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Zhou C, Li X, Mo Y, Wei F. The value of ultrasound parameters in predicting the efficacy of transabdominal ultrasound-guided suction curettage alone in the treatment of cesarean scar pregnancy. J Obstet Gynaecol Res 2024; 50:948-954. [PMID: 38520306 DOI: 10.1111/jog.15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To investigate the value of ultrasound parameters in assessing the efficacy of transabdominal ultrasound (TAUS)-guided suction curettage alone for cesarean scar pregnancy (CSP). METHODS Secondary retrospective analysis of a prospective study consisted of 137 women diagnosed with CSP who were performed TAUS-guided suction curettage alone for the first time at Maternity and Child Health Care of Guangxi Zhuang Autonomous Region in China. Prior to surgery, an ultrasound examination was conducted. Based on the need for secondary intervention, the patients were categorized into failure group and success group, and the predictive factors for failure of TAUS-guided suction curettage alone were analyzed. RESULTS Multivariate logistic regression showed that maximum diameter of the gestational sac>29 mm (odds ratio [OR] = 4.043, 95% CI: 1.100-14.862), residual myometrium thickness ≤1.8 mm (OR = 3.719, 95% CI: 1.148-12.048) and chorionic villi thickness at the scar >4.7 mm (OR = 15.327, 95% CI: 4.617-50.881) were independent predictors of failure in TAUS-guided suction curettage alone for CSP. Furthermore, the logistic regression model that was jointly constructed by these three predictors demonstrated an area under the curve, sensitivity, specificity, and Youden index of 0.913, 0.912, 0.864, and 0.776, respectively. CONCLUSION The maximum diameter of the gestational sac, residual myometrium thickness, and chorionic villi thickness at the scar has certain predictive efficacy of TAUS-guided suction curettage alone for CSP. Nevertheless, it is more valuable to apply the model of this study, composed of the three ultrasound parameters, for this prediction purpose.
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Affiliation(s)
- Chunqiao Zhou
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xinyan Li
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yu'ning Mo
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Fangtao Wei
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
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Nijjar S, Jauniaux E, Jurkovic D. Surgical evacuation of cesarean scar ectopic pregnancies. Best Pract Res Clin Obstet Gynaecol 2023; 89:102361. [PMID: 37356118 DOI: 10.1016/j.bpobgyn.2023.102361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/13/2023] [Accepted: 05/02/2023] [Indexed: 06/27/2023]
Abstract
Cesarean scar ectopic pregnancy is associated with significant maternal morbidity, including severe hemorrhage, need for the blood transfusion and hysterectomy. Early diagnosis is therefore key in ensuring timely management, with consensus being that treatment before 9 weeks of gestation leads to reduced morbidity. There is no universally adopted management protocol for cesarean scar ectopic pregnancy, but surgical management generally has a higher success rate than medical management. The primary surgical treatment modalities are suction evacuation versus resection of the pregnancy via multiple routes. Adjuncts that have been shown to successfully minimize bleeding with surgical management include cervical cerclage, balloon catheter, and uterine artery embolization. However, there remains a lack of high-quality evidence regarding what is the best surgical treatment option for cesarean scar ectopic pregnancy, and therefore it is essential that clinicians provide tailored management to patients considering the presenting symptoms and local expertise with various surgical techniques.
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Affiliation(s)
- Simrit Nijjar
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
| | - Davor Jurkovic
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
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Leanza V, Incognito GG, Gulino FA, Tuscano A, Cimino M, Palumbo M. Cesarean Scar Pregnancy and Successful Ultrasound-Guided Removal after Uterine Artery Ligation. Case Rep Obstet Gynecol 2023; 2023:6026206. [PMID: 37123052 PMCID: PMC10147527 DOI: 10.1155/2023/6026206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023] Open
Abstract
A correct management of cesarean scar pregnancy (CSP) is mandatory to avoid further complications. There is no consensus for the standard therapy and the most frequent methods used are not free from failures and sequelae. A 38-year-old woman was admitted referring amenorrhea lasting 9 weeks, pelvic pain, and vaginal bleeding. She had three previous cesarean sections. Transvaginal ultrasound showed a gestational sac of 16 mm in the cervico-isthmic site and inside the thickness of the uterine wall, and the dosage of beta-human chorionic gonadotropin was 12,770 mU/mL. A diagnosis of CSP was done, and an ultrasound-guided removal after uterine artery cervical branch ligation was performed. The follow-up was uneventful. Even if not yet codified in the literature, our therapeutic procedure should be considered in other similar cases in the future, as it potentially limits the possible iatrogenic problems and reduces intraoperative and postoperative bleeding to a minimum.
