Purse-string suture technique to enable laparoscopic management of the interstitial gestation of a heterotopic pregnancy

Objective: To describe the laparoscopic management of an interstitial gestation of a heterotopic pregnancy. Design: Case report and technique description. Setting: Tertiary-level private practice. Patient(s): Woman with a 6-week gestation spontaneous heterotopic twin pregnancy: one twin intrauterine, one interstitial. Intervention(s): A purse-string suture was applied to the proximal portion of the interstitial heterotopic pregnancy. Main Outcome Measure(s): To enable a cornual resection to be performed with minimal bleeding and without recourse to laparotomy. Result(s): At 8 weeks gestation an ultrasound scan confirmed a viable singleton intrauterine pregnancy, but a scan at 12 weeks showed a missed miscarriage. Conclusion(s): The embedding of the suture into the uterine serosa prevents slipping of the ligature that could occur with a pretied loop. (Fertil Steril (R) 2011;95:261-3. (C) 2011 by American Society for Reproductive Medicine.)