OT notes · Obstetrics

Laparotomy / laparoscopy for ruptured ectopic pregnancy

Usual anaesthesia
General anaesthesia
Position
Supine; lithotomy (legs in stirrups) for laparoscopy if a uterine manipulator is used
Setting
emergency

Operative note template for laparotomy or laparoscopy for a ruptured tubal ectopic pregnancy, with a filled example for an emergency laparotomy and right salpingectomy in a woman in shock.

Download printable PDFFree. Just log in with your Google (Gmail) account.

Blank template

Follow this order in the case sheet. Tick the options that apply and fill the blanks.

Patient and case

  1. Name / Age / Sex
  2. UHID / IP no. / Ward-Bed
  3. Date of surgery / OT no.
  4. CaseElectiveEmergency (non-elective)if emergency, state urgency and reason
  5. Timesin OT ___ anaesthesia start ___ incision ___ closure ___ out of OT ___

Team

  1. Operating surgeonname, designation
  2. Assistant(s)
  3. Supervising consultantpresent in OT / available / not applicable
  4. Steps done by the residentwhole procedure / named steps, under whose supervision
  5. Anaesthetist
  6. Scrub nurse / circulating nurse

Diagnosis and procedure

  1. Pre-operative diagnosis
  2. Post-operative diagnosis
  3. Procedure planned
  4. Procedure performedif different from plan, state why
  5. Extra procedure done and reason'none' if none. Only to save life or health if not consented

Consent and safety checks

  1. Informed consentGeneralProcedure-specificHigh-riskAnaesthesiain a language the patient understands: language ___ witness ___
  2. Site / side markedYesNot applicable
  3. WHO Surgical Safety ChecklistSign inTime outSign out
  4. Antibiotic prophylaxisdrug, dose, route, time given before incision
  5. VTE prophylaxisMechanicalPharmacologicalNot indicated

Risks to explain in the consent for this operation

  • bleeding and blood transfusion
  • removal of the affected tube
  • removal of the ovary if it cannot be saved (rare)
  • persistent pregnancy tissue needing methotrexate or further surgery (after salpingostomy)
  • conversion from laparoscopy to laparotomy
  • injury to bowel, bladder or blood vessels
  • future ectopic pregnancy and reduced fertility
  • wound infection and thromboembolism

Pre-operative details for this operation

  1. Presentationamenorrhoea duration, pain, syncope, shoulder tip pain, vaginal bleeding
  2. Haemodynamic statuspulse, BP, shock index, signs of peritonism
  3. Urine / serum hCGresult and value with date
  4. Ultrasoundno intrauterine sac, adnexal mass side and size, free fluid in pouch of Douglas / Morison's pouch
  5. BloodHb, blood group and Rh type, units cross-matched and given
  6. Fertility wishes and contralateral tube status (if known)decides salpingectomy vs salpingostomy
  7. Previous ectopic or tubal surgery / sterilisation
  8. Consentinclude salpingectomy, possible laparotomy, blood transfusion; tubal sterilisation only with separate consent

Anaesthesia and position

  1. AnaesthesiaGeneral
  2. ApproachLaparoscopyLaparotomyMinilaparotomyLaparoscopy converted to laparotomyif laparotomy or converted, reason
  3. PositionSupineLithotomy
  4. BladderFoley catheterEmptied with plain catheter
  5. IV access and resuscitationtwo large-bore lines, fluids and blood given before incision

Operative findings

  1. Haemoperitoneumvolume of blood and clots removed
  2. Site of ectopicAmpullaryIsthmicFimbrialInterstitial / cornualOvarianAbdominalside
  3. StateRuptured, actively bleedingRuptured, not bleedingTubal abortionUnrupturedsize of mass
  4. Contralateral tubeHealthyDamaged / hydrosalpinxAbsent
  5. Both ovaries and uterus
  6. Adhesions / other pelvic findingsendometriosis, PID adhesions

Procedure (steps)

