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Ectopic Pregnancy

Chapter

Abstract

Ectopic pregnancy is defined as an implantation of a fertilized ovum at a site other than within the endometrium. Ectopic pregnancies are responsible for approximately 10% of all maternal mortality and are the leading cause of pregnancy-related death during the first trimester [1], mainly related to hemorrhage [2]. In addition to maternal mortality and ectopic pregnancy-related complications, ectopic pregnancy is an economic burden. The total cost associated with ectopic pregnancy in the USA in 1990 was estimated at $1.1 billion [3].

Keywords

Fallopian Tube Ectopic Pregnancy Expectant Management Intrauterine Pregnancy Cesarean Scar Pregnancy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Goldner TE, Lawson HW, Xia Z, Atrash HK. Surveillance for ectopic pregnancy–United States, 1970–1989. MMWR CDC Surveill Summ. 1993;42(6):73–85.PubMedGoogle Scholar
  2. 2.
    Dorfman SF, Grimes DA, Cates Jr W, Binkin NJ, Kafrissen ME, O’Reilly KR. Ectopic pregnancy mortality, United States, 1979 to 1980: clinical aspects. Obstet Gynecol. 1984;64(3):386–90.PubMedGoogle Scholar
  3. 3.
    Washington AE, Katz P. Ectopic pregnancy in the United States: economic consequences and payment source trends. Obstet Gynecol. 1993;81(2):287–92.PubMedGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention (CDC). Ectopic pregnancy–United States, 1990–1992. MMWR Morb Mortal Wkly Rep. 1995;44:46–8. http://www.ncbi.nlm.nih.gov/pubmed/7823895.Google Scholar
  5. 5.
    Coste J, Bouyer J, Job-Spira N. [Epidemiology of ectopic pregnancy: incidence and risk factors]. Contracept Fertil Sex. 1996;24(2):135–9.PubMedGoogle Scholar
  6. 6.
    Cooper GM, Lewis G, Neilson J. Confidential enquiries into maternal deaths, 1997–1999. Br J Anaesth. 2002;89(3):369–72.PubMedGoogle Scholar
  7. 7.
    Ory SJ. New options for diagnosis and treatment of ectopic pregnancy. JAMA. 1992;267(4): 534–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Kamwendo F, Forslin L, Bodin L, Danielsson D. Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Sex Transm Infect. 2000;76(1):28–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Ankum WM, Hajenius PJ, Schrevel LS, Van der Veen F. Management of suspected ectopic pregnancy. Impact of new diagnostic tools in 686 consecutive cases. J Reprod Med. 1996;41(10):724–8.PubMedGoogle Scholar
  10. 10.
    Zane SB, Kieke Jr BA, Kendrick JS, Bruce C. Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States. Matern Child Health J. 2002;6(4):227–36.PubMedCrossRefGoogle Scholar
  11. 11.
    Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol. 2006;46(6):521–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Shaw JL, Dey SK, Critchley HO, Horne AW. Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update. 2010;16(4):432–44.PubMedCrossRefGoogle Scholar
  13. 13.
    Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093–9.PubMedGoogle Scholar
  14. 14.
    Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel AC, Shaunik A. Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies. Fertil Steril. 2006;86(1):36–43.PubMedCrossRefGoogle Scholar
  15. 15.
    Sindos M, Togia A, Sergentanis TN, et al. Ruptured ectopic pregnancy: risk factors for a ­life-threatening condition. Arch Gynecol Obstet. 2009;279(5):621–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Pulkkinen MO, Talo A. Tubal physiologic consideration in ectopic pregnancy. Clin Obstet Gynecol. 1987;30(1):164–72.PubMedCrossRefGoogle Scholar
  17. 17.
    A Multinational Case-Control Study of Ectopic Pregnancy. The World Health Organization’s Special Programme of Research, Development and Research Training in Human Reproduction: Task Force on Intrauterine Devices for Fertility Regulation. Clin Reprod Fertil. 1985;3(2):131–43.Google Scholar
  18. 18.
    Liukko P, Erkkola R, Laakso L. Ectopic pregnancies during use of low-dose progestogens for oral contraception. Contraception. 1977;16(6):575–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Sivin I. International experience with NORPLANT and NORPLANT-2 contraceptives. Stud Fam Plann. 1988;19(2):81–94.PubMedCrossRefGoogle Scholar
  20. 20.
    Sivin I. Dose- and age-dependent ectopic pregnancy risks with intrauterine contraception. Obstet Gynecol. 1991;78(2):291–8.PubMedGoogle Scholar
  21. 21.
