59136 Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus

Name of the Procedure:

Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus (also known as Interstitial Ectopic Pregnancy Surgery).

Summary

This surgical procedure addresses an ectopic pregnancy that occurs within the interstitial part of the uterus (the area where the fallopian tube connects to the uterus). It involves removing the pregnancy and a portion of the uterus.

Purpose

The main goal is to resolve an ectopic pregnancy that poses a risk of significant internal bleeding and life-threatening complications. The procedure aims to remove the ectopic pregnancy and preserve as much of the uterus as possible.

Indications

• Diagnosis of an interstitial ectopic pregnancy
• Acute abdominal pain and vaginal bleeding in a patient with a positive pregnancy test
• Evidence of a rupture or impending rupture of the uterus
• Hemodynamic instability requiring immediate intervention

Preparation

• Fasting for at least 8 hours prior to surgery.
• Stopping certain medications as advised by the physician (e.g., blood thinners).
• Pre-operative imaging studies such as ultrasound or MRI to confirm the location of the ectopic pregnancy.
• Blood tests to assess overall health and pregnancy hormone levels.

Procedure Description

1. The patient is placed under general anesthesia.
2. A surgical incision is made in the abdomen to access the uterus.
3. The interstitial pregnancy is identified and carefully excised along with the affected portion of the uterus.
4. Hemostasis is achieved to control bleeding, and the uterine tissue is sutured.
5. The abdominal incision is then closed in layers.
6. The patient is transferred to a recovery area for monitoring.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeons specialized in obstetrics and gynecology
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: bleeding, infection, and pain.
• Rare risks: damage to surrounding organs, blood clots, and adverse reactions to anesthesia.
• Possible complications: excessive blood loss requiring transfusion, uterine rupture, and issues related to future fertility.

Benefits

• Resolution of a life-threatening ectopic pregnancy.
• Preservation of the uterus to potentially allow for future pregnancies.
• Immediate alleviation of symptoms once the ectopic pregnancy is removed.

Recovery

• Hospital stay of 1-2 days for close monitoring.
• Pain management with prescribed medications.
• Instructions on wound care and activity restrictions (e.g., no heavy lifting for several weeks).
• Follow-up appointments to monitor recovery and assess healing.

Alternatives

• Non-surgical management with methotrexate if diagnosed early and appropriate.
• Expectant management in very rare cases where the ectopic pregnancy may resolve spontaneously, though not recommended for interstitial pregnancies.
• Pros: Less invasive options such as medication.
• Cons: Higher risk of complications and lower success rates compared to surgical intervention.

Patient Experience

Patients will experience general anesthesia, leading to no awareness during the surgery itself. Post-operative discomfort and pain are common and managed with pain relief medications. Recovery involves gradual return to normal activities and follow-up for medical supervision.