Intramyometrial Injection of Vasopressin: A Novel Method for Hemostasis at Laparoscopic Management of Cornual Ectopic

Abstract

Study ObjectiveAlthough all ectopic pregnancies are associated with risk of hemorrhage, cornual pregnancies are feared for catastrophic hemorrhage and uncontrollable bleeding. The maternal mortality rate can be as high as 2.5%, which is 7 times higher than the mortality rate for ectopic pregnancies in general. Different techniques have been used to control hemostasis, including purse string suture, square suture, endo-loop, electrocoagulation, and devascularization. Injection of vasopressin into the uterus is a simple method that greatly reduces the blood loss at cornuostomy. DesignA step by step demonstration of the surgical procedure (Canadian Task Force classification III). SettingHospital. Patient, Interventions, Measurements and Main ResultsA 32-year-old woman, G7P3L3A3 (Gravida 7, Para 3, Living 3, Abortion 3), with 4 months of amenorrhea, was diagnosed with a cornual ectopic pregnancy. She was treated with 200 mg mifepristone and 800 μg misoprostol. She had undergone dilatation and curettage twice and was referred for persisting cornual ectopic pregnancy. At laparoscopy, 20 U injection vasopressin in 100 mL .9% normal saline was injected into the myometrium of the uterus. Incision was made over the ectopic pregnancy with ultrasonic energy and the ectopic pregnancy enucleated using suction apparatus and ultrasonic energy. Hemostasis was ensured and the bed sutured with barbed suture. Surgery duration was 1 hour, and blood loss was 200 mL. Institutional review board and ethics committee approval was obtained. ConclusionInjection of vasopressin into the uterus significantly reduces blood loss, operative time, and patient morbidity and mortality at laparoscopic cornuostomy.