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


METHODS
Retrospective chart review.


METHODS
University-affiliated hospital.


METHODS
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.


METHODS
Laparoscopic surgery.


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.


CONCLUSIONS
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.
Soriano
D
D
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, 52621, Israel.
Yefet
Y
Y
Oelsner
G
G
Goldenberg
M
M
Mashiach
S
S
Seidman
D S
DS
D000328:Adult; D001803:Blood Transfusion; D016022:Case-Control Studies; D000075202:Contraindications; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000150:complications / Q000601:surgery*; D012151:Resuscitation; D012189:Retrospective Studies; D012769:Shock / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome