Ectopic pregnancy in the abdominal cavity should be treated promptly with surgery

After the diagnosis of ectopic pregnancy in the abdominal cavity is confirmed, the fetus should be removed by cesarean section. The handling of the placenta should be particularly cautious, and the decision should be made based on its attachment site, fetal survival, and the duration of death.

Treatment principles

Abdominal ectopic pregnancy may cause infection, abscess and sinus tract due to the presence of pregnancy products. Once the diagnosis is confirmed, surgical treatment should be considered. The key to surgery is the treatment of the placenta. If it is not handled properly, massive bleeding and organ damage may occur on the surface where the placenta is attached. During surgery, the treatment method should be determined based on the site of placental attachment, whether the fetus has died and the length of time since death. If the placenta is attached to the uterus, fallopian tube or broad ligament, the placenta can be removed together with the attached organs.

The dangers of delayed surgery

If the fetus is not removed surgically, the following may occur:

Fetal bones remain and soft tissues are absorbed;

Formation of adipocere;

Formation of lithotripsy or calcification;

Fetal tissue infection, necrosis, and abscess formation;

If fetal tissue remains in the abdominal cavity for a long time, it can penetrate into the bladder and rectum and be discharged, forming abdominal fistulas, etc.

Methotrexate

The use of methotrexate can destroy the remaining placenta. Its mechanism of action is that methotrexate can destroy the trophoblastic tissue, reduce the blood supply of the placenta, and promote its degeneration and necrosis. Human chorionic gonadotropin can be reduced to normal levels. The disadvantage is that the destroyed placental tissue left in the abdominal cavity is a good bacterial culture medium, which may cause complications such as peritonitis, abdominal wall wound rupture, pelvic abscess, sepsis, etc., and even cause death in severe cases. In cases where methotrexate is not used, although the placenta is absorbed more slowly and the patient's recovery period is delayed, there are fewer complications.