{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T02:11:56Z","timestamp":1767838316124,"version":"3.49.0"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T00:00:00Z","timestamp":1708128000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Cesarean 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A retrospective single\u2010center 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\u2010rump length (CRL) of \u226540\u2009mm (\u226510\u2009weeks' 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median CRL of the 17 patients included was 54.1\u2009mm (range: 40.0\u201385.7) and median gestational age based on CRL was 12\u2009+\u20093\u2009weeks (range: 10\u2009+\u20096\u201315\u2009+\u20090). On preoperative ultrasound scan placental lacunae were recorded in 76% (13\/17) of patients and color Doppler score was \u22653 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\u2009mL (range: 250\u20132500) and 41% (7\/17) women lost &gt;1000\u2009mL. 35% (6\/17) needed blood transfusion. No women required hysterectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Surgical evacuation with Shirodkar cervical suture and selective UAE is an effective treatment for advanced live CSEPs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14803","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T08:14:13Z","timestamp":1708157653000},"page":"1054-1062","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Surgical evacuation combined with Shirodkar cervical suture and selective uterine artery embolization: A fertility preserving treatment for 10\u201315\u2009weeks' live cesarean scar ectopic pregnancies"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8002-0981","authenticated-orcid":false,"given":"Simrit","family":"Nijjar","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"An","family":"Ngo","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology University College Hospital  London UK"},{"name":"Division of Surgery and Interventional Science University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucrezia V.","family":"de\u00a0Braud","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conrad Von","family":"Stempel","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology University College Hospital  London UK"},{"name":"Division of Surgery and Interventional Science University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Bottomley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0925-7737","authenticated-orcid":false,"given":"Eric","family":"Jauniaux","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6487-5736","authenticated-orcid":false,"given":"Davor","family":"Jurkovic","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, EGA Institute for Women's Health, Faculty of Population Health Sciences University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,2,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24815"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15255"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2015.12.130"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-005671"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2023.102361"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2021.07.030"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2020.11.036"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.08.056"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.01.030"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15857"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.4058"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/GCO.0000000000000808"},{"key":"e_1_2_11_14_1","unstructured":"NICE.Uterine artery embolisation for fibroids. 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