[Diagnostic and therapeutic interventions in extrauterine pregnancy]

Between 1969 and 1985 surgery was performed in 456 cases of extrauterine pregnancy (EUP) at Tübingen University Gynecological Clinic. The average number of such operations performed annually rose from 11 in the first six years to 61 in the last three years. As a result of early detection and treatment of EUP, tubal ruptures and severe intraabdominal hemorrhages have become increasingly rare. In the last six years, blood transfusions were only necessary in 6% of the patients who underwent surgery. In 28% no blood at all was found in the abdomen at surgery. For this reason, puncture of the pouch of Douglas was increasingly--and finally completely--supplanted by laparoscopy. Up to 1977 the affected tube was always removed; subsequently it was ever more frequently preserved. From 1983 to 1985 preservation of the tube was already being requested by 83% of the patients and it was possible to achieve this in 90% of them. In a total of 202 patients in whom the affected tube was preserved the following surgical procedures were employed: salpingotomies in 61%, salpingostomies in 4%, segmental resections with and without anastomoses in 22%, and expression or removal of a tubal abortion in 10%. The principal complications were continued growth of the tubal pregnancy following expression and salpingotomy in one case each, and occurrence of a hematosalpinx with the tentative diagnosis of continued pregnancy. Therefore, it is imperative to check the drop in the beta-HCG level after procedures in which the tube is preserved.