Laparoscopic surgery for extrauterine pregnancy in hemodynamically unstable patients

Study Objective. To assess the feasibility and safety of laparoscopic surgery in treatment of ectopic pregnancy in hemodynamically unstable women. Design. Three-year observational study (Canadian Task Force classification II-2). Setting. Tertiary university hospital. Patients. One hundred one women with ectopic pregnancy who underwent laparoscopic surgery, 18 with substantial intraabdominal bleeding and with clinical signs and symptoms of hemodynamic instability. Intervention. Laparoscopic surgery. Measurements and Main Results. Compared with stable patients, hemodynamically unstable women had significantly more free blood in the abdomen (1244 ± 590 vs 173 ± 301 ml, p <0.0001), had significantly lower hemoglobin levels (7.8 ± 1.4 vs 11.9 ± 1.4 g%, p <0.0001), and required significantly more frequent blood transfusions (83% vs 3.6%, p <0.0001). Similarly, their hemodynamic values such as pulse rate and blood pressures were worse. Among these women, 15 (83%) had a tubal pregnancy, 2 had an interstitial pregnancy, and 1 had a tubal abortion. Those with tubal pregnancy who were hemodynamically unstable underwent salpingectomy. Only one required conversion to laparotomy. No major intraoperative or postoperative complications occurred, and all women made a full and uneventful recovery. Conclusion. Improved anesthesia and cardiovascular monitoring, together with advanced laparoscopic surgical skills and experience, justifies operative laparoscopy for surgical treatment of ectopic pregnancy even in women with hemodynamic instability.