This video is of laparoscopic wedge resection of an 11/40 pregnancy with a single embryo in the right interstitium of the uterus with haemoperitoneum. 

The background history is of a 31 year old woman G4P2, referred for a tertiary level Ultrasound scan when previous Ultrasound reported a uterine pregnancy with an unusual position. She had a history of sudden onset severe lower abdominal pain with unknown LMP and no PV bleeding.

Her background history includes two normal vaginal births and a right salpingectomy due to right tubal ectopic pregnancy. She had no other significant medical or surgical history.

Upon Presentation, she was noted to have a tender abdomen with rebound tenderness. Her Haemoglobin dropped from 135 to 91. On Ultrasound, she had Endometrial thickness of 18mm, 500mls of free fluid in the pelvis, and a gestational sac with an embryo CRL 44mm with a fetal Heart rate of 180 bpm in the right cornua of the uterus consistent with interstitial pregnancy at the sight of previous salpingectomy.

She subsequently underwent emergency laparoscopy. At laparoscopy haemoperitoneum and bleeding right cornual ectopic noted. Using monopolar and bipolar energy modality, a wedge resection was performed and the sac removed. Haemostasis was achieved with bipolar to the base. Myometrium repaired using two layer closure with interrupted vicryl sutures to first deep layer and continuous V-Lock suture to second layer layer. Estimated Blood loss was 1800mls. A drain was inserted and patient received three units of packed red blood cells.

Her haemoglobin on day 1 post-operatively was 101, her drain and IDC were removed and she made a good recovery and was discharged on day 2 post- operatively. She was followed up in the gynaecology clinic, counselled regarding future pregnancy management and had an implanon device inserted for contraception.

Of all ectopic pregnancies, almost 95% of pregnancies are implanted in the various segments of the fallopian tubes, 2.1% of extra-tubal ectopics are found to occur in the cornua of the uterus. Cornual pregnancy is often misdiagnossd as an intrauterine pregnancy because its implantation site is so close to the uterine cavity. Management ranges from conservative, medical or surgical. The implications for future pregnancies, subsequent mode of delivery, and surgical technique are also explored.