    Coste J, Job-Spira N, Fernandez H. Increased risk of ectopic pregnancy with maternal cigarette smoking. Am J Public Health. 1991;81(2):199–201.PubMedCrossRefGoogle Scholar
  22. 22.
    Handler A, Davis F, Ferre C, Yeko T. The relationship of smoking and ectopic pregnancy. Am J Public Health. 1989;79(9):1239–42.PubMedCrossRefGoogle Scholar
  23. 23.
    Karande VC, Flood JT, Heard N, Veeck L, Muasher SJ. Analysis of ectopic pregnancies resulting from in-vitro fertilization and embryo transfer. Hum Reprod. 1991;6(3):446–9.PubMedGoogle Scholar
  24. 24.
    Nazari A, Askari HA, Check JH, O’Shaughnessy A. Embryo transfer technique as a cause of ectopic pregnancy in in vitro fertilization. Fertil Steril. 1993;60(5):919–21.PubMedGoogle Scholar
  25. 25.
    Homm RJ, Holtz G, Garvin AJ. Isthmic ectopic pregnancy and salpingitis isthmica nodosa. Fertil Steril. 1987;48(5):756–60.PubMedGoogle Scholar
  26. 26.
    Job-Spira N, Fernandez H, Bouyer J, Pouly JL, Germain E, Coste J. Ruptured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France. Am J Obstet Gynecol. 1999;180(4):938–44.PubMedCrossRefGoogle Scholar
  27. 27.
    Weckstein LN, Boucher AR, Tucker H, Gibson D, Rettenmaier MA. Accurate diagnosis of early ectopic pregnancy. Obstet Gynecol. 1985;65(3):393–7.PubMedGoogle Scholar
  28. 28.
    Alsuleiman SA, Grimes EM. Ectopic pregnancy: a review of 147 cases. J Reprod Med. 1982;27(2):101–6.PubMedGoogle Scholar
  29. 29.
    Seeber BE, Barnhart KT. Suspected ectopic pregnancy. Obstet Gynecol. 2006;107(2 Pt 1):399–413.PubMedCrossRefGoogle Scholar
  30. 30.
    Della-Giustina D, Denny M. Ectopic pregnancy. Emerg Med Clin North Am. 2003;21(3):565–84.PubMedCrossRefGoogle Scholar
  31. 31.
    Dart RG, Kaplan B, Varaklis K. Predictive value of history and physical examination in patients with suspected ectopic pregnancy. Ann Emerg Med. 1999;33(3):283–90.PubMedCrossRefGoogle Scholar
  32. 32.
    Aleem FA, DeFazio M, Gintautas J. Endovaginal sonography for the early diagnosis of intrauterine and ectopic pregnancies. Hum Reprod. 1990;5(6):755–8.PubMedGoogle Scholar
  33. 33.
    Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I. Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases. Fertil Steril. 1998;69(1):62–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Barnhart K, Mennuti MT, Benjamin I, Jacobson S, Goodman D, Coutifaris C. Prompt diagnosis of ectopic pregnancy in an emergency department setting. Obstet Gynecol. 1994;84(6):1010–5.PubMedGoogle Scholar
  35. 35.
    Atri M, Leduc C, Gillett P, et al. Role of endovaginal sonography in the diagnosis and management of ectopic pregnancy. Radiographics. 1996;16(4):755–74. discussion 75.PubMedGoogle Scholar
  36. 36.
    Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008;28(6):1661–71.PubMedCrossRefGoogle Scholar
  37. 37.
    Hammoud AO, Hammoud I, Bujold E, Gonik B, Diamond MP, Johnson SC. The role of sonographic endometrial patterns and endometrial thickness in the differential diagnosis of ectopic pregnancy. Am J Obstet Gynecol. 2005;192(5):1370–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Fernandez H, Gervaise A. Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update. 2004;10(6):503–13.PubMedCrossRefGoogle Scholar
  39. 39.
    Goldman GA, Fisch B, Ovadia J, Tadir Y. Heterotopic pregnancy after assisted reproductive technologies. Obstet Gynecol Surv. 1992;47(4):217–21.PubMedCrossRefGoogle Scholar
  40. 40.
    Kadar N, Caldwell BV, Romero R. A method of screening for ectopic pregnancy and its indications. Obstet Gynecol. 1981;58(2):162–6.PubMedGoogle Scholar
  41. 41.
    Farquhar CM. Ectopic pregnancy. Lancet. 2005;366(9485):583–91.PubMedCrossRefGoogle Scholar
  42. 42.
