Abstract

PIP: Tubal abortion is the term used when an intact, viable pregnancy is surgically removed during an operative intervention in an ectopic pregnancy. Tubal abortion can follow several courses: resorption of the products of conception; intraluminal extension with expulsion of gestational products; and perforation and rupture into the peritoneal cavity. Spontaneous resorption occurs with very early embryonic death, and is usually symptomless and undiagnosed. Such spontaneously regressing tubal pregnancies are more easily detected with today's more sensitive and refined diagnostic capabilities that have detected previously unsuspected tubal pregnancies. Intraluminal extension results in hemorrhage and expulsion of the gestational products into the tubal lumen, but terminology about this is unclear. If the ovum remains attached to the implantation site, the term incomplete tubal abortion should be used. If the ovum completely separates from the tubal wall and is expelled, it should be termed complete tubal abortion. Stringent pathologic criteria are used for the diagnosis of tubal abortion, and earlier diagnosis and management have led to a decrease in the percentage of ruptured tubal pregnancy. Clinical presentation of tubal abortion includes symptoms of colicky pain, nausea, vomiting, faintness, and signs of peritoneal irritation and shock. In the past, salpingectomy was the treatment of choice for tubal abortions, but conservative techniques can be used to preserve the tube, depending on factors such as the state of the tube, stage of the abortion, and degree of associated bleeding. The method chosen can affect fertility after tubal abortion, although unruptured tubal pregnancies carry a more favorable prognosis for future fertility than do ruptured tubal pregnancies. Fimbrial evacuation, a conservative technique, is one of the least used intervention methods, but the data about later complications are controversial. BhCG levels may serve to determine whether fimbrial evacuation should be used. More experience and proper patient selection is needed before more definite recommendations can be made.