Conservative management of ectopic pregnancy

Authors: O. Sizzi, A. Rossetti

The ectopic pregnancy is a possible life threatening condition.
Only if the beta-HCG level is below 5000 IU and the increase of the beta-HCG has not been not very quick it is possible to perform a conservative treatment, otherwise the salpingectomy is the better choice.

The case shown in the video is the one of a patient with a left not ruptured ectopic pregnancy, with a minimal emoperitoneum. A linear salpingotomy was programmed. We injected a diluted solution of vasopressin (20 UI in 400 cc of saline) in the broad ligament close to the ectopic pregnancy. A little incision on the antimesenteric aspect of the tube in carried out, preferably at level of the medial portion of the lesion because that is the real site of the ectopic pregnancy. In the more distal part there are just blood clots.

A suction-irrigation cannula in inserted inside the incision. A washing with saline under high pressure is the correct way to do a hydro-dissection of the gestational sac from the tube.

Eventually the hemostasis and the integrity of the tube are thoroughly checked.