A young lady with 6 weeks amenorrhea had nausea and vomiting with severe abdominal pain. Her BP was 100/80 mm Hg. Examination revealed a 5 x 5 cm adnexal mass. What is the plan of management?
Ans: A. Plan for immediate laparoscopic surgery (Ref: Dutta 8/e. p215, 7/e p180-182; 24/e p3855Here adnexal mass size is 5 x 5 cm - Hence expectant management cannot be done.Patient is hemodynamically stable - Hence laparoscopic surgery is management of choice.Ectopic Pregnancy - Treatment:Laparoscopy:Preferred surgical treatment for ectopic pregnancy, unless hemodynamically unstable.Salpingostomy:Procedure of choice hemodynamically stable patient.Recommended surgical procedure for ampullary ectopic pregnancy.Retains feility.Salpingotomy: Not done nowadaysSegmental resection & anastomosis: Done in isthmic pregnancyFimbrial expression: Done in distal ampullary pregnancy.
Plan for immediate laparoscopic surgery
beta-hCG
Methotrexate
Give IV fluids, keep NPO and observe for 4-5 days