  1. EntryLaparoscopic portsPfannenstielLower midlineport sites and sizes / incision length
  2. Bleeding controlled firstaffected tube grasped and mesosalpinx clamped before clearing blood
  3. Blood and clots evacuatedvolume by suction and mops
  4. Procedure on tubeSalpingectomySalpingostomyPartial salpingectomyreason for choice
  5. Salpingectomy: techniquemesosalpinx divided close to the tube (clamp and tie / bipolar / pretied ligature), tube cut about 1 cm from the cornu, uterotubal junction secured, suture used
  6. Salpingostomy: techniquedilute vasopressin (dose), linear incision on antimesenteric border, products removed, tube irrigated, left open to heal
  7. Ovary preservedYesNo: reason
  8. Contralateral tube inspectednormal / abnormal
  9. Specimen removalendobag through port / delivered through incision
  10. Peritoneal toilet and haemostasisirrigation fluid, pedicles checked dry
  11. Tubal sterilisation (only if separately consented)Not doneDone: method

Closure, drains and dressing

  1. Port sites / rectus sheathsuture material and technique
  2. SkinSubcuticularInterruptedStaples
  3. DrainNonePelvic drain
  4. Urine at endvolume and colour

Specimens and implants

  1. Tube with ectopic sent for HPEside, in formalin, requisition form; ask for chorionic villi
  2. Clot / products (if salpingostomy or no clear sac)Sent for HPENot applicable

End of procedure

  1. Estimated blood lossml
  2. IV fluids and blood / products givenfluids (ml); blood: type, units, bag nos.
  3. Swab, needle and instrument countCorrectIncorrect: action taken
  4. Intra-operative complications / difficultieswhat happened and what was done; 'none' if none
  5. Implant stickersNo implantAffixed in case sheet, OT register and for discharge summary
  6. Condition at end of surgery / shifted toPACUWardICU/HDU

Post-operative orders

  1. Vitalspulse, BP every 15 min for 1 hour, then half-hourly till stable
  2. Bloodfurther transfusion, Hb after 6 to 12 h
  3. IV fluids and oral intaketype, rate; sips from when
  4. Analgesiadrug, dose, frequency
  5. Catheter removaltime
  6. Rh negative motheranti-D as per unit protocol, record dose and time
  7. Serum hCG follow-upafter salpingostomy: repeat till undetectable; after salpingectomy: as per unit plan
  8. Thromboprophylaxis and mobilisation
  9. Counsellingearly scan in next pregnancy, contraception, findings of the other tube

Signature

  1. Name and designation of person writing note
  2. Medical Council registration no.
  3. Signature / date / time of writingwrite before the patient leaves recovery

Worked example

Fictional case: Mrs. L.T., 25 years, G2P1L1, 7 weeks amenorrhoea, collapsed at home with lower abdominal pain, urine pregnancy test positive, pulse 128/min, BP 80/50 mmHg, ultrasound showing empty uterus, right adnexal mass and free fluid up to Morison's pouch.

Case details

Date: 03/10/2026. Emergency laparotomy with right salpingectomy for ruptured right tubal ectopic pregnancy. OT 1.

Seen in casualty 21:10. Decision 21:25. In OT 21:45. Skin incision 21:55. Bleeding controlled 22:00. Closure completed 22:40.

Surgeon: Dr A. (3rd-year resident, OBGY). Assistant: Dr B. Consultant Dr C. informed and present.

Anaesthetist: Dr D. Scrub nurse: Sr E.

Indication and pre-op

Indication: suspected ruptured ectopic pregnancy with haemodynamic instability. Laparotomy chosen because the patient was in shock.

Hb 7.2 g/dl. Blood group O positive. 2 units PRBC cross-matched, first unit started 21:40.

Two 16G IV lines. 1 L RL given in casualty.

One living child. Wants to keep fertility if possible. No request for sterilisation.

Consent for laparotomy, salpingectomy and blood transfusion signed by patient and husband in Marathi. WHO checklist done. Inj cefazolin 1 g IV at 21:50.

Anaesthesia and position

General anaesthesia. Supine. Foley catheter inserted, urine clear. Parts painted with povidone-iodine and draped.

Findings

About 1500 ml blood and clots in the peritoneal cavity.

Right ampullary ectopic, 3 x 2 cm, ruptured on the antimesenteric side and actively bleeding.

Left tube healthy, fimbriae normal. Both ovaries normal. Uterus bulky, soft. No adhesions.

Procedure

Pfannenstiel incision 12 cm. Right tube grasped with Babcock forceps and lifted, mesosalpinx clamped to control bleeding.

Blood and clots cleared by suction and mops.

