Preview

Кубанский научный медицинский вестник

Расширенный поиск

ЭКТОПИЧЕСКАЯ СТЕНОЧНАЯ БЕРЕМЕННОСТЬ

https://doi.org/10.25207/1608-6228-2017-24-6-150-160

Полный текст:

Аннотация

Цель. Систематизация и анализ опубликованных данных для уточнения терминологии, факторов риска, методов диагностики и лечебной тактики для внематочной (эктопической) стеночной беременности. Материалы и методы. Поиск информации, опубликованной в электронных библиографических базах данных PubMed и Cochrane Library, по ключевым словам. Ограничения: английский язык, период до 31 октября 2017 года включительно. Для анализа отбирались работы, содержащие информацию о факторах риска, методах и критериях диагностики, сведения о методах лечения, либо проспективного наблюдения с эктопической стеночной беременностью. Работы распределялись по категориям: клинический случай/серия случаев, обзор, клиническое исследование, рандомизированное контролируемое исследование, систематический обзор/мета-анализ; выделялись абстракты и полноразмерные статьи. Результаты. Обнаружено 1425 источников, соответствующих ключевым словам. Из включенных согласно критериям 1006 работ 236 представлены статьями и 770 – абстрактами; в том числе 863 клинических случаев, 129 обзоров, 5 клинических исследований, 4 рандомизированных контролируемых исследования, 5 систематических обзоров. Эктопическая стеночная беременность включает различные формы со специфическими факторами риска, в ряде случаев возможно донашивание беременности до срока жизнеспособности плода. Основным методом диагностики является ультразвуковое исследование. Сроки диагностики и методы лечения не стандартизированы. Заключение. Ввиду редкости патологии и высокого риска серьезных осложнений, включая утрату фертильности и смерть, необходим национальный аудит стеночных эктопических беременностей с формированием базы данных для анализа исходов и расчета индивидуального прогноза. Для повышения информированности врачей о редких формах эктопической беременности и совершенствования стандартов оказания медицинской помощи необходима разработка клинических рекомендаций.

 

Об авторах

Т. Б. МАКУХИНА
Федеральное государственное бюджетное образовательное учреждение высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской Федерации
Россия


В. В. МАКУХИНА
Федеральное государственное бюджетное образовательное учреждение высшего образования «Кубанский государственный медицинский университет» Министерства здравоохранения Российской Федерации
Россия


Список литературы

1. Shen L, Fu J, Huang W, Zhu H, Wang Q, Yang S, Wu Tet_al2014-Interventions for non-tubal ectopic pregnancies (Protocol). Cochrane Database of Systematic Reviews. 2014, Issue 7. Art. No.: CD011174. DOI: 10.1002/14651858.CD011174.

2. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Human Reproduction. 2002; 17(12): 3224-30.

3. Centre for Maternal and Child Enquiries, CMACE (2011). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer, 2006–08: the eighth report on confidential enquiries into maternal deaths in the United Kingdom. British Journal Obstetrics & Gynaecology, 118 (S1), 1-203.

4. Barnhart KT. Clinical practice. Ectopic pregnancy. The New England Journal of Medicine. 2009; 361(4): 379-87.

5. Orazulike NC, Konje JC. Diagnosis and management of ectopic pregnancy. Womens Health (Lond Engl). 2013; 9(4): 373-85.

6. Ngu SF, Cheung VY. Non-tubal ectopic pregnancy. International Journal of Gynaecology and Obstetrics. 2011; 115(3): 295-7.

7. Makukhina T., Makukhina V. Low-lying-implantation ectopic pregnancies treatment and outcomes. Ultrasound in Obstetrics & Gynecology. 2016; 48(Suppl. 1): 228.

8. Sekiguchi A, Okuda N, Kawabata I, Nakai A, Takeshita T. Ultrasound detection of lacunae-like image of a cesarean scar pregnancy in the first trimester. J Nippon Med Sch. 2013; 80(1): 70-3.

9. Zorn B, Lumbroso P, Fingerhut A. 3 new cases of pregnancy of the uterine horn. Rev Fr Gynecol Obstet. 1984 Jul-Sep; 79(7-9): 541-5. French.