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Affiliation(s)
- Vito Leanza
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione Garibaldi Nesima, Catania, Italy
| | - Attilio Tuscano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Monia Cimino
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Shen F, Lv H, Wang L, Zhao R, Tong M, Lee ACL, Guo F, Chen Q. A Comparison of Treatment Options for Type 1 and Type 2 Caesarean Scar Pregnancy: A Retrospective Case Series Study. Front Med (Lausanne) 2021; 8:671035. [PMID: 34211987 PMCID: PMC8240870 DOI: 10.3389/fmed.2021.671035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background: There is currently no agreement on the optimal management of caesarean scar pregnancy. Caesarean scar pregnancy is currently categorised into two subtypes according to the site of implantation. This may consequently result in the difference in treatment options. However, the comparison of the success rate of each treatment option according to the subtypes has not been fully investigated. Methods: 71 patients who were treated by uterine curettage (D and C), or uterine artery embolization with curettage (UAE) or hysteroscopy in conjunction with laparoscopy between January 2016 and March 2020 were included. Data on maternal age, gestational sac age, the sac diameter, the interval between two pregnancies, the number of previous caesarean sections, amount of bleeding and β-hCG levels were collected and analysed dependent on the subtypes. Results: There was no difference in the clinical parameters of the cases who received different options of treatment, as well as no difference in the clinical parameters between type 1 and type 2 caesarean scar pregnancy. The primary success rate for type 1 caesarean scar pregnancy by D and C, or UAE, or hysteroscopy in conjunction with laparoscopy was 95, or 100 or 100%, respectively. The primary success rate for type 2 caesarean scar pregnancy by D and C, or UAE, or hysteroscopy in conjunction with laparoscopy was 27, or 67, or 95% respectively. Conclusion: Our data demonstrates that hysteroscopy in conjunction with laparoscopy for type 2 caesarean scar pregnancy was the most successful compared to other options, but for type 1 caesarean scar pregnancy, D and C could be the cost-effective option.
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Affiliation(s)
- Fanghua Shen
- Department of Obstetrics and Gynaecology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Hongdao Lv
- Department of Obstetrics and Gynaecology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Liming Wang
- Department of Obstetrics and Gynaecology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Ruiheng Zhao
- Department of Obstetrics and Gynaecology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Mancy Tong
- Department of Obstetrics, Gynaecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Arier Chi-Lun Lee
- Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Fang Guo
- The Hospital of Obstetrics and Gynaecology, Fudan University, Shanghai, China
| | - Qi Chen
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
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Wang J, Zhao R, Qian H, Lv H. Pituitrin local injection versus uterine artery embolization in the management of cesarean scar pregnancy: A retrospective cohort study. J Obstet Gynaecol Res 2021; 47:1711-1718. [PMID: 33749101 DOI: 10.1111/jog.14720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/12/2021] [Accepted: 02/06/2021] [Indexed: 11/27/2022]
Abstract
AIM To compare the effect of pituitrin local injection (PIT) and uterine artery embolization (UAE) as pretreatment before surgery during the management of cesarean scar pregnancy (CSP). METHODS Forty-nine CSP patients diagnosed in our department of Suzhou Ninth People's Hospital from October 2017 to October 2019. All patients underwent hysteroscopy and negative pressure aspiration (for type I CSP) or laparoscopic wedge-resection (for type II and III CSP) following one of the preoperative treatments: PIT group (n = 26) and UAE group (n = 23). The baseline clinical data, intraoperative blood loss, blood transfusion rate, postoperative hospital stay, hospitalization expenses, postoperative pain, postoperative fever, postoperative serum β-human chorionic gonadotropin (β-hCG) level, and pregnancy outcome were reviewed and analyzed. RESULTS There was no significant difference (p ≥ 0.05) between two groups in baseline characteristics including age, gravidity, previous cesarean section times, interval since last cesarean delivery, menolipsis time, maximum diameter of gestational sac or mass under ultrasound, fetal cardiac activity and preoperative β-hCG level. There was no significant difference in blood loss, transfusion rate, and postoperative β-hCG reduction percentage (p ≥ 0.05) either. The postoperative hospital stay, hospitalization expenses, postoperative pain, and postoperative fever rate in PIT group were significantly lower than those in UAE group (p < 0.05). Moreover, β-hCG level of all patients turned negative 1 month after surgery successfully. CONCLUSIONS PIT pretreatment seems to be a same effective, more economical, and with fewer side effects pretreatment method compared to traditional UAE pretreatment in the management of CSP.
