Risk factors for conversion to laparotomy during laparoscopic management of an ectopic pregnancy

Objective: To identify risk factors for conversion to laparotomy during laparoscopic management of ectopic pregnancy. Methods: A retrospective chart review of patients who underwent laparoscopy for treatment of ectopic pregnancy, during a 32-month period (6/1999–2/2002), at the University of Miami Jackson Memorial Hospital. We identified 229 patients; 201 had a successful laparoscopy (non-converted group) and 28 who were converted to laparotomy (converted group).Variables analyzed between the two groups were demographic data, patient-related risk factors available to the surgeon prior to the surgery (previous laparotomy, previous laparoscopy, history of PID, history of endometriosis, diameter of ectopic pregnancy as measured by ultrasound, amount of free fluid on ultrasound, BMI), and surgeons’ experience. Results: Out of the 229 laparoscopies, 28 were converted to laparotomy (12.2%). The rate of conversion was significantly higher for less experienced compared to experienced surgeon (OR=6.1, 95% CI=2.35–15.88). Significantly more women had a BMI>30 kg/m² in the converted group compared to the non-converted group (42% vs. 14%; OR=4.28, 95% CI=1.7–10.75) and the converted group had significantly higher rate of large free fluid reported on ultrasound compared to the non-converted group (21.42% vs. 7.46%; OR =3.38, 95% CI=1.04–10.61). Conclusion: Less experienced surgeon, BMI>30 kg/m², and large amount of free fluid on ultrasound increase the risk of conversion to laparotomy during laparoscopic management of ectopic pregnancy.