Ectopic Pregnancy Surgery: Everything You Need to Know

Ectopic pregnancy surgery involves removing a pregnancy that has begun developing outside of the uterus. In the vast majority of cases, ectopic pregnancies occur within one of the fallopian tubes. These narrow tubes connect the ovaries to the uterus. Less commonly, a fertilized egg may begin developing within the cervix, ovary, abdomen, or a prior cesarean scar.

Pregnancies that grow outside of the uterus cannot develop normally or survive to viability. Ectopic pregnancy also can cause the organ it's developing in to break open (rupture), which can become a life-threatening emergency for the pregnant person. This is why medical or surgical treatment is required as soon as possible after diagnosis.

Ectopic Pregnancy Surgery

Ectopic pregnancy surgery is performed under general anesthesia by an obstetrician-gynecologist (OB/GYN). The surgery is usually scheduled but may be performed sooner if there is an emergency. During ectopic pregnancy surgery, the surgeon will perform one of two procedures:

• Salpingectomy: Pregnancy tissue is removed along with part or all of the fallopian tube
• Salpingostomy: Pregnancy tissue is removed and the fallopian tube is repaired

The decision depends on a number of factors, including the condition of the tube, the size of the ectopic pregnancy, whether any bleeding is present, and surgeon comfort or preference. Specifically, a salpingectomy rather than a salpingostomy is indicated when there is a ruptured or extensively damaged fallopian tube, large ectopic pregnancy, and/or uncontrolled bleeding.

Another factor taken into consideration when deciding between the two surgeries is whether the patient desires to have any more children in the future. A patient may opt for a salpingectomy if they are finished having children and want permanent sterilization. In this case, the surgeon can remove both fallopian tubes during the same surgery—what's known as a bilateral salpingectomy.

People who are planning in vitro fertilization (IVF) for future pregnancies may also choose salpingectomy. On the other hand, preserving the fallopian tube would be important for people who desire future children (not through IVF) and whose other fallopian tube is absent or damaged.

Surgical Approaches

Ectopic pregnancy surgery may be performed in one of two ways. The first is called a laparotomy. In this surgery, a large incision is made in the skin of the abdomen to remove the pregnancy tissue. A one- to five-night hospital stay is required afterward. With laparoscopic surgery, thin surgical tools (one of which has a camera attached to it) are inserted through multiple small skin incisions in the abdomen to perform the same operation. The patient can go home the same day as the surgery.

Compared with a laparotomy, laparoscopic surgery is safer and allows for a faster recovery. Laparoscopy is the preferred or "gold standard" surgical treatment for ectopic pregnancies because of its superior safety and efficacy statistics.

That said, laparotomy may be required in emergency situations. For example, if a patient has significant amounts of internal bleeding or if large amounts of scar tissue are present within their abdomen.

Contraindications

Certain medical conditions, like underlying heart or lung disease, may increase a patient's risk for complications during surgery. The pros and cons of surgery in these cases must be weighed carefully before proceeding.

Potential Risks

In addition to the general risks of surgery, which include infection, bleeding, and problems with anesthesia, the risks associated with ectopic pregnancy surgery include developing scar tissue (adhesion) formation and injury to nearby organs, such as the bladder or intestines. Retained pregnancy tissue is another risk of ectopic pregnancy surgery; although, this complication is typically only a concern in salpingostomy.

Purpose of Ectopic Pregnancy Surgery

The purpose of ectopic pregnancy surgery is to remove the developing embryo before it grows too large and causes potentially life-threatening complications like internal bleeding or sepsis.

Ectopic pregnancy surgery is usually a last resort option, though. Medical management of ectopic pregnancy with the medication methotrexate is generally considered the first-choice treatment.

Indications for ectopic pregnancy surgery include having unstable vital signs (such as low blood pressure and high heart rate), suspicion of a ruptured fallopian tube, or methotrexate treatment failed or is not possible.