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Affiliation(s)
- Jianing Wang
- Department of Gynecology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Ruiheng Zhao
- Department of Gynecology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Huiying Qian
- Department of Gynecology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Hongdao Lv
- Department of Gynecology, Suzhou Ninth People's Hospital, Suzhou, China
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Altay MM, Mert SA, Gemici A, Kaplan M, Gelisen O. Successful technique of manual vacuum aspiration for treatment of type 2 cesarean scar pregnancies: evaluation of 40 cases. J Matern Fetal Neonatal Med 2019; 34:2693-2700. [PMID: 31575309 DOI: 10.1080/14767058.2019.1670807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To demonstrate the effectiveness and safety of the defined manual vacuum aspiration (MVA) technique for treatment of type 2 cesarean scar pregnancies (CSPs). METHODS We treated 40 patients with CSP by MVA at the Early Pregnancy Clinic of our hospital between 1 January 2012 and 31 December 2014. The files of patients were reviewed and evaluated retrospectively. Eligibility criteria were hemodynamic stability and at least 2 mm myometrial thickness at the anterior part of the CSP. The key-point of successful MVA procedure is to keep away from entering the cesarean scar cavity directly; instead, CSP is displaced from the implantation site by applying vacuum, only while the cannula is passing near. RESULTS During the study period, the ratio of CSP to total pregnancies was 1/1000. The ratio of CSP to cesarean delivery (CD) was 1/372. In that time period, CSPs were constituted 4.41% of all ectopic pregnancies. Total of 40 patients were treated with dilatation and MVA. Complications such as excessive hemorrhage, persistence of CSP, and any need of extra intervention were not observed. The beta-hCG values of 21 patients (52.5%) decreased below 10 mIU/mL after the first 15 days, and the rest decreased below 10 mIU/mL after 3 weeks following MVA. CONCLUSIONS This MVA technique for treatment of CSP is easily applicable and effective method with high success and low complication rates. For appropriately selected patients, we think that this method can be considered as the first- line treatment.
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Affiliation(s)
- Mehmet Metin Altay
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sule Atalay Mert
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Ali Gemici
- Obstetrics and Gynecology, Guven Hospital, Ankara, Turkey
| | - Metin Kaplan
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Orhan Gelisen
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
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Wang S, Li Y, Ma X. Lower uterine segment thickness in assessing whether cesarean scar pregnancy patients could be treated with suction curettage. J Matern Fetal Neonatal Med 2018; 33:3332-3337. [PMID: 30270684 DOI: 10.1080/14767058.2018.1531118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: To find a suitable indicator in selecting appropriate patients with cesarean scar pregnancy (CSP) for treatment with ultrasound-guided suction curettage alone.Methods: A retrospective review of all women with CSP treated at the Tongji Hospital, Wuhan, China, between 1 January 2013 and 31 December 2015 was conducted. The women were grouped according to the following management options: ultrasound-guided suction curettage only (Group 1); combination with other therapeutic options (Group 2). The clinical characteristics and outcomes were analyzed.Results: Of 174 patients with lower uterine segment myometrium thickness ≥0.2 cm, 93 (53.4%) patients underwent ultrasound-guided suction curettage only, 81 (46.6%) patients underwent a combination with other therapeutics. Clinical characteristics of women who underwent ultrasound-guided suction curettage alone did not significantly differ from those who were treated with combination. Intraoperative blood loss and length of stay differed significantly between the two groups.Conclusions: In appropriate CSP cases with lower uterine segment myometrium thickness more than 0.2 cm, ultrasound-guided suction curettage appears to be a reliable treatment option producing satisfying success rates, lower blood loss, and a shorter hospital-stay compared to combined therapies.
