title: Low-lying-implantation ectopic pregnancy: a cluster of cesarean scar, cervico-isthmus, and cervical ectopic pregnancies in the first trimester.
abstract: OBJECTIVE
  To describe the treatment outcomes of aberrant ectopic implantations in the lower segment of the uterus in a cohort population and to evaluate whether or not low-lying-implantation ectopic pregnancy (LLIEP), a new term, is appropriate to include in the traditional diagnoses of cervical pregnancy (CP), cesarean scar pregnancy (CSP), and other unusual aberrant implantations in the lower segment of the uterus in the first trimester, in terms of clinical characteristics, treatment, and prognosis.
  
  
  METHODS
  Forty-two women with ectopic pregnancies of <12 weeks' gestational age from July 2003 to December 2008 were prospectively studied. Each patient underwent an ultrasound evaluation by an experienced consultation team and was grouped into the CP, CSP, or cervico-isthmic pregnancy (CIP) group. Patients underwent either suction dilatation and curettage (D and C) alone, or laparoscopic uterine artery blockage followed by suction D and C, to remove the aberrant trophoblasts without other adjuvant treatments. Clinical characteristics and biochemical factors, including obstetric history, patient age, body mass index (BMI), gestational age, serum hematocrit and β-hCG level, operation method, operation time, and intraoperative blood loss were evaluated.
  
  
  RESULTS
  There were no significant differences in patient age (mean = 34.1 ± 6.4 years), previous number of cesarean deliveries (mean = 1.5 ± 0.8), gestational age (mean = 6.9 ± 1.2 weeks), serum β-hCG (mean = 35,384.3 ± 41,726.9 mIU/mL), operation time (mean = 60.3 ± 46.6 minutes), and surgical blood loss (mean = 124.7 ± 191.5 mL) among the three patient groups. The uterus was successfully preserved in all patients after treatment.
  
  
  CONCLUSIONS
  The prognosis of surgical management for ectopic implantations in the lower segment of the uterus is good. The new term LLIEP seems appropriate to cover all forms of aberrant ectopic implantations in the lower segment of the uterus in the first trimester, in terms of treatment efficacy. The use of LLIEP for preoperative ultrasound diagnosis would enable the clinician to diagnose unusual cases more easily, without the need to change the current treatment policy.
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Tsai
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Kuan-Hui
authors.initials: KH
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Che
authors.initials: YC
authors.lastname: Ou
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Te-Yao
authors.initials: TY
authors.lastname: Hsu
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chia Yi, Chang Gung University College of Medicine, Taiwan.
authors.forename: Chen-Bin
authors.initials: CB
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Ming-Shan
authors.initials: MS
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Ko-Hsin
authors.initials: KH
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Electronic address: ftkung@adm.cgmh.org.tw.
authors.forename: Fu-Tsai
authors.initials: FT
authors.lastname: Kung
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D002584:Cervix Uteri; D002585:Cesarean Section / Q000009:adverse effects; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D002921:Cicatrix / Q000209:etiology; D005260:Female; D006801:Humans; D061646:Operative Time; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D055357:Uterine Artery Embolization; D014619:Vacuum Curettage
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human
keywords: cervical pregnancy; cesarean scar pregnancy; low-lying-implantation ectopic pregnancy; ultrasound