Which one of the following is the procedure of choice when un-ruptured tubal pregnancy is found in women who want to preserve their fertility?

1. A

   Hysterectomy

2. B

   Oophorectomy

3. C

   Salpingectomy

4. D

   Linear Salpingostomy

Appeared in: NVS Staff Nurse - 2022

Explanation

• Linear salpingostomy is a conservative surgical procedure specifically designed to treat an unruptured tubal pregnancy while preserving the fallopian tube.
• The procedure involves making a small incision over the ectopic pregnancy, removing the tissue, and allowing the tube to heal.
• This approach is prioritized for women who wish to maintain their fertility, as it keeps the fallopian tube intact for potential future pregnancies.
• It is the treatment of choice when the patient is hemodynamically stable, the ectopic pregnancy is small, and there is a strong desire for future childbearing.

Why Other Options Were Wrong

• Option A: Hysterectomy is the removal of the uterus. It is not a treatment for a pregnancy located in the fallopian tube and would result in permanent sterility, which is directly against the patient's wish to preserve fertility.
• Option B: Oophorectomy is the removal of an ovary. A tubal pregnancy is located in the fallopian tube, not the ovary. Therefore, removing an ovary would not address the ectopic pregnancy.
• Option C: Salpingectomy, the removal of the entire fallopian tube, is a definitive treatment for ectopic pregnancy but is not the procedure of choice when fertility preservation is the primary goal for an unruptured tube. It removes the tube, thereby reducing fertility potential.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Surgical management of unruptured ectopic pregnancy with fertility preservation as background academic context rather than a clinical decision trigger.
• The choice between salpingostomy and salpingectomy is a critical clinical decision that balances the immediate resolution of the ectopic pregnancy with the patient's long-term fertility goals.
• Nurses play a vital role in ensuring the patient understands the options, risks, and benefits, including the need for diligent post-operative follow-up (beta-hCG monitoring) after a salpingostomy to rule out persistent trophoblastic disease.
• What if the patient's tubal pregnancy had ruptured? In that case, the priority shifts from fertility preservation to controlling life-threatening hemorrhage. A salpingectomy would become the emergent procedure of choice to remove the source of bleeding and the damaged tube.

How to Approach the Question

• First, identify the core components of the clinical scenario presented in the question stem.
• Note the diagnosis: 'un-ruptured tubal pregnancy'. This indicates the situation is likely stable and not a dire emergency.
• Identify the patient's primary goal: 'to preserve their fertility'. This is the most important clue for selecting the correct procedure.
• Evaluate each option based on its definition and its impact on fertility.
• Hysterectomy (removes uterus) and Oophorectomy (removes ovary) target the wrong organs for a tubal pregnancy.
• Compare Salpingectomy (removes the tube) and Salpingostomy (incises and repairs the tube).

Concept Tested & Keywords

• Concept Tested: Surgical management of unruptured ectopic pregnancy with fertility preservation.
• Stem keywords: un-ruptured tubal pregnancy, preserve fertility, procedure of choice
• Lead-in keywords: Which one
• Clinical cues: Patient's desire to preserve fertility is a key factor in treatment selection.

Question ID

Qew8z3mQRbF0BXp2ySfUrR

Copy ID

Reference Book

E6 Gynecology Williams pp. 180-216, 141-171

E6 Obstetrics Williams p. 22-41