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Meta-Analysis
. 2020 Jul 1;7(7):CD011174.
doi: 10.1002/14651858.CD011174.pub2.

Interventions for non-tubal ectopic pregnancy

Ying Long  1   2 , Huili Zhu  1 , Yuanyuan Hu  3 , Licong Shen  1 , Jing Fu  1 , Wei Huang  1
Affiliations
Meta-Analysis

Interventions for non-tubal ectopic pregnancy

Ying Long et al. Cochrane Database Syst Rev. .

Abstract

Background: Non-tubal ectopic pregnancy is the implantation of an embryo at a site lying outside the uterine cavity or fallopian tubes. Sites include a caesarean scar, the cornua uteri, the ovary, the cervix, and the abdomen. There has been an increasing trend in the occurrence of these rare conditions, especially caesarean scar pregnancy (CSP).

Objectives: To evaluate the clinical effectiveness and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy in terms of fertility outcomes and complications.

Search methods: We searched the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, the World Health Organization (WHO) search portal and nine other databases to 12 December 2019. We handsearched reference lists of articles retrieved and contacted experts in the field to obtain additional data.

Selection criteria: We included randomized controlled trials (RCTs) published in all languages that examined the effects and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy.

Data collection and analysis: We used Cochrane standard methodological procedures. Primary outcomes were treatment success and complications.

Main results: We included five RCTs with 303 women, all reporting Caesarean scar pregnancy. Two compared uterine arterial embolization (UAE) or uterine arterial chemoembolization (UACE) plus methotrexate (MTX) versus systemic MTX and subsequent dilation and suction curettage; one compared UACE plus MTX versus ultrasonography-guided local MTX injection; and two compared suction curettage under hysteroscopy versus suction curettage under ultrasonography after UAE/UACE. The quality of evidence ranged from moderate to very low. The main limitations were imprecision (small sample sizes and very wide confidence intervals (CI) for most analyses), multiple comparisons with a small number of trials, and insufficient data available to assess heterogeneity. UAE/UACE versus systemic MTX prior to suction curettage Two studies reported this comparison. One compared UAE with systemic MTX and one compared UACE plus MTX versus systemic MTX, in both cases followed by a suction curettage. We are uncertain whether UAE/UACE improved success rates after initial treatment (UAE: risk ratio (RR) 1.00, 95% CI 0.90 to 1.12; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.87, 95% CI 0.54 to 1.38; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced rates of complications (UAE: RR 0.47, 95% CI 0.13 to 1.75; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.62, 95% CI 0.26 to 1.48; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced adverse effects (UAE: RR 1.58, 95% CI 0.41 to 6.11; 1 RCT, 72 women; low-quality evidence; UACE: RR 1.16, 95% CI 0.32 to 4.24; 1 RCT, 28 women; low-quality evidence), and it was not obvious that the types of events had similar values to participants (e.g. fever versus vomiting). Blood loss was lower in UAE/UACE groups than systemic MTX groups (UAE: mean difference (MD) -378.70 mL, 95% CI -401.43 to -355.97; 1 RCT, 72 women; moderate-quality evidence; UACE: MD -879.00 mL, 95% CI -1135.23 to -622.77; 1 RCT, 28 women; moderate-quality evidence). Data were not available on time to normalize β-human chorionic gonadotropin (β-hCG). UACE plus MTX versus ultrasonography-guided local MTX injection We are uncertain whether UACE improved success rates after initial treatment (RR 0.95, 95% CI 0.56 to 1.60; 1 RCT, 45 women; very low-quality evidence). Adverse effects: the study reported the same number of failed treatments in each arm (RR 0.88, 95% CI 0.40 to 1.92; 1 RCT, 45 women). We are uncertain whether UACE shortened the time to normalize β-hCG (MD 1.50 days, 95% CI -3.16 to 6.16; 1 RCT, 45 women; very low-quality evidence). Data were not available for complications. Suction curettage under hysteroscopy versus under ultrasonography after UAE/UACE. Two studies reported this comparison. One compared suction curettage under hysteroscopy versus under ultrasonography after UAE, and one compared these interventions after UACE. We are uncertain whether suction curettage under hysteroscopy improved success rates after initial treatment (UAE: RR 0.91, 95% CI 0.81 to 1.03; 1 RCT, 66 women; very low-quality evidence; UACE: RR 1.02, 95% CI 0.96 to 1.09; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced rates of complications (UAE: RR 4.00, 95% CI 0.47 to 33.91; 1 RCT, 66 women; very low-quality evidence; UACE: RR 0.18, 95% CI 0.01 to 3.72; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced adverse effects (UAE: RR 3.09, 95% CI 0.12 to 78.70; 1 RCT, 66 women; very low-quality evidence; UACE: not estimable; 1 RCT, 92 women; very low-quality evidence). We are uncertain whether suction curettage under hysteroscopy shortened the time to normalize β-hCG (UAE: MD 4.03 days, 95% CI -1.79 to 9.85; 1 RCT, 66 women; very low-quality evidence; UACE: MD 0.84 days, 95% CI -1.90 to 3.58; 1 RCT, 92 women; low-quality evidence). Non-tubal ectopic pregnancy other than CSP No studies reported on non-tubal ectopic pregnancies in locations other than on a caesarean scar.

