**7.2.4 Serum hCG clearance**

244 Ectopic Pregnancy – Modern Diagnosis and Management

cover the cornual resection site aiming to reduce post operative adhesions and to facilitate the closure of resection site especially when large size ectopics are removed. (Api M& Api

No clear data is available to compare risks of subsequent ectopic and the chances of persistent trophoblastic disease after cornual resection versus cornuotomy. Preservation of fertility following these surgical techniques has been confirmed. However, there is an expected reduction in chances of conception due to loss of the function of that tube. Future pregnancy is usually ending by a caesarean section due to the risk of uterine rupture.

Uterine artery ligation may help to conserve the uterus in ruptued corneal ectopic as it can aid the homeostasis if conservative surgery attempted via open approach (Khawaja N et al,

Laparotomy is preferred in hemodynamically unstable patients with signs and symptoms of hypovolaemic shock. Senior operator is necessary in such situation where the bleeding might be sever and life threatening because of the enormous blood supply to the uterine cornue especially when the gestation is advanced at time of ectopic rupture. (Grimbizis GF

Laparoscopic approach is preferred over the laparotomy for unruptured cases provided a skilled laparoscopic surgeon is available. (Hill GA et al, 1989; Grobman WA& MP Milad , 1998) Laparoscopic approach is associated with less intra-operative bleeding, less post operative pain and analgesia requirement, shorter hospital stay and fewer post operative

No clear data available to compare chances of having a subsequent intrauterine pregnancy between the open versus the laparoscopic approaches for cornual ectopics however the

In the last decade, trans-cervical approach for the treatment of cornual ectopic has been advocated. The cornual ectopic is disturbed under hyteroscopic, laparoscopic or even

It avoids extensive surgery and can be useful for women who are reluctant to undergo medical treatment with Methorexate or in whom this treatment failed.(Pal B et al, 2003) The approach involves identification and disturbance of ectopic sac through a vaginal approach using a curette. The products of conception then removed using polyp forceps or a suction curette. (Minelli L et al, 2003; MeyerWR& Mitchell DE, 1989; Sanz LE& Verosko J, 2002) The use of laparoscopic or ultrasonic guidance is recommended due to the high risk of perforation. (Marian Morgan et al, 2009) Also this approach is not aimed at evacuation of all the product of conception as this could be associated with perforation. It is only aiming at disturbing the pregnancy and removing some of the product safely. (Marian Morgan et al, 2009) Therefore, follow-up is essential to ensure complete resolution of the pregnancy. In severe bleeding, laparoscopic local injection of vasopressin may reduce intraoperative

This approach is simple and associated with less morbidity than abdominal approach. It is associated with less bleeding as the myometrium remained undisturbed, rapid recovery and

a shorter post-operative stay resulting in financial and psychological benefits.

O, 2010; MacRae R et al, 2009; Tinelli A et al, 2010; Moon HS et al, 2000).

**7.2.2 Open approach versus laparscopic approach** 

adhesions. (Royal College of Obstetricians and Gynaecologists, 2004)

latter is though to be possibly associated with less risk of recurrent ectopics.

(Lindheim SR et al, 2006)

**7.2.3 Vaginal approach** 

bleeding. (Pal B et al, 2003)

ultrasound guidance. (Thakur Y et al, 2004)

2005).

et al, 2004)

Serial serum hCG should be measured after any conservative surgical treatment of corneal ectopic to ensure complete resolution. The duration of the monitoring is of little significant but a declining titre is essential and needs monitoring at intervals till resolution. (Kamrava MM et al, 1983)
