Ramesh Bettaiah1, Shwetha Sudhakar Kamath2. 1. Department of Obstetrics and Gynaecology, Advanced Laparoscopy Division, Altius Hospital, Bangalore, India. 2. Department of Obstetrics and Gynaecology, Advanced Laparoscopy Division, Altius Hospital, Bangalore, India. Electronic address: drshwkam@gmail.com.
Abstract
STUDY OBJECTIVE: Although 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. DESIGN: A step by step demonstration of the surgical procedure (Canadian Task Force classification III). SETTING: Hospital. PATIENT, INTERVENTIONS, MEASUREMENTS AND MAIN RESULTS: A 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. CONCLUSION: Injection of vasopressin into the uterus significantly reduces blood loss, operative time, and patient morbidity and mortality at laparoscopic cornuostomy.
STUDY OBJECTIVE: Although 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. DESIGN: A step by step demonstration of the surgical procedure (Canadian Task Force classification III). SETTING: Hospital. PATIENT, INTERVENTIONS, MEASUREMENTS AND MAIN RESULTS: A 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. CONCLUSION: Injection of vasopressin into the uterus significantly reduces blood loss, operative time, and patient morbidity and mortality at laparoscopic cornuostomy.