Welcome to the Ectopic Pregnancy Module. This ALL-SAFE module will allow surgeons to become confident and competent in the laparoscopic management of ectopic pregnancy.

Why Ectopic Pregnancy?[edit | edit source]

We began our journey with addressing the laparoscopic treatment of ectopic pregnancy in a resource-constrained setting. We found the disparity in the care of surgically-treatable conditions is epitomized by the treatment and clinical course of ectopic pregnancy throughout the world.

Ectopic pregnancy occurs in 1-2% of pregnancies worldwide and is the leading cause of maternal death in the first trimester. The prevalence of ectopic pregnancy is higher in sub-Saharan Africa, ranging from 2-4%, with a maternal mortality rate between 1-2%, 10-fold higher than in high-income countries.[1] Ectopic pregnancy is a significant contributor to the obstetrical morbidity and mortality in sub-Saharan Africa, which are the highest in the world.[2]

In high-income countries, stable patients without rupture are treated with laparoscopic salpingectomy or salpingostomy or methotrexate administration.[3][4][5][6] However, in sub-Saharan Africa, patients, regardless of their hemodynamic status, are approached through laparotomy, a procedure with significant morbidity, starkly highlighting the treatment disparity.

Laparoscopic management of ectopic pregnancy has been shown to have significantly shorter operation time, perioperative blood loss, length of stay, and convalescence time compared to its open counterpart. [4][7] The lack of trainers, training equipment, and simulation – not cost or lack of equipment - has been identified as the greatest barrier towards the implementation of laparoscopy.[8]

Because of the potential to decrease morbidity and mortality for women who are critical to the success and vitality of nations, we chose to develop a module to teach the laparoscopic treatment of ectopic pregnancy. With ALL-SAFE, our goal is learners will become competent and confident in performing all aspects of patient care in the laparoscopic treatment of ectopic pregnancy.

References[edit | edit source]

  1. Goyaux N, Leke R, Keita N, Thonneau P. Ectopic pregnancy in African developing countries. Acta Obstetricia et Gynecologica Scandinavica. 2003;82(4):305-312. doi:10.1034/j.1600-0412.2003.00175.x
  2. Onibokun O, Boatin A, Diouf K. The Role of Minimally Invasive Gynecologic Surgery in Sub Saharan Africa. Curr Obstet Gynecol Rep. 2016;5(4):333-340. doi:10.1007/s13669-016-0184-9
  3. ACOG Practice Bulletin No. 191: Tubal Ectopic Pregnancy. Obstetrics & Gynecology. 2018;131(2):e65. doi:10.1097/AOG.0000000000002464
  4. 4.0 4.1 Hajenius PJ, Mol F, Mol BWJ, Bossuyt PM, Ankum WM, Veen FV der. Interventions for tubal ectopic pregnancy. Cochrane Database of Systematic Reviews. 2007;(1). doi:10.1002/14651858.CD000324.pub2
  5. Barnhart KT. Ectopic Pregnancy. New England Journal of Medicine. 2009;361(4):379-387. doi:10.1056/NEJMcp0810384
  6. D’Hooghe T, Tomassetti C. Surgery for ectopic pregnancy: making the right choice. The Lancet. 2014;383(9927):1444-1445. doi:10.1016/S0140-6736(14)60129-X
  7. Saleh AM, Mahjoub MM, El-Kurdy AM. Laparoscopy versus laparotomy management of tubal pregnancy. Saudi Med J. 2001;22(9):771-775.
  8. Robertson F, Mutabazi Z, Kyamanywa P, et al. Laparoscopy in Rwanda: A National Assessment of Utilization, Demands, and Perceived Challenges. World J Surg. 2019;43(2):339-345. doi:10.1007/s00268-018-4797-1.

Discussion[View | Edit]

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