{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T07:18:13Z","timestamp":1768461493181,"version":"3.49.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,11,4]],"date-time":"2019-11-04T00:00:00Z","timestamp":1572825600000},"content-version":"vor","delay-in-days":307,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>STUDY QUESTION<\/jats:title>\n                  <jats:p>Do management strategies (treatment type and order), including provision of reproductive counseling, differ in patients with non-tubal pregnancies?<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>SUMMARY ANSWER<\/jats:title>\n                  <jats:p>Medical and surgical treatment strategies varied widely for each type of non-tubal pregnancy and reproductive counseling in this patient population is lacking.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WHAT IS KNOWN ALREADY<\/jats:title>\n                  <jats:p>Owing to the rarity of non-tubal pregnancies, there is no consensus regarding treatment strategies or protocol. Furthermore, there is limited data on how patients with a non-tubal pregnancy are counseled about future fertility.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY DESIGN, SIZE, DURATION<\/jats:title>\n                  <jats:p>This is a descriptive retrospective study. Data were collected from January 2006 to December 2017. A total of 50 patients were included in the study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/jats:title>\n                  <jats:p>Patients with an ultrasound diagnosis of a non-tubal ectopic pregnancy (e.g. cervical ectopic pregnancy [CEP], Caesarean scar pregnancy [CSP] or interstitial ectopic pregnancy [IEP]) were included. This study was performed at a university-based institution tertiary referral center. Demographic and clinical characteristics, treatment type and order, reproductive counseling and outcomes were collected. Descriptive statistics were used for analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>MAIN RESULTS AND THE ROLE OF CHANCE<\/jats:title>\n                  <jats:p>Of the 50 patients identified, 13 were CEP (26%), 8 were CSP (16%) and 29 were IEP (58%). Patients with a CSP had a higher parity (median\u2009=\u20093, P\u2009=\u20090.02) and number of prior Caesarean deliveries (mean\u2009=\u20092.1, P\u2009&lt;\u20090.001). A total of 66% (23\/35) of patients expressed a desire for future fertility prior to treatment and only 56% (28\/50) of patients received reproductive counseling according to the electronic medical records. Among all non-tubal pregnancies, there were variations in the type and the order of treatments that patients received.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>LIMITATIONS, REASONS FOR CAUTION<\/jats:title>\n                  <jats:p>This study was performed in a tertiary referral center therefore the management strategy could have been influenced by the prior interventions and patient response. The descriptive retrospective design precluded any assumption of causation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WIDER IMPLICATIONS OF THE FINDINGS<\/jats:title>\n                  <jats:p>The management for non-tubal pregnancies has wide variations. Reproductive counseling in this patient population is lacking. The findings highlight the need for the development of a treatment algorithm and a reproductive counseling protocol for each non-tubal pregnancy to better standardize treatment strategy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY FUNDING\/COMPETING INTEREST(S)<\/jats:title>\n                  <jats:p>There was no funding for this study. The authors have no conflict of interest to report.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/hropen\/hoz028","type":"journal-article","created":{"date-parts":[[2019,9,13]],"date-time":"2019-09-13T11:42:03Z","timestamp":1568374923000},"source":"Crossref","is-referenced-by-count":12,"title":["Management and reproductive counseling in cervical, caesarean scar and interstitial ectopic pregnancies over 11\u00a0years: identifying the need for a modern management algorithm"],"prefix":"10.1093","volume":"2019","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7040-0542","authenticated-orcid":false,"given":"Jaimin S","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2270-3615","authenticated-orcid":false,"given":"Susan","family":"Nasab","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3801-346X","authenticated-orcid":false,"given":"Ramesha","family":"Papanna","sequence":"additional","affiliation":[{"name":"Department of Fetal Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9510-4923","authenticated-orcid":false,"given":"Han-Yang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7731-2219","authenticated-orcid":false,"given":"Pamela","family":"Promecene","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7644-7779","authenticated-orcid":false,"given":"Pamela","family":"Berens","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Fetal Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asha","family":"Bhalwal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,11,4]]},"reference":[{"key":"2019112109302936600_ref1","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1080\/01443615.2017.1323852","article-title":"Evidence-based management of non-tubal ectopic pregnancies","volume":"37","author":"Alalade","year":"2017","journal-title":"J Obstet Gynaecol"},{"key":"2019112109302936600_ref2","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.1097\/AOG.0000000000002560","article-title":"ACOG Practice Bulletin No. 193: tubal ectopic pregnancy","volume":"131","author":"American College of Obstetricians and Gynecologists","year":"2018","journal-title":"Obstet Gynecol"},{"key":"2019112109302936600_ref3","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.bpobgyn.2008.12.011","article-title":"Treating non-tubal ectopic pregnancy","volume":"23","author":"Chetty","year":"2009","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2019112109302936600_ref4","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1097\/00006250-200402000-00044","article-title":"ACOG Committee Opinion. 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