Evidence map›Paper›PMID 38366724›Full record

ArticleActa obstetricia et gynecologica Scandinavica2024

Surgical evacuation combined with Shirodkar cervical suture and selective uterine artery embolization: A fertility preserving treatment for 10-15 weeks' live cesarean scar ectopic pregnancies.

Simrit Nijjar, An Ngo, Lucrezia V de Braud, Conrad Von Stempel, Cecilia Bottomley, Eric Jauniaux, Davor Jurkovic

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In one paragraph

Article in Acta obstetricia et gynecologica Scandinavica, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
3.3field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 6 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 2 countries.

Simrit NijjarDepartment of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.ORCID 0000-0001-8002-0981
An NgoDepartment of Interventional Radiology, University College Hospital, London, UK.
Lucrezia V de BraudDepartment of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.
Conrad Von StempelDepartment of Interventional Radiology, University College Hospital, London, UK.
Cecilia BottomleyDepartment of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.
Eric JauniauxDepartment of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.ORCID 0000-0003-0925-7737
Davor JurkovicDepartment of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.ORCID 0000-0001-6487-5736
Institute for Reproductive Health · USUniversity College Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionCesarean scar ectopic pregnancies (CSEPs) are associated with significant maternal morbidity and termination is often recommended in the early first trimester. Management of more advanced cases is challenging due to higher risks of major intraoperative hemorrhage. Hysterectomy is currently the intervention of choice for advanced cases. This study aimed to investigate if advanced live CSEPs could be managed effectively conservatively using suction curettage and interventional radiology. MATERIAL AND

methodsA retrospective single-center cohort study was performed. A total of 371 women diagnosed with CSEP were identified between January 2008 and January 2023. A total of 6% (22/371) women had an advanced live CSEP with crown-rump length (CRL) of ≥40 mm (≥10 weeks' gestation). Of these, 77% (17/22) opted for surgical intervention, whilst the remaining five continued their pregnancies. A preoperative ultrasound was performed in each patient. All women underwent suction curettage under ultrasound guidance and insertion of Shirodkar cervical suture as a primary hemostatic measure combined with uterine artery embolization (UAE) if required. The primary outcome was rate of blood transfusion. Secondary outcomes were estimated intraoperative blood loss, UAE, intensive care unit admission, reintervention, hysterectomy, hospitalization duration and rate of retained products of conception. Descriptive statistics were used to describe these variables.

resultsMedian CRL of the 17 patients included was 54.1 mm (range: 40.0-85.7) and median gestational age based on CRL was 12 + 3 weeks (range: 10 + 6-15 + 0). On preoperative ultrasound scan placental lacunae were recorded in 76% (13/17) of patients and color Doppler score was ≥3 in 67% (10/15) of patients. At surgery, Shirodkar cervical suture was used in all cases. It was successful in achieving hemostasis by tamponade in 76% (13/17) of patients. In the remaining 24% (4/17) patients tamponade failed to achieve complete hemostasis and UAE was performed to stop persistent arterial bleeding into the uterine cavity. Median intraoperative blood loss was 800 mL (range: 250-2500) and 41% (7/17) women lost >1000 mL. 35% (6/17) needed blood transfusion. No women required hysterectomy.

conclusionsSurgical evacuation with Shirodkar cervical suture and selective UAE is an effective treatment for advanced live CSEPs.

Indexed as

Cesarean SectionCicatrixFertility PreservationPregnancy, EctopicUterine Artery EmbolizationAdultBlood Loss, SurgicalFemaleHumansPregnancyPregnancy Trimester, FirstRetrospective StudiesSuture TechniquesVacuum Curettagecesarean scar pregnancyfertility preservationsecond trimestersuction curettageuterine artery embolization

Identifiers

PMID38366724
PMCPMC11103148
OpenAlexW4391897727

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.