Authors' conclusions: For Caesarean scar pregnancies (CSP) it is uncertain whether there is a difference in success rates, complications, or adverse events between UAE/UACE and administration of systemic MTX before suction curettage (low-quality evidence). Blood loss was lower if suction curettage is conducted after UAE/UACE than after administration of systemic MTX (moderate-quality evidence). It is uncertain whether there is a difference in treatment success rates, complications, adverse effects or time to normalize β-hCG between suction curettage under hysteroscopy and under ultrasonography (very low-quality evidence). There are no studies of non-tubal ectopic pregnancy other than CSP and RCTs for these types of pregnancy are unlikely.

PubMed Disclaimer

Conflict of interest statement

HZ, YH, LS, JF, WH, QW, and SY had no conflicts to declare.

YL's institution received grants from National Natural Science Foundation of China and Science and Technology Department of Sichuan Province, Sichuan Science and Technology with respect to this Cochrane Review.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 UAE/UACE versus systemic MTX, outcome: 1.1 Treatment success after initial treatment.
5
5
Forest plot of comparison: 1 UAE/UACE versus systemic MTX, outcome: 1.2 Complications.
6
6
Forest plot of comparison: 1 UAE/UACE versus systemic MTX, outcome: 1.3 Adverse effects (overall).
7
7
Forest plot of comparison: 1 UAE/UACE versus systemic MTX, outcome: 1.4 Blood loss [mL].
8
8
Forest plot of comparison: 2 UACE plus MTX versus ultrasonography‐guided local MTX injection, outcome: 2.1 Treatment success after initial treatment.
1.1
1.1. Analysis
Comparison 1: UAE/UACE versus systemic MTX, both + suction curettage, Outcome 1: Treatment success after initial treatment
1.2
1.2. Analysis
Comparison 1: UAE/UACE versus systemic MTX, both + suction curettage, Outcome 2: Complications
1.3
1.3. Analysis
Comparison 1: UAE/UACE versus systemic MTX, both + suction curettage, Outcome 3: Adverse effects (overall)
1.4
1.4. Analysis
Comparison 1: UAE/UACE versus systemic MTX, both + suction curettage, Outcome 4: Blood loss
1.5
1.5. Analysis
Comparison 1: UAE/UACE versus systemic MTX, both + suction curettage, Outcome 5: Hospital stay
2.1
2.1. Analysis
Comparison 2: UACE plus MTX versus ultrasonography‐guided local MTX injection, Outcome 1: Treatment success after initial treatment
2.2
2.2. Analysis
Comparison 2: UACE plus MTX versus ultrasonography‐guided local MTX injection, Outcome 2: Time to normalize β‐hCG
2.3
2.3. Analysis
Comparison 2: UACE plus MTX versus ultrasonography‐guided local MTX injection, Outcome 3: Adverse effects (overall)
3.1
3.1. Analysis
Comparison 3: Suction curettage under hysteroscopy versus under ultrasonography, Outcome 1: Treatment success after initial treatment
3.2
3.2. Analysis
Comparison 3: Suction curettage under hysteroscopy versus under ultrasonography, Outcome 2: Complications
3.3
3.3. Analysis
Comparison 3: Suction curettage under hysteroscopy versus under ultrasonography, Outcome 3: Adverse effects (overall)
3.4
3.4. Analysis
Comparison 3: Suction curettage under hysteroscopy versus under ultrasonography, Outcome 4: Time to normalize β‐hCG
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Li 2011b {published data only}
    1. Li C, Li C, Feng D, Jia C, Liu B, Zhan X. Transcatheter arterial chemoembolization versus systemic methotrexate for the management of cesarean scar pregnancy. International Journal of Gynaecology and Obstetrics 2011;113(3):178-82. - PubMed
Li 2016 {published data only}
    1. Li Y, Gong L, Wu X, Gao H, Zheng H, Lan W. Randomized controlled trial of hysteroscopy or ultrasonography versus no guidance during D&C after uterine artery chemoembolization for cesarean scar pregnancy. International Journal of Gynaecology and Obstetrics 2016;135(2):158-62. - PubMed
Qian 2015 {published data only}
    1. Qian Z, Huang L, Zhu X. Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy. Archives of Gynecology and Obstetrics 2015;292(5):1055-61. - PubMed
Wang 2015 {published data only}
    1. Wang M, Yang Z, Li Y, Chen B, Wang J, Ma X, et al. Conservative management of cesarean scar pregnancies: a prospective randomized controlled trial at a single center. International Journal of Clinical and Experimental Medicine 2015;8(10):18972-80. - PMC - PubMed
Zhuang 2009 {published data only}
    1. Zhuang Y, Huang L. Uterine artery embolization compared with methotrexate for the management of pregnancy implanted with in a cesarean scar. American Journal of Obstetrics and Gynecology 2009;201(2):152.e1-3. - PubMed