    Chung K, Allen R. The use of serial human chorionic gonadotropin levels to establish a viable or a nonviable pregnancy. Semin Reprod Med. 2008;26(5):383–90.PubMedCrossRefGoogle Scholar
  43. 43.
    Pittaway DE, Reish RL, Wentz AC. Doubling times of human chorionic gonadotropin increase in early viable intrauterine pregnancies. Am J Obstet Gynecol. 1985;152(3):299–302.PubMedGoogle Scholar
  44. 44.
    Braunstein GD, Rasor J, Danzer H, Adler D, Wade ME. Serum human chorionic gonadotropin levels throughout normal pregnancy. Am J Obstet Gynecol. 1976;126(6):678–81.PubMedGoogle Scholar
  45. 45.
    Barnhart KT, Sammel MD, Rinaudo PF, Zhou L, Hummel AC, Guo W. Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstet Gynecol. 2004;104(1):50–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Kadar N, Freedman M, Zacher M. Further observations on the doubling time of human chorionic gonadotropin in early asymptomatic pregnancies. Fertil Steril. 1990;54(5):783–7.PubMedGoogle Scholar
  47. 47.
    Romero R, Kadar N, Copel JA, Jeanty P, DeCherney AH, Hobbins JC. The value of serial human chorionic gonadotropin testing as a diagnostic tool in ectopic pregnancy. Am J Obstet Gynecol. 1986;155(2):392–4.PubMedGoogle Scholar
  48. 48.
    Silva C, Sammel MD, Zhou L, Gracia C, Hummel AC, Barnhart K. Human chorionic gonadotropin profile for women with ectopic pregnancy. Obstet Gynecol. 2006;107(3):605–10.PubMedCrossRefGoogle Scholar
  49. 49.
    Kadar N, Romero R. Sonographic evaluation of ectopic pregnancy. Am J Obstet Gynecol. 1981;141(4):473–5.PubMedGoogle Scholar
  50. 50.
    Stovall TG, Ling FW, Andersen RN, Buster JE. Improved sensitivity and specificity of a single measurement of serum progesterone over serial quantitative beta-human chorionic gonadotrophin in screening for ectopic pregnancy. Hum Reprod. 1992;7(5):723–5.PubMedGoogle Scholar
  51. 51.
    McCord ML, Muram D, Buster JE, Arheart KL, Stovall TG, Carson SA. Single serum progesterone as a screen for ectopic pregnancy: exchanging specificity and sensitivity to obtain ­optimal test performance. Fertil Steril. 1996;66(4):513–6.PubMedGoogle Scholar
  52. 52.
    Mol BW, Lijmer JG, Ankum WM, van der Veen F, Bossuyt PM. The accuracy of single serum progesterone measurement in the diagnosis of ectopic pregnancy: a meta-analysis. Hum Reprod. 1998;13(11):3220–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Stovall TG, Ling FW, Carson SA, Buster JE. Serum progesterone and uterine curettage in ­differential diagnosis of ectopic pregnancy. Fertil Steril. 1992;57(2):456–7.PubMedGoogle Scholar
  54. 54.
    Barnhart KT, Katz I, Hummel A, Gracia CR. Presumed diagnosis of ectopic pregnancy. Obstet Gynecol. 2002;100(3):505–10.PubMedCrossRefGoogle Scholar
  55. 55.
    Kaplan BC, Dart RG, Moskos M, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996;28(1):10–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Stovall T. Early pregnancy loss and ectopic pregnancy. In: Berek JS, editor. Berek & Novak’s gynecology. 14th ed. Philadelphia: Lippincott William & Wilkins; 2006. p. 882–931.Google Scholar
  57. 57.
    Anderson FW, Hogan JG, Ansbacher R. Sudden death: ectopic pregnancy mortality. Obstet Gynecol. 2004;103(6):1218–23.PubMedCrossRefGoogle Scholar
  58. 58.
    Korhonen J, Stenman UH, Ylostalo P. Low-dose oral methotrexate with expectant management of ectopic pregnancy. Obstet Gynecol. 1996;88(5):775–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Trio D, Strobelt N, Picciolo C, Lapinski RH, Ghidini A. Prognostic factors for successful expectant management of ectopic pregnancy. Fertil Steril. 1995;63(3):469–72.PubMedGoogle Scholar
  60. 60.
    Shalev E, Peleg D, Tsabari A, Romano S, Bustan M. Spontaneous resolution of ectopic tubal pregnancy: natural history. Fertil Steril. 1995;63(1):15–9.PubMedGoogle Scholar
  61. 61.
