One injection can terminate a pregnancy
Ectopic pregnancy: therapy
With modern examination methods, ectopic pregnancies are recognized earlier and earlier today. There is rarely an acute emergency. However, if a malfunction is discovered, treatment must be initiated immediately. The procedure depends on the various test results: location of the malfunction, stage of pregnancy, concentration of the pregnancy hormone HCG, physical and psychological situation of the patient. The wishes of the patient concerned with regard to further family planning must also be taken into account.
There are basically three possible approaches:
- Surgical removal of the pregnancy tissue or the entire affected fallopian tube
- Medicinal killing of the pregnancy tissue / embryo
- Waiting and observing whether the pregnancy comes off naturally
The operation, the mechanical removal of a malfunction, is now one of the standard procedures in the case of an ectopic pregnancy. In almost all cases, the operation is carried out endoscopically with the so-called laparoscopy (laparoscopy) - regardless of whether the affected fallopian tube is preserved or completely removed. Rod-shaped surgical instruments are pushed into the body cavity through a small incision in the abdominal wall. This microsurgical procedure not only has cosmetic advantages, but also shortens the operating time and the length of the hospital stay. Furthermore, blood loss is minimal and overall recovery is faster.
In the case of unstable circulation and extensive adhesions, however, surgical opening of the abdominal cavity (laparotomy = abdominal incision) is more advantageous. This can be planned in advance or become necessary in the event of complications during or after a microsurgical procedure. In the acute emergency of a ruptured fallopian tube, a laparotomy cannot be avoided.
During an ectopic pregnancy operation, either only the pregnancy tissue is removed via an opening of the fallopian tube (salpingotomy) or the entire fallopian tube is removed (salpingectomy). Since around half of all affected patients are still childless at the time of the procedure, preservation of the fallopian tube has absolute priority. Complete removal of the fallopian tube is necessary if the tube is irreversibly damaged or complications arise. A salpingectomy is also advisable after family planning has been completed.
As with any surgery, complications can arise with the surgical removal of an ectopic pregnancy. In some cases, minimal remnants of the pregnancy tissue remain (trophoblast persistence) and continue to grow. As a result of these growing pregnancy residues, the fallopian tube can also be ruptured afterwards in extreme cases. A follow-up of the pregnancy hormone HCG is therefore absolutely necessary. Only when no more HCG can be detected in the blood, the complete removal of the pregnancy tissue was successful.
Another option for treating an ectopic pregnancy is drug therapy. So far, it has not been used as often as surgery, but in most cases it has very good success rates. This type of treatment is often used after an operation, for example when there is still growing pregnancy tissue.
The cytotoxin methotrexate (MTX) is most commonly used in drug therapy. It acts on the growth and reproduction of the cells surrounding the embryo. These perish, which also leads to the death of the embryonic tissue. The body then breaks down the dead material. Methotrexate is given either intravenously or intramuscularly. It is also possible to inject the drug directly into the pregnancy tissue. The choice of method depends in principle on the patient's condition. In principle, an MTX treatment can only be carried out if the ectopic pregnancy was discovered before symptoms occurred, the embryo and the surrounding tissue are smaller than four centimeters and the concentration of the pregnancy hormone HCG is below a certain threshold value.
With the drug therapy with MTX, the fallopian tube is not injured, as with the operation. This has the advantage that there is no scarring that could promote another ectopic pregnancy. Experience shows that after MTX treatment, the majority of women trying to conceive have a normal uterine pregnancy. An ectopic pregnancy occurs again in only about 7% of the women treated with medication.
MTX is a cytotoxin that is also used in chemotherapy to treat cancer. However, side effects such as those that occur with chemotherapy are very rare, but cannot be ruled out, due to the low dosage and the short period of treatment. General fears that MTX therapy increases the risk of malformations, abortions and malignant tumors in subsequent pregnancies have been refuted by a large number of studies. However, for safety reasons, it is recommended that half a year to a full year pass after drug treatment before attempting a new pregnancy. During this time, a safe method of contraception must be chosen.
The wait-and-see approach and observing whether the pregnancy regresses is a very rare option for therapy. This is based on the fact that patients often only notice an ectopic pregnancy when there is a need for immediate action. However, a wait-and-see approach is only possible if the pregnancy is very early. The main criteria are freedom from symptoms and a low or falling HCG concentration in the blood serum.
With this procedure, the progress of the ectopic pregnancy must be checked regularly. In addition, the pregnant woman bears a great deal of personal responsibility. The possible danger that a surgical procedure may nevertheless be necessary must be clearly communicated. Therefore, with this procedure, fast inpatient admission and surgery must be guaranteed in the event of an emergency.
Author (s): äin-red
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