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Ectopic Pregnancy Implanted Over the Uterine Artery Venu Jain, MD, PhD Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB

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30-year-old woman, gravida 7, para 5, presented in hypotensive shock at 6 weeks’ gestation with a rising serum β-hCG, having had an ultrasound examination on the previous day showing no intrauterine gestational sac. After stabilization, she underwent laparoscopy for a presumed ectopic pregnancy. At laparoscopy, an area with ongoing bleeding was identified adjacent to the lower left side of the uterus (Figure 1, arrow). Chorionic villi were visible (Figure 2, arrows). A biopsy specimen was taken for pathological evaluation.

Placement of an O’Leary-type stitch1 above and below the lesion resulted in hemostasis. The histology of the biopsy confirmed an ectopic pregnancy. Consent to publish these images was obtained from the patient. REFERENCES 1. O’Leary JL, O’Leary JA. Uterine artery ligation in the control of intractable postpartum hemorrhage. Am J Obstet Gynecol 1966;94(7):920–4.

Superficial cautery of the area did not stop the bleeding. Because of the proximity of the uterine artery, a minilaparotomy was performed. Palpation confirmed an ectopic pregnancy implanted over the left ascending uterine artery.

J Obstet Gynaecol Can 2013;35(10):875

Figure 1.

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OCTOBER JOGC OCTOBRE 2013 l 875

Ectopic pregnancy implanted over the uterine artery.

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