    Atri M, Chow CM, Kintzen G, et al. Expectant treatment of ectopic pregnancies: clinical and sonographic predictors. AJR Am J Roentgenol. 2001;176(1):123–7.PubMedGoogle Scholar
  62. 62.
    Mol F, Mol BW, Ankum WM, van der Veen F, Hajenius PJ. Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Hum Reprod Update. 2008;14(4):309–19.PubMedCrossRefGoogle Scholar
  63. 63.
    Tintara H, Choobun T. Laparoscopic adnexectomy for benign tubo-ovarian disease using abdominal wall lift: a comparison to laparotomy. Int J Gynaecol Obstet. 2004;84(2):147–55.PubMedCrossRefGoogle Scholar
  64. 64.
    Tulandi T, Saleh A. Surgical management of ectopic pregnancy. Clin Obstet Gynecol. 1999;42(1):31–8. quiz 55–6.PubMedCrossRefGoogle Scholar
  65. 65.
    Yao M, Tulandi T. Surgical and medical management of tubal and non-tubal ectopic pregnancies. Curr Opin Obstet Gynecol. 1998;10(5):371–4.PubMedCrossRefGoogle Scholar
  66. 66.
    Lundorff P, Thorburn J, Lindblom B. Fertility outcome after conservative surgical treatment of ectopic pregnancy evaluated in a randomized trial. Fertil Steril. 1992;57(5):998–1002.PubMedGoogle Scholar
  67. 67.
    Seifer DB, Gutmann JN, Doyle MB, Jones EE, Diamond MP, DeCherney AH. Persistent ectopic pregnancy following laparoscopic linear salpingostomy. Obstet Gynecol. 1990;76(6):1121–5.PubMedGoogle Scholar
  68. 68.
    Desroque D, Capmas P, Legendre G, Bouyer J, Fernandez H. [Fertility after ectopic pregnancy]. J Gynecol Obstet Biol Reprod (Paris). 2010;39(5):395–400.Google Scholar
  69. 69.
    Rabischong B, Larrain D, Pouly JL, Jaffeux P, Aublet-Cuvelier B, Fernandez H. Predicting success of laparoscopic salpingostomy for ectopic pregnancy. Obstet Gynecol. 2010;116(3):701–7.PubMedCrossRefGoogle Scholar
  70. 70.
    van Mello NM, Mol F, Opmeer BC, et al. Salpingotomy or salpingectomy in tubal ectopic pregnancy: what do women prefer? Reprod Biomed Online. 2010;21(5):687–93.PubMedCrossRefGoogle Scholar
  71. 71.
    Berlin NI, Rall D, Mead JA, et al. Folic acid antagonist. Effects on the cell and the patient. Combined clinical staff conference at the National Institutes of Health. Ann Intern Med. 1963;59:931–56.PubMedGoogle Scholar
  72. 72.
    Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005;173(8):905–12.PubMedCrossRefGoogle Scholar
  73. 73.
    Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens. Obstet Gynecol. 2003;101(4):778–84.PubMedCrossRefGoogle Scholar
  74. 74.
    Alexander JM, Rouse DJ, Varner E, Austin Jr JM. Treatment of the small unruptured ectopic pregnancy: a cost analysis of methotrexate versus laparoscopy. Obstet Gynecol. 1996;88(1):123–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev 2007;(1):CD000324.Google Scholar
  76. 76.
    Stovall TG, Ling FW. Single-dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol. 1993;168(6 Pt 1):1759–62. discussion 62–5.PubMedGoogle Scholar
  77. 77.
    Lipscomb GH, Givens VM, Meyer NL, Bran D. Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol. 2005;192(6):1844–7. discussion 7–8.PubMedCrossRefGoogle Scholar
  78. 78.
    Alleyassin A, Khademi A, Aghahosseini M, Safdarian L, Badenoosh B, Hamed EA. Comparison of success rates in the medical management of ectopic pregnancy with single-dose and multiple-dose administration of methotrexate: a prospective, randomized clinical trial. Fertil Steril. 2006;85(6):1661–6.PubMedCrossRefGoogle Scholar
  79. 79.
    Guvendag Guven ES, Dilbaz S, Dilbaz B, Aykan Yildirim B, Akdag D, Haberal A. Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study. Acta Obstet Gynecol Scand. 2010;89(7):889–95.PubMedCrossRefGoogle Scholar
  80. 80.
