Suture Hemostasis - Conservative Management of Ectopic Pregnancy

Study Objective The conservation of fertility in spite of recurrent ectopic pregnancy in women who want to continue to have children. This procedure will allow for the regeneration of the tubal structure which will make future pregnancies possible and affordable when compared to other methods such as in vitro fertilization. Design Case Study, early first trimester diagnosis of ectopic pregnancy which includes ultrasound and serial serum B-hCG levels will lead to medical or surgical management of the ectopic pregnancy. Setting Hospital, operating room. Patients or Participants Case Study 28-yo Gravida 4 Para 2 with a previous salpingectomy for and ectopic gestation presents with a recurrent ectopic in her remaining fallopian tube and had failed medical management with methotrexate. She was offered conservative surgical management with suture hemostasis. Interventions At laparotomy (in this case) or laparoscopy the ectopic site was identified in the fallopian tube. Overlapping vicryl rapide sutures were placed proximal to the ectopic site and distal to it. An anterolateral incision was made in the ectopic site with removal of the products of conception. The site remained blood less, hemostasis of the surgical site was noted, peritoneal lavage performed and the abdomen closed in layers. Measurements and Main Results 1. Hemostatic suture placement. 2. Removal of the products of conception and confirmation of same on histopathology. 3. Hemostasis of the surgical site. 4. Confirmation of a tubal patency by a successful intrauterine pregnancy. Conclusion Suture hemostasis must be an option in ectopic pregnancy whether primary or recurrent since the method is cost effective and tubal patency can be confirmed in the post operative recovery phase. It allows for an additional conservative surgical option when hemostasis may be difficult using linear salpingostomy for larger ectopics leading to an unfortunate salpingectomy. A more extensive case series is recommended to further advance the technique and to note its potential benefits and drawbacks.