Design: Educational video with narration highlighting surgical management of a cervical ectopic pregnancy with a fertility sparing approach.

Setting: Single academic center

Patients or Participants: 42 year old female who presented at 8 weeks gestation by frozen embryo transfer who was diagnosed with a cervical ectopic pregnancy by ultrasound early in her prenatal care. She failed medical treatment with a multi-dose methotrexate regimen and was transferred for consultation by the Minimally Invasive Gynecologic Surgery (MIGS) team. She was counseled and desired fertility sparing surgical management.

Interventions: The patient underwent a diagnostic laparoscopy with several interventions aimed to minimize blood loss which are emphasized in this video. A bilateral temporary uterine artery ligation with laparoscopic hemoclips was performed, and a bladder flap was developed in case of need for an emergent hysterectomy. Vasopressin was injected into the cervix and a suction dilation and curettage was performed under laparoscopic visualization. Finally, a Foley balloon was inserted in the cervix overnight as a tamponade to prevent further bleeding.

Measurements and Main Results: There were no surgical complications. The patient was observed overnight and the Foley balloon tamponade was removed on postoperative day 1 with no further bleeding. Her beta hCG levels down-trended appropriately.

Conclusion: This video presents a stepwise approach for surgical management of a rare type of ectopic pregnancy. Cervical ectopic pregnancies are high risk for severe bleeding. Thus, it is important to have an organized approach to complete the procedure with minimal blood loss. The techniques emphasized in this video allow a fertility sparing procedure to be done safely and efficiently.