OPERATIVE LAPAROSCOPY FOR MANAGEMENT OF ECTOPIC PREGNANCY IN PATIENTSWITH HYPOVOLEMIC SHOCK

Study Objective. To determine the safety of operative laparoscopy in t he management of ectopic pregnancy in women with hypovolemic shock. De sign. Retrospective chart review. Setting. University-affiliated hospi tal. Patients. Two hundred eleven women with tubal pregnancy, of whom 33 were suffering from hypovolemic shock, based on a combination of si gns and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill. Intervention. Laparoscopic surge ry. Measurements and Main Results. Mean +/- SEM intraabdominal blood l oss was significantly (p < 0.01) higher in women with hypovolemic shoc k, 1369 +/- 149 versus 114 +/- 14 ml. Blood transfusions were given to 88% and 0.5%, respectively (p < 0.01). Laparoscopic salpingectomy was performed in all hemodynamically compromised women compared with 87% of stable women. Conversion to laparotomy was required in three patien ts in the hypovolemic shock group and live in the stable group. All pa tients had an uncomplicated postoperative course and made a full recov ery. Conclusion. The availability oi optimal anesthesia and advanced c ardiovascular monitoring, and the ability to convert rapidly to laparo tomy if required, allow safe performance of operative laparoscopic sur gery in most women in hypovolemic shock. In fact, the superior exposur e of laparoscopy, providing rapid diagnosis and control of the source of bleeding, makes it a highly suitable approach.