Tubal Pregnancy

Tubal pregnancy is also known as ectopic pregnancy - a condition where the fertilized egg implants itself in the fallopian tubes or any other tissue outside of the uterus. Tubal pregnancy can be life threatening, if not attended to in time. This is because it can lead to the rupture of the pelvic organ and consequent hemorrhage. It can also affect the woman's ability to become pregnant later.

Since it is impossible to carry a tubal pregnancy to term, it becomes imperative to resort to surgery to remove the products of conception since they cannot develop into a fetus. This is done without damage to fallopian tubes, as far as possible. This can be done with laparoscopy in non-emergency situations. Tubal pregnancy can happen to any woman but there are some causes that can increase the likelihood of such a pregnancy condition. Some of the causes for tubal pregnancy are: Pelvic Inflammatory Disease, endometriosis or tubal scarring. Infection of the fallopian tubes such as gonorrhea or chlamydia can lead to a tubal pregnancy. The risk of ectopic pregnancy is manifold in cases of pregnancy after tubal sterilization. The use of the 'morning after pill' - emergency contraception is often noticed as a cause for tubal pregnancy.

An ectopic pregnancy is usually detected in the first 5 - 10 weeks of pregnancy. Ultrasound tests and hCG levels in the blood can help in identifying an ectopic pregnancy. The rate of increase of hCG in the blood is much slower in the case of an ectopic pregnancy or a potential miscarriage. Lower progesterone levels can also be an indication of likely tubal pregnancy. A woman having a tubal pregnancy will experience lower abdominal pain with cramping. There may be abnormal vaginal bleeding and breast tenderness. Lower back pain is another symptom. Severe bleeding and hemorrhage is the most dangerous symptom of ectopic pregnancy and needs prompt medical attention. If there is an emergency situation, there may be a need for blood transfusion.

Tubal Reconstructive Surgery

Tubal reconstructive surgery is performed to reconstruct the fallopian tubes which are obstructed or tied intentionally. This procedure helps in restoring the normal functioning of the fallopian tubes. Fallopian tubes play an important role in the reproduction process. The matured egg released by the ovary travels through the tube and converges with the sperm to facilitate fertilization. The fertilized egg gets implanted in the uterus to form the embryo. Sometimes the tubes may get blocked due to scar tissue caused by a pelvic infection, endometriosis, or pelvic surgery. When there is an obstruction, the egg cannot reach uterus nor can the sperm meet the egg causing infertility. Tubal reconstruction is a surgical method performed to repair the Fallopian tubes and thereby improving the chances of conception.

Tubal reconstructive surgery is also considered by those women who have undergone sterilization via tubal ligation earlier, but would want to reverse it now for personal reasons. Surgical techniques to reconstruct the fallopian tubes are aimed at achieving patency without harming the tubal anatomy. Hence microsurgical technique is the most preferred choice in conducting the tubal reconstructive surgery.

HSG (hysterosalpingogram) test is performed prior to surgery to evaluate the abnormalities inside the fallopian tubes. HSG Test will reveal the presence of blockage in the fallopian tubes.

Laparoscopic procedure is performed with micro instruments; it is minimally invasive, causes fewer traumas and relatively requires less hospital stay. Not all problems can be corrected using laparoscopy; few cases require an elaborate surgical procedure called laparotomy. Laparotomy is a procedure that involves making a large cut on the abdomen. Through Laparotomy, the surgeon can view the organs clearly, remove the blockage and join the healthy parts of the tubes. This procedure is usually adopted in case of reversal tubal ligation. The choice of the procedure depends upon various factors such as severity of the blockage, location of the obstruction and length of the Fallopian tubes.

There are three types of tubal reconstructive surgical techniques followed by the doctors to repair the Fallopian tubes. The technique chosen depends upon the nature of the problem.

Tubal anastomosis: Tubal anastomosis is a surgical procedure that is normally performed to restore the function of fallopian tubes, which have been blocked by a previous sterilization operation. It is also called tubal ligation reversal or reanastomosis. Typically, sterilization procedure would have closed the mid portion of the tube that lies between the uterus and fimbrial end. Tubal anastomosis technique removes the blocked segment of the tube and joins the two remaining open segments to make it patent.

Tubal implantation: Tubal implantation is a surgical technique that is opted when the blockage is detected at the proximal end (where the Fallopian tube and uterus join). In such cases a new opening will be created in the uterus and a healthy portion of the tube will be inserted into the uterine cavity.

Salpingostomy: Salpingostomy is used in case of distal tubal occlusion, an obstruction near fimbrial end or near ovaries. Salpingostomy involves creating an opening into the Fallopian tube surgically. Salpingostomy is also effective for treatment of hydrosalpinges, a condition where fluid builds up in the tubes leading to an occlusion. Through salpingostomy, excess fluid can be drained and tubes can be cleared to allow normal functioning. Sometimes the problem may occur in the fimbrial region, an end portion of the Fallopian tube that is responsible for sweeping the egg into tube. In such cases fimbria is reconstructed through a surgery called fimbrioplasty.

Tubal reconstructive surgery success rates

The degree of success from surgery will depend upon the extent of tubal damage. Surgery works very well, if the adhesions are small and thin. However with dense adhesions the chances of pregnancy become remote. Age is an important factor that is taken into consideration before proceeding with surgery. Women below 35 years of age have fair chances of becoming pregnant within an year of tubal surgery.

Those who fail to conceive through tubal reconstructive surgery, or, are not right candidates for a surgery are advised to chose an alternative method called IVF or other assisted reproductive techniques.

Risks associated with tubal surgery

The biggest risk associated with tubal surgery is the possibility of developing ectopic pregnancy (tubal pregnancy). Tubal pregnancy is a serious issue and may prove fatal to the mother and hence should be removed as early as possible. Other risks include infection, bleeding, trauma to adjoining organs and also the risk associated with anaesthesia.