References to studies excluded from this review

Gu 2010 {published data only}
    1. Gu W, Wang H, Wan J, Zhang L, Wang Y, Wang W, et al. Intra-arterial infusion of MTX for the treatment of cesarean scar pregnancy: a comparative study between different doses [不同剂量MTX经动脉灌注治疗切口妊娠疗效的分析]. Journal of Interventional Radiology 2010;19(7):568-71.
Li 2010 {published data only}
    1. Li Y, Tan S, Qu Q, Liu F. Clinical randomized controlled study on the efficacy and safety of curettage and conservative treatment of cervical pregnancy [宫颈妊娠保守治疗后清宫与单纯保守治疗疗效及安全性的临床随机对照研究]. Journal of Sichuan University (Medical Edition) 2010;41(2):370-1.
Liu 2015 {published data only}
    1. Liu B, Cao M, Zhang Y, Zhu Z. Uterine artery embolization and uterine artery chemoembolization for the treatment of cesarean scar pregnancy: a comparative study [子宫动脉栓塞与化疗栓塞治疗瘢痕妊娠 疗效比较]. Journal of Interventional Radiology 2015;24(7):588-91.
Peng 2015 {published data only}
    1. Peng P, Gui T, Liu X, Chen W, Liu Z. Comparative efficacy and safety of local and systemic methotrexate injection in cesarean scar pregnancy. Therapeutics and Clinical Risk Management 2015;11:137-42. - PMC - PubMed
Wei 2007 {published data only}
    1. Wei X, Li M, Shao H, Ni Q, Shao J. A comparative study of tieing vs suturing on laparoscopic management of interstitial tubal pregnancy [腹腔镜下套圈法与缝合法治疗输卵管问质部妊娠的对照研究]. Chinese Primary Health Care 2007;21(1):84-5.
Wu 2014 {published data only}
    1. Wu X, Xue X, Wu X, Lin R, Yuan Y, Wang Q, et al. Combined laparoscopy and hysteroscopy vs. uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a retrospective cohort study. International Journal of Clinical and Experimental Medicine 2014;7(9):2793-803. - PMC - PubMed
Yan 2007 {published data only}
    1. Yan B. Application of laparoscopy in the treatment of cornual pregnancy [腹腔镜在宫角妊娠治疗中的应用]. Guangzhou Medical Journal 2007;38(4):43-5.
Zhuang 2008 {published data only}
    1. Zhuang Y, Wei L, Wang W, Huang L. Treatment of pregnancy in a previous caesarean section scar with uterine artery embolization: analysis of 60 cases [应用子宫动脉栓塞术治疗剖宫产瘢痕处妊娠]. Zhonghua Yi Xue za Zhi [Chinese Medical Journal; Free China Ed] 2008;88(33):2372-4. - PubMed

