Management of patients with ectopic pregnancy with massive hemoperitoneum by laparoscopic surgery with intraoperative autologous blood transfusion.
OBJECTIVE
To evaluate the feasibility and safety of surgical laparoscopy with intraoperative autologous blood transfusion for ectopic pregnancy with massive hemoperitoneum.


METHODS
Retrospective analysis (Canadian Task Force classification II-1).


METHODS
Department of gynecology at a general hospital.


METHODS
Seventeen consecutive patients with ectopic pregnancy with massive hemoperitoneum.


METHODS
Laparoscopic surgery with salvage device-based intraoperative autologous blood transfusion.


RESULTS
From January 2000 through June 2005, one hundred and twelve women with ectopic pregnancy (interstitial/cornual: 4; isthmic: 18; ampullary: 86; and ovarian: 4) were treated by laparoscopic surgery. Seventeen patients who demonstrated more than 501 g of intraabdominal bleeding were classified as having massive hemoperitoneum and retrospectively analyzed. Site of pregnancy in these 17 patients was interstitial/cornual: 3; isthmic: 5; ampullary: 7; and ovarian: 2. Except for two women with tubal abortion of ampullary pregnancy, all other patients had rupture at the pregnancy site. During laparoscopic surgery, blood pooled in the abdominal cavity was collected by an irrigation and aspiration procedure, and sent to an autologous blood-salvage device to make concentrated red blood cell solution. Processed blood was immediately transfused back to the patient through a leukocyte reduction filter. The mean amount of estimated intraabdominal bleeding, which was calculated by the difference between the volumes of aspirated and irrigated fluids, was 1362.1 +/- 491.4 g, and the mean volume of reinfused processed blood was 680.6 +/- 209.5 g. No patient received banked blood at any time. The degree of hemoperitoneum was well correlated with the shock index calculated by dividing the heart rate by systolic blood pressure at triage (r = 0.72; 95% CI 0.37-0.89; p = .001). In all cases of massive hemoperitoneum, there was no need for laparotomic conversion, and homologous blood transfusion was avoided.


CONCLUSIONS
Even in women with ectopic pregnancy with massive hemoperitoneum, laparoscopic surgery can be safely conducted by experienced laparoscopists with intraoperative autologous blood transfusion if hemodynamic stability is achieved by perioperative management.
Takeda
Akihiro
A
Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan. reef@syd.odn.ne.jp
Manabe
Shuichi
S
Mitsui
Takashi
T
Nakamura
Hiromi
H
D000293:Adolescent; D000328:Adult; D001804:Blood Transfusion, Autologous; D005240:Feasibility Studies; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000209:etiology / Q000628:therapy; D010535:Laparoscopy / Q000379:methods*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000150:complications; D016896:Treatment Outcome