Laparoscopic Management of Atypical Presentation of Ectopic Pregnancy

Objective: Analysis of management in 22 ectopic pregnancies clinically presented as an atypical form. Patients and Methods: Twenty two patients with suspected ectopic pregnancy were successfully managed laparoscopically during three years period at Victory Nursing and infertility management centre, Khulna, Bangladesh. Results: All patients had dull ache pain in lower abdomen or any one of the iliac fossa. All cases were hemodynamically stable and ambulatory. Ultrasonography findings were complex Heterogeneous mass without any free fluid in 8 cases, definitive gestational sac in 6, and sac like structure in 8 cases. Urinary ß–hCG was positive in 40.9% and negative in 59% cases. Pre-operative diagnoses were chronic ectopic pregnancy in 11, ruptured corpus luteum in six and chocolate cyst in five cases. Operating diagnosis were chronic ectopic pregnancy 14, unruptured tubal and cornual pregnancy 5, ovarian ectopic in three cases. Surgical procedures were salpingostomy, salpingectomy, salpingo-ophrectomy, partial ovarian resection and only sac removal with peritoneal toileting. Operating time was 30–120 minutes. The average postoperative stay was 24–48 hours without any complications. Conclusion: Unruptured early ectopic may present with minimal symptomotology. Hence in all women of child bearing age the provisional diagnosis of ectopic pregnancy may be kept in mind while examining and investigating a patient.