Additional references

Alammari 2017
    1. Alammari R, Thibodeau R, Harmanli O. Vaginal hysterectomy for treatment of cervical ectopic pregnancy. American College of Obstetricians and Gynecologists 2017;129(1):63-5. - PubMed
Anev 2013
    1. Anev I, Wang J, Palep-Singh M, Seif MW. Monochorionic diamniotic twin cervical ectopic pregnancy following assisted conception: a case report. Journal of Reproductive Medicine 2013;58(9-10):445-7. - PubMed
Barnhart 2009
    1. Barnhart KT. Clinical practice. Ectopic pregnancy. New England Journal of Medicine 2009;361(4):379-87. - PubMed
Bernstein 2001
    1. Bernstein HB, Thrall MM, Clark WB. Expectant management of intramural ectopic pregnancy. Obstetrics and Gynecology 2001;97(5 Pt 2):826-7. - PubMed
Bouyer 2002
    1. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Human Reproduction 2002;17(12):3224-30. - PubMed
Chetty 2009
    1. Chetty M, Elson J. Treating non-tubal ectopic pregnancy. Best Practice & Research. Clinical Obstetrics & Gynaecology 2009;23(4):529-38. - PubMed
Comstock 2005
    1. Comstock C, Huston K, Lee W. The ultrasonographic appearance of ovarian ectopic pregnancies. Obstetrics and Gynecology 2005;105(1):42-5. - PubMed
Einenkel 2000
    1. Einenkel J, Baier D, Horn L-C, Alexander H. Laparoscopic therapy of an intact primary ovarian pregnancy with ovarian hyperstimulation syndrome. Human Reproduction 2000;15(9):2037-40. - PubMed
Elson 2016
    1. Elson CJ, Salim R, Potdar N, Chetty M, Ross JA, Kirk EJ on behalf of the Royal College of Obstetricians and Gynaecologists. Diagnosis and Management of Ectopic Pregnancy. BJOG 2016;123(13):e15.
Faschingbauer 2011
    1. Faschingbauer F, Mueller A, Voigt F, Beckmann MW, Goecke TW. Treatment of heterotopic cervical pregnancies. Fertility and Sterility 2011;95(5):1787.e9-13. - PubMed
Frates 1994
    1. Frates MC, Benson CB, Doubilet PM, Disalvo DN, Brown DC, Laing FC. Cervical ectopic pregnancy: results of conservative treatment. Radiology 1994;191:773-5. - PubMed
Fuchs 2015
    1. Fuchs N, Manoucheri E, Verbaan M, Einarsson JI. Laparoscopic management of extrauterine pregnancy in caesarean section scar: description of a surgical technique and review of the literature. BJOG 2015;122(1):137. - PubMed
Fylstra 2014
    1. Fylstra DL. Cervical pregnancy: 13 cases treated with suction curettage and balloon tamponade. American Journal of Obstetrics and Gynecology 2014;210(6):581.e1-5. - PubMed
Gerli 2004
    1. Gerli S, Rossetti D, Baiocchi G, Clerici G, Unfer V, Carlo Di Renzo G. Early ultrasonographic diagnosis and laparoscopic treatment of abdominal pregnancy. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2004;113(1):103-5. - PubMed
Gibbons 2012
    1. Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. Inequities in the use of cesarean section deliveries in the world. American Journal of Obstetrics and Gynecology 2012;206:331.e1-19. - PubMed
Goyal 2014
    1. Goyal DL, Tondon R, Goel P, Sehgal A. Ovarian ectopic pregnancy: a 10 years’ experience and review of literature. International Journal of Reproductive Biomedicine 2014;12(12):825-30. - PMC - PubMed
GRADEpro GDT [Computer program]
    1. McMaster University (developed by Evidence Prime) GRADEpro GDT. Version accessed 12 February 2019. Hamilton (ON): McMaster University (developed by Evidence Prime).Available at gradepro.org.
Graesslin 2005
    1. Graesslin O, Dedecker F, Quereux C, Gabriel R. Conservative treatment of ectopic pregnancy in a cesarean scar. Obstetrics and Gynecology 2005;105(4):869-71. - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Honey 1999
