in women with hypovolemic shock.

DESIGN

Retrospective chart review.

SETTING

University-affiliated hospital.

PATIENTS: Two hundred eleven women with tubal pregnancy, of whom 33 were suffering from hypovolemic shock, based on a combination of signs and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill.

INTERVENTION: Laparoscopic surgery.

MEASUREMENTS AND MAIN

RESULTS

Mean +/- SEM intraabdominal blood loss was significantly (p <0.01) higher in women with hypovolemic shock, 1369 +/- 149 versus 114 +/- 14 ml. Blood transfusions were given to 88% and 0.5%, respectively (p <0. 01). Laparoscopic salpingectomy was performed in all hemodynamically compromised women compared with 87% of stable women. Conversion to laparotomy was required in three patients in the hypovolemic shock group and five in the stable group. All patients had an uncomplicated postoperative course and made a full recovery.

CONCLUSION

The availability of optimal anesthesia and advanced cardiovascular monitoring, and the ability to convert rapidly to laparotomy if required, allow safe performance of operative laparoscopic surgery in most women in hypovolemic shock. In fact, the superior exposure of laparoscopy, providing rapid diagnosis and control of the source of bleeding, makes it a highly suitable approach.