10. Kirk E, McDonald K, Rees J, Govind A. Intramural ectopic pregnancy: a case and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2013; 168: 129-33.

11. Wang J., X. Xie J Sonographic Diagnosis of Intramural Pregnancy. Ultrasound Med. 2013; 32: 2212-2219.

12. Panelli D.M, Phillips C.H., Brady P.C. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertility Research and Practice. 2015; 1: 15.

13. Buttenberg D. Intramural pregnancy]. Zentralbl Gynakol. 1955; 77(26): 1018-24. German.

14. Chida H, Kikuchi A, Murai M, Sasaki Y, Kanasugi T, Isurugi C, Oyama R, Sugiyama T. Intramural Pregnancy Implanted Into a Myometrial Defect Caused by Curettage: Diagnosis With Transvaginal Sonography and Preconception and Postconception Magnetic Resonance Imaging. J Ultrasound Med. 2016 Sep; 35(9): 2066-7. doi: 10.7863/ultra.15.11071

15. Memtsa M., Jamil A., Sebire N., Jauniaux E.and Jurkovic D.. Diagnosis and management of intramural ectopic pregnancy. Ultrasound Obstet Gynecol. 2013; 42: 359-362.

16. Jurkovic D, Mavrelos D. Catch me if you scan: ultrasound diagnosis of ectopic pregnancy. Ultrasound Obstet Gynecol. 2007; 30: 1-7.

17. Naftalin J, Jurkovic D. The endometrial-myometrial junction: a fresh look at a busy crossing. Ultrasound Obstet Gynecol. 2009 Jul; 34(1): 1-11. doi: 10.1002/uog.6432.

18. Bannon K, Fernandez C, Rojas D, Levine EM, Locher S. Diagnosis and management of intramural ectopic pregnancy. J Minim Invasive Gynecol. 2013 Sep-Oct; 20(5): 697-700. doi: 10.1016/j. jmig.2013.02.023.

19. Nabeshima H, Nishimoto M, Utsunomiya H, Arai M, Ugajin T, Terada Y, Yaegashi N. Total laparoscopic conservative surgery for an intramural ectopic pregnancy. Diagn Ther Endosc. 2010; 2010:504062. doi: 10.1155/2010/504062. Epub 2010 Oct 11.

20. Lazović B., Milenković V. Intramural ectopic pregnancy. Arch Oncol. 2010; 18(1-2): 30-1.

21. Wu PJ, Han CM, Wang CJ, Lee CL. Early detection and minimally invasive management of intramural pregnancy. J Minim Invasive Gynecol. 2013 Jan-Feb; 20(1): 123-6. doi: 10.1016/j. jmig.2012.08.783.

22. Capogna M.V., Costantini A., Santomarco N., Piccione E., Boninfante M.: Intramural ectopic pregnancy: report of a singular case of intramural pregnancy. It. J. Gynaecol. Obstet. 2014; 26(4): 37-40.

23. Levine D. Ectopic pregnancy. Radiology. 2007; 245(2): 385-97.

24. Moawad NS, Mahajan ST, Moniz MH, Taylor SE, Hurd WW. Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol. 2010; 202: 15-29.

25. Poon LC, Emmanuel E, Ross JA, Johns J. How feasible is expectant management of interstitial ectopic pregnancy? Ultrasound Obstet Gynecol. 2014 Mar; 43(3): 317-21. doi: 10.1002/ uog.12565. Epub 2014 Feb 12.

26. Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Human Reproduction. Update 2014; 20(2): 250- 61.

27. Ngu S, Hamontri S, Chua I, Chern B, Siow A. Laparoscopic management of 53 cases of cornual ectopic pregnancy. Fertil Steril. 2009; 92: 448-52.

28. Parker RA , Yano M, Tai AW, Friedman M, Narra VR, Menias CO. MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics. 2012 Sep-Oct; 32(5): 1445-60; discussion 1460-2. doi: 10.1148/rg.325115153. Review.

29. Takeda A, Koike W, Hayashi S, Imoto S, Nakamura H. Magnetic resonance imaging for diagnosis and management of unruptured interstitial pregnancy. J Obstet Gynaecol Res. 2015 Sep; 41(9): 1384-93. doi: 10.1111/jog.12718. Epub 2015 Jul 14.

