EXPLAIN: ECTOPIC PREGNANCY

CONTENT: LAPAROSCOPIC ECTOPIC PREGNANCY

Clinical Information:

LMP:_____________, PMP: ________________,

hCG

Major symptoms and signs:

Abnormal uterine bleeding: [[Irregular spotting, Nil, Irregular bleeding]]

Pain: [[Persistent, Cramping, Dull]][[LLQ pain, RLQ pain, Mid-lower abdominal pain, diffuse abdominal pain, periumbilical pain, Flank soreness, Low back pain, with radiation to leg]

With abdominal [[tenderness, rebound pain, muscle guardness]]

Sonography:

Uterus: {{AVF, RVF}}, {{Normal size, There are/is _____ myomata measuring up to _____ cm, Adenomyosis measuring up to ______cm.}}

Right adnexa: {{Normal size, mass measuring up to ____ cm}}

Left adnexa: {{Normal size, mass measuring up to ____ cm]]

CDS: [[Free, Echolucent fluid, Heteroechoic amorphous mass]]

Culdocentesis: {{Nil, dry tapping, uncoagulated blood, Sero-sanguineous fluid}}

Operative Procedures:

Type of operation: Laparoscopic {{salpingectomy, salpingotomy, salpingostomy}}

+ Chromotubation + D&C + Lysis of adhesion,

The patient was placed in the dorsal lithotomy position with both legs wrapped with elastic bandage. The uterine manipulator was inserted through the cervix and locked in place. The telescope was introduced through the umbilicus after establishing a pneumoperitoneum of 15 mmHg in pressure with Veress needle. And two other 5-mm accessory cannulas were placed through each lower quadrant.

The accumulated blood clots were firstly evacuated with vigorous and careful suction, until the lesion of ectopic pregnancy was identified. Then the linear salpingostomy was performed on the anti-mesosalpinx side to remove the ectopic gestational tissue, or if the ruptured tubal tissue is too fragile, the total salpingectomy was performed after the mesosalpinx was secured, coagulated, and cut. The specimen was then put into a sterile plastic bag and later removed within the bag.

The adhesion tissues were removed, and the intestine, the omentum, and the peritoneum were separated and relocated at sites as normal anatomical structures. The whole pelvis and operation sites were irrigated thoroughly to ensure the proper hemostasis.

The procedures ended with careful removal of the instruments and closure of the wounds. The patient stood the procedure well.

Operative Finding:

Internal bleeding: {{Nil, about _______ ml}}.

Ectopic pregnany: {{Right, Left}}{{ampullar, isthmic, interstitial, tubal aborted, ovarian, cornual, cervical, abdominal}} pregnancy, {{intact, ruptured}}

Uterus: {{AVF, RVF}}, {{Normal size, enlarged as GA ____ weeks size}}.

Right ovary: [[free, adhesion]] and [[grossly normal, solid mass measuring up to __ cm, cystic mass measuring up to __ cm, mass with mix component measuring up to __ cm]]

Left ovary: [[free, adhesion]] and [[grossly normal, solid mass measuring up to __ cm, cystic mass measuring up to __ cm, mass with mix component measuring up to __ cm]]

Right tubes: [[free, adhesion]] and [[grossly normal, s/p ATS, hydorsalpinx, ectopic pregnancy]]

Left tubes: [[free, adhesion]] and [[grossly normal, s/p ATS, hydorsalpinx, ectopic pregnancy]]

Cul-de-sac: [[free, membranous adhesion, partially obliterated, total obliteration, _____________]]

Adhesion: among/between [[uterus, left adnexa, right adnexa, colon, small intestine, pelvic side wall]]

Complication: [[Massive bleeding, Bladder injury, Ureter injury, Bowel injury, __________________ ]]

Pathology:

Dr:_______________________ Date:______________________