    1. Honey L, Leader A, Claman P. Uterine artery embolization – a successful treatment to control bleeding cervical pregnancy with a simultaneous intrauterine gestation. Human Reproduction 1999;14(2):553-5. - PubMed
Horne 2014
    1. Horne AW, Skubisz MM, Tong S, Duncan WC, Neil P, Wallace EM, et al. Combination gefitinib and methotrexate treatment for non-tubal ectopic pregnancies: a case series. Human Reproduction 2014;29(7):1375-9. - PMC - PubMed
Hsieh 1998
    1. Hsieh YY, Chang CC, Tsai HD, Yeh LS, Hsu TY, Yang TC. Intramural pregnancy with negative b-hCG. Journal of Reproductive Medicine 1998;43:468-70. - PubMed
Hu 2016
    1. Hu J, Tao X, Yin L, Shi Y. Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases. BJOG 2016;123(S3):97. - PubMed
Hung 1998
    1. Hung TH, Shau WY, Hsieh TT, Hsu JJ, Soong YK, Jeng CJ. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Human Reproduction 1998;13(9):2636-42. - PubMed
Jabeen 2018
    1. Jabeen K, Karuppaswamy J. Non-surgical management of caesarean scar ectopic pregnancy – a five-year experience. Journal of Obstetrics and Gynaecology 2018;38(8):1121-7. - PubMed
Jin 2004
    1. Jin H, Zhou J, Yu Y, Dong M. Intramural pregnancy, a report of two cases. Journal of Reproductive Medicine 2004;49(7):569-72. - PubMed
Jin 2016
    1. Jin L, Chen WL, Zhou YF. Expert consensus on diagnosis and treatment of caesarean scar pregnancy (2016) [剖宫产术后子宫瘢痕妊娠诊治专家共识 (2016)]. Chinese Journal of Obstetrics and Gynecology 2016;51(8):568-72.
Jurkovic 1996
    1. Jurkovic D, Hackett E, Campbell S. Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound in Obstetrics & Gynecology 1996;8(6):373-80. - PubMed
Jurkovic 2003
    1. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound in Obstetrics & Gynecology 2003;21(3):220-7. - PubMed
Jurkovic 2007
    1. Jurkovic D, Marvelos D. Catch me if you can: ultrasound diagnosis of ectopic pregnancy. Ultrasound in Obstetrics & Gynecology 2007;30(1):1-7. - PubMed
Jurkovic 2011
    1. Jurkovic D, Wilkinson H. Diagnosis and management of ectopic pregnancy. BMJ 2011;342:d3397. - PubMed
Kirk 2014
    1. Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Human Reproduction Update 2014;20(2):250-61. - PubMed
Lee 1999
    1. Lee CL, Wang C, Chao A, Yen C-F, Soong Y-K. Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar. Human Reproduction 1999;14(5):1234-6. - PubMed
Levine 2007
    1. Levine D. Ectopic pregnancy. Radiology 2007;245(2):385-97. - PubMed
Lewis 2007
    1. Lewis G. Saving mothers' lives: reviewing maternal deaths to make motherhood safer – 2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London, UK: CEMACH; 2007.
Li 2011a
    1. Li H, Guo H, Han J, Wang J, Xiong G, Shen J, et al. Endoscopic treatment of ectopic pregnancy in a cesarean scar. Journal of Minimally Invasive Gynecology 2011;18(1):31-5. - PubMed
Lian 2012
    1. Lian F, Wang Y, Chen W, Li J, Zhan Z, Ye Y, et al. Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern. Cardiovascular and Interventional Radiology 2012;35(2):286-91. - PubMed
Liang 2010
    1. Liang FB, He J. Methotrexate-based bilateral uterine arterial chemoembolization for treatment of cesarean scar pregnancy. Acta Obstetricia et Gynecologica Scandinavica 2010;89(12):1592-4. - PubMed
Litwicka 2011
    1. Litwicka K, Greco E. Caesarean scar pregnancy: a review of management options. Current Opinion in Obstetrics & Gynecology 2011;23(6):415-21. - PubMed
Marchiole 2004