30. Cassik P, Ofili-Yebovi D, Yazbek J, Jurkovic D. Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol. 2005; 26: 279-283.

31. Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril. 2007; 87: 481-4.

32. Tamarit G, Lonjedo E, González M, Tamarit S, Domingo S, Pellicer A. Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis. Fertil Steril. 2010; Mar 1; 93(4): 1348.e1-4. doi: 10.1016/j.fertnstert.2009.03.087.

33. Deruelle P, Lucot JP, Lions C, Robert Y. Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 2005; 106: 1165-7.

34. Siow A, Ng S. Laparoscopic management of 4 cases of recurrent cornual ectopic pregnancy and review of literature. J Minim Invasive Gynecol. 2011; 18: 296-302.

35. Douysset X, Verspyck E, Diguet A, Marpeau L, Chanavaz-Lacheray I, Rondeau S, Resch B, Sergent F. Interstitial pregnancy: experience at Rouen's hospital. Gynecol Obstet Fertil. 2014 Apr; 42(4): 216-21.

36. Horne AW, Skubisz MM, Tong S, Duncan WC, Neil P, Wallace EM, Johns TG. Combination gefitinib and methotrexate treatment for non-tubal ectopic pregnancies: a case series. Hum Reprod. 2014 Jul; 29(7): 1375-9.

37. Watanabe T, Watanabe Z, Watanabe T, Fujimoto K, Sasaki E. Laparoscopic cornuotomy for interstitial pregnancy and postoperative course. J Obstet Gynaecol Res. 2014 Aug; 40(8): 1983-8.

38. Mayer RB, Yaman C, Ebner T, Shebl O, Sommergruber M, Hartl J, Tews G. Ectopic pregnancies with unusual location and an angular pregnancy: Report of eight cases. Wien Klin Wochenschr. 2012 Mar; 124(5-6): 193-7. doi: 10.1007/s00508-011-0115-8. Epub 2012 Jan 4.

39. Nadi M, Richard C, Filipuzzi L, Bergogne L, Douvier S, Sagot P. Interstitial, angular and cornual pregnancies: Diagnosis, treatment and subsequent fertility. Gynecol Obstet Fertil Senol. 2017 Jun; 45(6): 340-347. doi: 10.1016/j.gofs.2017.05.002. Epub 2017 May 25.

40. Alanbay İ, Öztürk M, Karaşahin KE, Yenen MC. Angular pregnancy. Turk J Obstet Gynecol. 2016 Dec; 13(4): 218-220. doi: 10.4274/tjod.42402. Epub 2016 Dec 15.

41. Grant A, Murji A, Atri M. Can the Presence of a Surrounding Endometrium Differentiate Eccentrically Located IntrauterinePregnancy from Interstitial Ectopic Pregnancy? J Obstet Gynaecol Can. 2017 Aug; 39(8): 627-634. doi: 10.1016/j.jogc.2017.03.087.

42. Arleo EK, DeFilippis EM. Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging. 2014 Nov-Dec; 38(6): 763-70. doi: 10.1016/j.clinimag.2014.04.002. Epub 2014 Apr 16. Review.

43. Srisajjakul S, Prapaisilp P, Bangchokdee S. Magnetic resonance imaging in tubal and non-tubal ectopic pregnancy. Eur J Radiol. 2017 Aug; 93: 76-89. doi: 10.1016/j.ejrad.2017.05.023. Epub 2017 May 22. Review.

44. Tanaka Y, Mimura K, Kanagawa T, Kajimoto E, Takahashi K, Kakigano A, Fujita S, Kinugasa-Taniguchi Y, Endo M, Kimura T. Three-dimensional sonography in the differential diagnosis of interstitial, angular, and intrauterine pregnancies in a septate uterus. J Ultrasound Med. 2014 Nov; 33(11): 2031-5. doi: 10.7863/ultra.33.11.2031.

45. Chou MM, Tseng JJ, Yi YC, Chen WC, Ho ES Diagnosis of an interstitial pregnancy with 4-dimensional volume contrast imaging. Am J Obstet Gynecol. 2005 Oct; 193(4): 1551-3.