Some people cannot take methotrexate. They may be sensitive to the drug, or unable or unwilling to return for post-treatment follow-up visits. People who are breastfeeding or who have kidney disease or chronic liver disease cannot take methotrexate.

Pre-Surgery Testing

An ectopic pregnancy is diagnosed with transvaginal ultrasound and a blood measurement of the pregnancy hormone human chorionic gonadotropin (hCG). Once the diagnosis is made, additional blood tests, like a complete blood count (CBC) or comprehensive metabolic panel (CMP), may be performed to help determine whether methotrexate can be safely administered.

These same blood tests, possibly along with other tests, like an electrocardiogram (ECG), may be used to assess the patient's medical status in preparation for surgery.

How to Prepare

If you are scheduled for an ectopic pregnancy surgery, your surgeon will give you instructions on how to prepare.

Location

Your operation will take place in a hospital or surgical center.

What to Wear

Wear comfortable, easy-to-remove clothes as you will change into a gown upon arrival. Avoid wearing makeup, moisturizers, perfume, or nail polish. Leave all valuables, including jewelry, at home.

Food and Drink

Typically, you will be required not to eat or drink anything after midnight the evening before your surgery. Check in with your doctor for your specific timing requirements for abstaining from food and drink.

Medications

Up to a week before surgery, your surgeon will likely ask you to stop taking medications that increase your risk for bleeding, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen).

What to Bring

Since you may experience vaginal bleeding and abdominal cramping/swelling after surgery, bring a sanitary pad and loose-fitting clothing to go home in. You will also need your driver's license or other identification and an insurance card. You will need someone to drive you home after your procedure.

If you are staying overnight in the hospital, pack any medical devices you use (such as an asthma inhaler), comfortable and loose-fitting clothes to go home in, slip-on shoes or non-skid slippers, personal toiletries, and small personal or comfort items, such as a book and cell phone charger.

Pre-Op Lifestyle Changes

Stop smoking as soon as possible prior to surgery. Smoking increases your risk for complications, including breathing and wound healing problems, both during and after the procedure.

What to Expect on the Day of Surgery

On the day of your surgery, you will arrive at the hospital/surgical center and check in. You may be asked to show identification at this time.

Before the Surgery

What to expect for your surgical experience will vary based on your provider and the specifics of your case. However, generally, the process will follow the below steps.

After checking in, you will be taken to a surgical holding area where you will change out of your clothes into a hospital gown. A nurse will then review your medication list, record your vitals, and place an intravenous (IV) line for administering fluids and medications into a vein in your hand or arm.

Your surgeon will come to greet you and briefly review the operation with you. You may need to sign a consent form at this time. Your anesthesiologist will also come to say hello and review the anesthesia process and potential risks involved. From there, you will be walked or wheeled on a gurney into the operating room.

During the Surgery

Upon entering the operating room, the surgical team will transfer you onto a table. The anesthesiologist will then administer inhaled or intravenous medication to put you to sleep. You will not remember anything that occurs during the surgery after this point.

Next, a breathing tube called an endotracheal tube will be inserted into your windpipe. This tube is connected to a ventilator that takes control of your breathing during the operation.

Ectopic pregnancy surgery typically takes between 45 to 90 minutes to complete and generally proceeds in the following fashion:

Incision

The surgeon will make one or more incisions over the abdomen. The size and number of incisions depend on whether a laparotomy (large, single incision) or laparoscopy (small, multiple incisions) is being performed.

Visualization

The fallopian tube containing the ectopic pregnancy will be visualized through the incision site(s). Carbon dioxide gas may be pumped into the abdomen to help make it easier for the surgeon to see everything.

Salpingectomy

The fallopian tube containing the ectopic pregnancy will be partially or totally removed using various surgical instruments (such as clamps, grasping forceps, scissors, and/or a device that releases heat).