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Affiliation(s)
- Sheng Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyi Ma
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Management of Caesarean scar pregnancy with or without methotrexate before curettage: human chorionic gonadotropin trends and patient outcomes. BMC Pregnancy Childbirth 2018; 18:289. [PMID: 29973177 PMCID: PMC6032533 DOI: 10.1186/s12884-018-1923-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 06/27/2018] [Indexed: 02/08/2023] Open
Abstract
Background To evaluate the effects of systemic methotrexate in cesarean scar pregnancy (CSP) patients treated with ultrasound-guided suction curettage. Methods A retrospective review of all women presenting with CSP treated with ultrasound-guided suction curettage at Tongji Hospital, Wuhan, China, between January 1, 2013 and December 31, 2015, was conducted. Patients were grouped into those not treated with methotrexate before curettage (group 1), treated with methotrexate by intramuscular injection (group 2) and treated with methotrexate by intravenous injection (group 3). The clinical characteristics and outcomes were analyzed. Results Among 107 patients, 47 patients were not treated with methotrexate before curettage, 46 patients had methotrexate administered by intramuscular injection and 14 patients had methotrexate injected intravenously. There were no significant differences among the groups in basic and clinical characteristics, such as age, gravity, parity, positive fetal heart beat and gestational age at diagnosis. Patients presented similar initial human chorionic gonadotropin (hCG) levels in all groups. After treatment with methotrexate or curettage, the percentage changes and varied ranges of the hCG levels were also similar in all groups. There were no significant differences in intraoperative blood loss and retained products of conception among the three groups. However group 1 had significantly shorter hospital stays than the two groups that were treated with methotrexate (p<0.001). Conclusion By grouping CSP patients who shared similar age, gravity, parity, fetal heart beat positive and gestational age at diagnosis, we found that the presence or absence of methotrexate treatment before curettage resulted in comparable outcomes and hCG levels, although patients who were not treated with methotrexate had significantly shorter stays in the hospital.
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Dağdeviren EG, Dur R, Fadıloğlu E, Demirdağ E, Öztürk Ç, Altay M. Molar pregnancy in cesarean section scar: A case report. Turk J Obstet Gynecol 2017; 14:249-251. [PMID: 29379669 PMCID: PMC5780570 DOI: 10.4274/tjod.26878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/05/2017] [Indexed: 12/13/2022] Open
Abstract
Cesarean scar ectopic pregnancies and molar pregnancies are two very rare obstetric pathologies. In both cases, serious morbidities are involved that require careful management. The coexistence of the two clinical conditions is far less common and there are a limited number of cases in the literature. In this case report, a 34-year-old patient with previous cesarean section was diagnosed as having a molar pregnancy in a cesarean scar through ultrasonography. The patient was asymptomatic at that time. Ultrasonography revealed a protruding mass at the cesarean section and her human chorionic gonadotropin level was measured as 59.705 mIU/mL. Due to the risk of severe bleeding, cesarean section scar excision and revision were performed via laparotomy after counselling the patient. Removal of all trophoblastic tissue was observed as a result of the frozen pathology and the operation was terminated. After the definite pathology result came as a complete molar pregnancy, the patient was followed up according to molar pregnancy follow-up protocols and cured completely. Despite the alternative treatment options (methotrexate application, curettage, uterine artery embolization) in such patients, the decision for surgery was made after counselling the patient. In this very rare clinical condition, patients should be closely monitored and the appropriate treatment option should be applied as soon as possible, taking into consideration the bleeding risks of both pathologies.
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Affiliation(s)
- Elif Gülşah Dağdeviren
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Rıza Dur
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Erdem Fadıloğlu
- Kilis State Hospital, Clinic of Women’s Health, Kilis, Turkey
| | - Erhan Demirdağ
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Çağatayhan Öztürk
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Metin Altay
- TOBB University of Economics and Technology Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Women’s Health, Ankara, Turkey
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Özcan HÇ, Uğur MG, Balat Ö, Sucu S, Mustafa A, Bayramoğlu Tepe N, Uğur BK. Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study. J Matern Fetal Neonatal Med 2017; 31:2953-2958. [DOI: 10.1080/14767058.2017.1359827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hüseyin Çağlayan Özcan
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mete Gurol Uğur
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Özcan Balat
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Seyhun Sucu
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Aynur Mustafa
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Neslihan Bayramoğlu Tepe
- Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Berna Kaya Uğur
- Department of Anesthesiology and Reanimation, School of Medicine, Gaziantep University, Gaziantep, Turkey
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Cesarean Scar Pregnancy: A Systematic Review. J Minim Invasive Gynecol 2017; 24:731-738. [DOI: 10.1016/j.jmig.2017.02.020] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 12/24/2022]
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