    1. Marchiole P, Gorlero F, De Caro G. Intramural pregnancy embedded in a previous cesarean section scar treated conservatively. Ultrasound in Obstetrics & Gynecology 2004;23(3):305-9. - PubMed
Maymon 2004
    1. Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication. Human Reproduction Update 2004;10(6):515-23. - PubMed
Melcer 2015
    1. Melcer Y, Smorgick N, Vaknin Z, Mendlovic S, Raziel A, Maymon R. Primary ovarian pregnancy: 43 years experience in a single institute and still a medical challenge. Israel Medical Association Journal 2015;17(11):687-90. - PubMed
Mitra 2003
    1. Mitra AG, LeQuire MH. Minimally invasive management of 14.5-week abdominal pregnancy without laparotomy: a novel approach using percutaneous sonographically guided feticide and systemic methotrexate. Journal of Ultrasound in Medicine 2003;22(7):709-14. - PubMed
Molinaro 2007
    1. Molinaro TA, Barnhart KT. Ectopic pregnancies in unusual locations. Seminars in Reproductive Medicine 2007;25(2):123-30. - PubMed
Nadarajah 2002
    1. Nadarajah S, Sim LN, Loh SF. Laparoscopic management of an ovarian pregnancy. Singapore Medical Journal 2002;43(2):95-6. - PubMed
Nadi 2017
    1. Nadi M, Richard C, Filipuzzi L, Bergogne L, Douvier S, Sagot P. Interstitial, angular and cornual pregnancies: diagnosis, treatment and subsequent fertility [Grossesse interstitielle, angulaire et cornuale: diagnostic, traitement et futur obstetrical]. Gynecologie Obstetrique Fertilite & Senologie 2017;45:340-7. - PubMed
Ngu 2011
    1. Ngu SF, Cheung VY. Non-tubal ectopic pregnancy. International Journal of Gynaecology and Obstetrics 2011;115(3):295-7. - PubMed
Onan 2005
    1. Onan MA, Turp AB, Saltik A, Akyurek N, Taskiran C, Himmetoglu O. Primary omental pregnancy: case report. Human Reproduction 2005;20(3):807-9. - PubMed
Orazulike 2013
    1. Orazulike NC, Konje JC. Diagnosis and management of ectopic pregnancy. Women's Health (London, England) 2013;9(4):373-85. - PubMed
Ory 1986
    1. Ory SJ, Alelei L, Villanueva AL, Sand PK, Tamura RK. Conservative treatment of ectopic pregnancy with methotrexate. American Journal of Obstetrics and Gynecology 1986;154(6):1299-306. - PubMed
Pascual 2007
    1. Pascual MA, Hereter L, Graupera B, Tresserra F, Fernandez-Cid M, Simon M. Three-dimensional power Doppler ultrasound diagnosis and conservative treatment of ectopic pregnancy in a cesarean section scar. Fertility and Sterility 2007;88(3):706.e5-7. - PubMed
Petersen 2016
    1. Petersen BK, Hoffmann E, Larsen RC. Cesarean scar pregnancy: a systematic review of treatment studies. Fertility and Sterility 2016;105(4):958-67. - PubMed
Rahaman 2004
    1. Rahaman J, Berkowitz R, Mitty H, Gaddipati S, Brown B, Nezhat F. Minimally invasive management of an advanced abdominal pregnancy. Obstetrics and Gynecology 2004;103(5 Pt 2):1064-8. - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Sauer 1987
    1. Sauer MV, Gorill MJ, Rodi IA, Yeko TR, Greenberg LH, Bustillo M, et al. Nonsurgical management of unruptured pregnancy: an extended trial. Fertility and Sterility 1987;48:752-5. - PubMed
Seinera 1997
    1. Seinera P, Di Gregorio A, Arisio R, Decko A, Crana F. Ovarian pregnancy and operative laparoscopy: report of eight cases. Human Reproduction 1997;12(3):608-10. - PubMed
Seow 2004
    1. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound in Obstetrics & Gynecology 2004;23(3):247-53. - PubMed
Shan 2014
    1. Shan N, Dong D, Deng W, Fu Y. Response to unusual ectopic pregnancies: a retrospective analysis of 65 cases. Journal of Obstetrics and Gynaecology Research 2014;40(1):147-54. - PubMed
