Surgery Day: Pelvic Pain After Ectopic

Dr. Wilshire discusses surgery for pelvic pain after an ectopic pregnancy.

​Hello. This is Dr. Wilshire of Missouri Fertility in Columbia, Missouri. Today is obviously a Surgery Day.  We have a very interesting case today. Our patient is a young woman who, several months ago, had an ectopic pregnancy. It appears to have been on the right side.  Ectopic pregnancies are pregnancies that occur in the body, but outside of the uterus. These can be life-threatening. They are deadly. Nowadays, we can treat them with medicine rather than with surgery most of the time. So, she had her ectopic pregnancy about six months ago. It was treated medically, and she recovered from the pregnancy. Her pregnancy hormone levels are now zero—but now she has pain in her pelvis, and this strongly suggests that she has scar tissue from where this pregnancy used to be. Now, 97% of ectopic pregnancies are in the tube, and almost all of them are around the tube, so we can expect a lot of scar tissue around this tube. We need to evaluate the tube and get her out of pain; these are both very important goals. and we should be able to accomplish both. Of course, some very difficult decision making will need to be made, however—do we save this right tube, can we open it, can we free it of scar tissue, and can we get rid of the issues that might be causing her pain? That's the situation, and that's why we need to go inside. Hopefully, the left tube is open and looks really good. The right tube, however, will almost certainly have scar tissue around it. Now, if we take the right tube out, then she will be forced to use only the one remaining tube to become pregnant. If we leave it in and it is open, then she is at higher risk for having another ectopic pregnancy in this tube.  The risk is at least 6% and probably closer to a 25% chance of having another ectopic in that tube. She is aware of this and so is her family. This is a good example of how we can improve anatomy, but we can't make everything perfect again. So, we're going to do the surgery, hopefully help her out, and hopefully not have to make too many difficult decisions. This is Dr. Wilshire of Missouri Fertility. Have a nice day.