Laparoscopic Management of a Ruptured Interstitial Ectopic Pregnancy

Abstract

Video Objective We demonstrate laparoscopic management of an interstitial ectopic pregnancy with ongoing rupture and describe different techniques for hemostasis. Setting The patient was a 40 year old G6P2032 found to have a live 10 week interstitial ectopic pregnancy on ultrasound. She had no symptoms or free fluid at the time of diagnosis, and at the start of the surgery had evidence of hemoperitoneum with ongoing rupture. Interventions We performed a laparoscopic cornual resection and repair using vasopressin, a harmonic scalpel and bipolar device, and multilayer closure with barbed suture. We describe additional methods for hemostasis including a purse string suture and lateral control of the uterine vessels. Conclusion With a hemodynamically stable patient, ruptured interstitial pregnancy can be managed laparoscopically. Many techniques can help decrease blood loss including using vasopressin, surgical energy devices, compression around the base of the ectopic, and lateral control of the uterine vessels.