    Nowak-Markwitz E, Michalak M, Olejnik M, Spaczynski M. Cutoff value of human chorionic gonadotropin in relation to the number of methotrexate cycles in the successful treatment of ectopic pregnancy. Fertil Steril. 2009;92(4):1203–7.PubMedCrossRefGoogle Scholar
  81. 81.
    Dilbaz S, Caliskan E, Dilbaz B, Degirmenci O, Haberal A. Predictors of methotrexate treatment failure in ectopic pregnancy. J Reprod Med. 2006;51(2):87–93.PubMedGoogle Scholar
  82. 82.
    Bixby S, Tello R, Kuligowska E. Presence of a yolk sac on transvaginal sonography is the most reliable predictor of single-dose methotrexate treatment failure in ectopic pregnancy. J Ultrasound Med. 2005;24(5):591–8.PubMedGoogle Scholar
  83. 83.
    ACOG Practice Bulletin No. 94. Medical management of ectopic pregnancy. Obstet Gynecol 2008;111(6):1479–85.Google Scholar
  84. 84.
    Pisarska MD, Carson SA, Buster JE. Ectopic pregnancy. Lancet. 1998;351(9109):1115–20.PubMedCrossRefGoogle Scholar
  85. 85.
    Nama V, Manyonda I. Tubal ectopic pregnancy: diagnosis and management. Arch Gynecol Obstet. 2009;279(4):443–53.PubMedCrossRefGoogle Scholar
  86. 86.
    Ushakov FB, Elchalal U, Aceman PJ, Schenker JG. Cervical pregnancy: past and future. Obstet Gynecol Surv. 1997;52(1):45–59.PubMedCrossRefGoogle Scholar
  87. 87.
    Sheiner E, Yohai D, Katz M. Cervical pregnancy with placenta accreta. Int J Gynaecol Obstet. 1999;65(2):211–2.PubMedCrossRefGoogle Scholar
  88. 88.
    Valsky DV, Yagel S. Ectopic pregnancies of unusual location: management dilemmas. Ultrasound Obstet Gynecol. 2008;31(3):245–51.PubMedCrossRefGoogle Scholar
  89. 89.
    Stovall TG, Ling FW, Smith WC, Felker R, Rasco BJ, Buster JE. Successful nonsurgical treatment of cervical pregnancy with methotrexate. Fertil Steril. 1988;50(4):672–4.PubMedGoogle Scholar
  90. 90.
    Tang PP, Liu XY, Chen N, et al. Diagnosis and treatment of cervical ectopic pregnancy. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2010;32(5):497–500.PubMedGoogle Scholar
  91. 91.
    Comstock C, Huston K, Lee W. The ultrasonographic appearance of ovarian ectopic pregnancies. Obstet Gynecol. 2005;105(1):42–5.PubMedCrossRefGoogle Scholar
  92. 92.
    Van Coevering 2 RJ, Fisher JE. Laparoscopic management of ovarian pregnancy. A case report. J Reprod Med. 1988;33(9):774–6.PubMedGoogle Scholar
  93. 93.
    Odejinmi F, Rizzuto MI, Macrae R, Olowu O, Hussain M. Diagnosis and laparoscopic management of 12 consecutive cases of ovarian pregnancy and review of literature. J Minim Invasive Gynecol. 2009;16(3):354–9.PubMedCrossRefGoogle Scholar
  94. 94.
    Walid MS, Heaton RL. Diagnosis and laparoscopic treatment of cornual ectopic pregnancy. Ger Med Sci 2010;8. http://www.ncbi.nlm.nih.gov/pubmed?term=Heaton%20RL.%20Diagnosis%20and%20laparoscopic%20treatment%20of%20cornual%20ectopic%20pregnancy. Google Scholar
  95. 95.
    Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril. 1999;72(2):207–15.PubMedCrossRefGoogle Scholar
  96. 96.
    Dilbaz S, Katas B, Demir B, Dilbaz B. Treating cornual pregnancy with a single methotrexate injection: a report of 3 cases. J Reprod Med. 2005;50(2):141–4.PubMedGoogle Scholar
  97. 97.
    Worley KC, Hnat MD, Cunningham FG. Advanced extrauterine pregnancy: diagnostic and therapeutic challenges. Am J Obstet Gynecol. 2008;198(3):297.e1–7.CrossRefGoogle Scholar
  98. 98.
    Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. Br J Obstet Gynaecol. 2007;114(3):253–63.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical CenterBen-Gurion University of the NegevBeer-ShevaIsrael

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