Shaw 2007
    1. Shaw SW, Hsu JJ, Chueh HY, Han CM, Chen FC, Chang YL, et al. Management of primary abdominal pregnancy: twelve years of experience in a medical centre. Acta Obstetricia et Gynecologica Scandinavica 2007;86(9):1058-62. - PubMed
Shen 2012
    1. Shen L, Tan A, Zhu H, Guo C, Liu D, Huang W. Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy. American Journal of Obstetrics and Gynecology 2012;207(5):386.e1-6. - PubMed
Stucki 2008
    1. Stucki D, Buss J. The ectopic pregnancy, a diagnostic and therapeutic challenge. Journal of Medicine and Life 2008;1(1):40-8. - PMC - PubMed
Timor‐Tritsch 2015
    1. Timor-Tritsch IE, Khatib N, Monteagudo A, Ramos J, Berg B, Kovács S. Cesarean scar pregnancies: experience of 60 cases. Journal of Ultrasound in Medicine 2015;34(4):601-10. - PubMed
Tinelli 2008
    1. Tinelli A, Hudelist G, Malvasi A, Tinelli R. Laparascopic management of ovarian pregnancy. JSLS : Journal of the Society of Laparoendoscopic Surgeons 2008;12(2):169-72. - PMC - PubMed
Trambert 2005
    1. Trambert JJ, Einstein M, Banks E, Frost A, Goldberg G. Uterine artery embolization in the management of vaginal bleeding from cervical pregnancy. Journal of Reproductive Medicine 2005;50(11):844-50. - PubMed
Tulandi 2004
    1. Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from The Society of Reproductive Surgeons Registry. Obstetrics and Gynecology 2004;103(1):47-50. - PubMed
Ushakov 1997
    1. Ushakov FB, Elchalal U, Aceman PJ, Schenker JG. Cervical pregnancy: past and future. Obstetrical & Gynecological Survey 1997;52(1):45-59. - PubMed
Varma 2003
    1. Varma R, Mascarenhas R, Jame D. Successful outcome of advanced abdominal pregnancy with exclusive omental insertion. Ultrasound in Obstetrics & Gynecology 2003;21(2):192-4. - PubMed
Yao 2005
    1. Yao Y, Hu LN. The incidence of ectopic pregnancy and the main causes of misdiagnosis [异位妊娠发病率及误诊的主要原因]. Journal of Practical Obstetrics and Gynecology 2005;21(6):321-2.
Yu 2009
    1. Yu B, Douglas NC, Guarnaccia MM, Sauer MV. Uterine artery embolization as an adjunctive measure to decrease blood loss prior to evacuating a cervical pregnancy. Archives of Gynecology and Obstetrics 2009;279(5):721-4. - PubMed
Yuan 2010
    1. Yuan Y, Dai Q, Cai S, Lyu K, Liu X, Jin L, et al. Value of sonography in the diagnosis of caesarean scar pregnancy [超声对剖宫产瘢痕妊娠的诊断价值]. Chinese Journal of Ultrasonography 2010;19(4):321-4.
Zhang 2009
    1. Zhang YL, Huang LL. Uterine artery embolization compared with methotrexate for the management of pregnancy implanted with in a cesarean scar. American Journal of Obstetrics and Gynecology 2009;201(2):52.e1‐3. - PubMed
Zhang 2012
    1. Zhang B, Jiang Z, Huang M, Guan S, Zhu K, Qian J, et al. Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy: results of a case series and review of the literature. Journal of Vascular and Interventional Radiology 2012;23(12):1582-8. - PubMed
Zhu 2016
    1. Zhu X, Deng X, Xiao S, Wan Y, Xue M. A comparison of high-intensity focused ultrasound and uterine artery embolisation for the management of caesarean scar pregnancy. International Journal of Hyperthermia 2016;32(2):144. - PubMed

References to other published versions of this review

Shen 2014
    1. Shen L, Fu J, Huang W, Zhu H, Wang Q, Yang S, Wu T. Interventions for non‐tubal ectopic pregnancy. Cochrane Database of Systematic Reviews 2014, Issue 7. [DOI: 10.1002/14651858.CD011174] - DOI - PMC - PubMed

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