Salpingostomy

Alternatively, an incision will be made within the tube overlying the ectopic pregnancy. The pregnancy tissue will be released from the tube using a special tool called a suction-irrigator. With laparoscopy surgery, the tissue will be placed in a pouch and removed from the abdomen. The incision site within the tube will be left to heal on its own.

Closure

The abdominal incision site(s) will be closed with stitches or surgical glue or tape and covered with a dressing.

Pathology Review

The removed tissue may be sent off to a pathology laboratory to confirm the diagnosis of tubal pregnancy.

Post Surgery

The breathing tube will be removed and you will be taken to a recovery room. In the recovery room, you will slowly wake up from anesthesia. A nurse will monitor your vital signs and help you manage common post-operative symptoms like pain and nausea.

Once you are fully awake and alert, you will be discharged home (if you underwent a laparoscopy) or wheeled to a hospital room (if you underwent a laparotomy).

Recovery

Patients can generally resume normal activities within a week after undergoing laparoscopic ectopic pregnancy surgery. A laparotomy, on the other hand, requires a two- to six-week recovery period.

As you recover, you can expect abdominal soreness and swelling. Continue to use your prescribed pain medication as instructed. You may experience a day or so of mild nausea after surgery. Eating bland, light foods like toast, crackers, and chicken broth can be helpful. You may experience vaginal bleeding for one to four weeks after surgery. As you recover, you may be asked to avoid using tampons to help prevent infection.

Wound Care

Ask your surgeon when you can shower after your surgery. When able to do so, be sure to gently wash your incision site(s) and pat them dry with a clean towel afterward. Do not apply any powders or lotions to or near your incision site(s). Apply new dressings over the incision site(s) once they are dry if directed to do so by your doctor.

Activity

You will have specific activity guidelines to follow after surgery, such as avoiding swimming, taking baths, or having sex until cleared by your surgeon. Avoid driving until you are off all pain medication.

You can likely return to work two to six weeks after a laparotomy and one week after a laparoscopy. Avoid vigorous exercise and lifting more than 10 pounds until your incision site(s) are fully healed.

Expect to see your surgeon around one week after surgery. At this appointment, your surgeon will check your incision site(s), remove any non-absorbable stitches, and monitor for complications.

Long-Term Care

If you underwent a salpingostomy, your doctor will measure your hCG level every week to confirm that it declines to zero. This ensures that there is no pregnancy tissue remaining in the fallopian tube. If you underwent a salpingectomy and the lap report confirms a tubal pregnancy, you probably will not need a follow-up blood hCG measurement.

If you are interested in having children in the future, talk with your doctor about when it is safe for you to try to conceive again. As of now, there is no data to support waiting a specific time interval before conceiving after ectopic pregnancy surgery.

If you get pregnant again, tell your OB-GYN and be on the lookout for signs and symptoms of an ectopic pregnancy. Since people who have had an ectopic pregnancy are at an increased risk of having another one, your doctor may want to see you sooner than usual to confirm that your pregnancy is growing in your uterus.

Lastly, as for any patient, be certain to see your OB/GYN for your regular well check-ups and preventive care.

Possible Additional Treatment

Pregnancy tissue is retained in about 4% to 15% of salpingostomy cases. This may be treated with another surgery or by taking a dose of methotrexate.

Coping

It's normal to experience a wide range of emotions after an ectopic pregnancy. Disbelief or shock at how fast the diagnosis-to-treatment process went, grief over the loss of the pregnancy, and/or anxiety over whether this will happen again in the future are all common and normal reactions.

While joining an online or in-person support group may bring you comfort and emotional guidance, be sure to reach out to your doctor if you find it hard to get back to your daily routine after healing from surgery. You may benefit from talking with a therapist or counselor trained in pregnancy loss.

A Word From Verywell

Undergoing ectopic pregnancy surgery can feel surprising and upsetting from start to finish. Take the time you need to rest and care for yourself, both body and mind, after your procedure. If you have concerns about your future fertility, try to remain positive. In most cases, the chances of having a successful pregnancy after an ectopic one are high.