Right salpingectomy chosen as the left tube was healthy. Mesosalpinx clamped, cut and tied in two pedicles close to the tube, keeping away from the ovarian vessels. Tube cut about 1 cm from the cornu and the uterotubal junction transfixed with polyglactin 910 (Vicryl).

Right ovary preserved. Left tube and ovary inspected: normal.

Peritoneal cavity washed with warm normal saline. Pedicles checked, dry.

Closure

Rectus sheath closed with continuous Vicryl No. 1. Skin closed with staples. No drain.

Urine 200 ml, clear.

Specimens and implants

Right fallopian tube with ectopic sent for HPE in formalin with requisition, to look for chorionic villi.

End of procedure

Blood loss: haemoperitoneum about 1500 ml plus about 100 ml during surgery. Transfused 2 units PRBC (one in casualty/OT, one during surgery).

Mop, needle and instrument count correct, confirmed by scrub nurse.

No intra-operative complications.

Shifted to HDU in stable condition. Pulse 100/min, BP 104/66 mmHg.

Post-op orders

HDU. Pulse and BP every 15 min for 1 hour, then every 30 min.

Hb after 6 hours. Transfuse further only if ordered.

IV RL at 100 ml/h. Sips of water after 6 hours.

Analgesia as per anaesthetist's chart.

Foley catheter to be removed next morning.

Rh positive: anti-D not needed.

Early mobilisation.

Explain findings to patient: right tube removed, left tube normal. Early scan to confirm location in next pregnancy.

Signature

Dr A., JR-3, OBGY. Reg. no. ________. 03/10/2026, 22:55.

Must document for this operation

  • Haemodynamic state and the reason for choosing laparotomy or laparoscopy. Laparoscopy is preferred when the surgeon is experienced, so the note must show why an open operation was done.
  • Site and state of the ectopic, and the volume of haemoperitoneum. These define the severity for maternal near-miss review and explain the transfusion.
  • Condition of the other tube. It decides the chance of future pregnancy and is the main point in counselling.
  • Whether salpingectomy or salpingostomy was done, and why. After salpingostomy persistent trophoblast is common and hCG must be followed till undetectable.
  • Ovaries preserved or not. Loss of an ovary affects hormone function and must be clearly recorded with the reason.
  • Specimen sent for HPE for chorionic villi. Histology confirms the diagnosis; if no villi are found, hCG follow-up is needed.
  • Blood group, Rh type and blood products given. An Rh negative woman needs anti-D, and transfusions must be traceable.

Common mistakes in these notes

  • Writing 'right salpingectomy done' without saying whether the other tube was seen.
  • Not recording the haemoperitoneum volume, so the EBL (estimated blood loss) looks small.
  • Doing a tubal sterilisation on the other side without separate written consent.
  • Not recording the Rh type.
  • Not writing the reason for choosing salpingostomy and the hCG follow-up plan.

Sources

  • Handa VL, Van Le L, eds. Te Linde's Operative Gynecology. 13th ed. Wolters Kluwer; 2024, Ch 20, Surgical management of ectopic pregnancy (tubal pregnancy: laparoscopy vs laparotomy, salpingectomy vs salpingostomy, Box 20.1); Ch 18, Bilateral salpingectomy (technique at laparotomy), e-book PDF pp. 1000-1018, 944-949.
  • Apuzzio JJ, Vintzileos AM, Berghella V, Alvarez-Perez JR, eds. Operative Obstetrics. 4th ed. CRC Press; 2017, Ch 30, Cesarean delivery: fascial and skin closure only (no tubal ectopic chapter in this book); Ch 31, prevention of surgical site infection, pp. 402, 423.
  • Te Linde's Operative Gynecology 13e, Ch 20 (dilute vasopressin 5 units in 20 ml normal saline into mesosalpinx for salpingostomy; prophylactic MTX within 24 h after salpingostomy and hCG till undetectable). Operative Obstetrics 4e, Ch 31, p. 423 (cefazolin 1 g).

Educational template for residents. Adapt it to your institution's case-sheet format and your consultant's instructions. Patient details in the example are fictional.

Videos of this operation

Teaching videos and pages for this operation, listed under the curriculum item that asks for it.

This page cannot be printed from the browser. Use the Download printable PDF button on the page.