46. Cruz Martínez R, García Salazar N, Manzanares G. Non-broken, angular, and ectopic pregnancy of 22 weeks. Case report and literature review. Ginecol Obstet Mex. 2008 Jul; 76(7): 417-20. Review.

47. Ciavattini A, Cerè I, Tsiroglou D, Caselli FM, Tranquilli AL. Angular-interstitial pregnancy treated with minimally invasive surgery after adjuvant methotrexate medical therapy. JSLS. 2007 JanMar; 11(1): 123-6.

48. Tarim E, Ulusan S, Kilicdag E, Yildirim T, Bagis T, Kuscu E. Angular pregnancy. J Obstet Gynaecol Res. 2004 Oct; 30(5): 377-9.

49. Baldawa PS, Chaudhari HK. Angular ectopic pregnancy presenting as rupture of lateral wall of the uterus. J Hum Reprod Sci. 2008 Jan; 1(1): 33-4.

50. Hasanzadeh M, Dadgar S, Arian Y, Yousefi Y. Angular Ectopic Pregnancy Presenting as Rupture of Lateral Wall of the Uterus: Late Presentation in Gestation Week 20. Iran J Med Sci. 2017 May; 42(3): 314-317.

51. Alves JA, Alves NG, Alencar Júnior CA, Feitosa FE, da Silva Costa F Term angular pregnancy: successful expectant management. J Obstet Gynaecol Res. 2011 Jun; 37(6): 641-4. doi: 10.1111/j.1447-0756.2010.01405.x. Epub 2011 Mar 6.

52. Wehbé A, Ioan A, Allart JP, Fontanié P, Assemekang B, Azoulay M, Delezoide AL. A case of cervico-isthmic pregnancy with delayed development. Rev Fr Gynecol Obstet. 1993 Jul-Sep; 88(7- 9): 439-44.

53. Hingorani SR, Parulekar SV, Ratnam KL. Isthmico-cervical ectopic pregnancy following caesarean section. J Postgrad Med. 1994 Jan-Mar; 40(1): 33-5.

54. Hsieh BC, Seow KM, Hwang JL, Lin YH, Huang LW, Chen HJ, Tzeng CR. Conservative treatment of cervico-isthmic heterotopic pregnancy by fine needle aspiration for selective embryo reduction. Reprod Biomed Online. 2008 Dec; 17(6): 803-5.

55. Loureiro T, Cunha M, Marques E, Araújo ML, Montenegro N, Laurini R, Exposito MI, del Pilar Martinez M. Non-viable cervico-isthmic pregnancy: the importance of an accurate sonographic diagnosis to preserve fertility. Fetal Diagn Ther. 2003 Sep-Oct; 18(5): 289-91.

56. Di Spiezio Sardo, G. Saccone, R. Mccurdy, E. Bujold, G. Bifulco and V. Berghella. Risk of Cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol. 2017. Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.17401

57. Tsai SW, Huang KH, Ou YC, et al. Low-lying- implantation ectopic pregnancy: a cluster of cesarean scar, cervico-isthmus, and cervical ectopic pregnancies in the first trimester. Taiwan J Obstet Gynecol. 2013 Dec; 52(4): 505-11.

58. Shahraki AD, Khani B, Mohammadizadeh F, Hashemi L. Cervico-isthmic pregnancy is a potentially dangerous ectopic pregnancy. J Res Med Sci. 2014 Jan; 19(1): 85-6.

59. Bari S, Ara G, Nessa K. Pregnancy Located below the Internal Os – Cervical and Caesarean Scar Ectopics. J Enam Med Col. 2015; 5(2): 118-21.

60. Makukhina T, Knyazeva N Cervico-isthmic ectopic pregnancy: A case report. Edorium J Gynecol Obstet. 2016; 2: 17-20.

61. Oyelese Y, Elliott TB, Asomani N, Hamm R, Napoli L, Lewis KM. Sonography and magnetic resonance imaging in the diagnosis of cervico-isthmic pregnancy. J Ultrasound Med. 2003 Sep; 22(9): 981-3.

62. Strobelt N, Locatelli A, Ratti M, Ghidini A. Cervico-isthmic pregnancy: a case report, critical reappraisal of the diagnostic criteria, and reassessment of the outcome. Acta Obstet Gynecol Scand. 2001 Jun; 80(6): 586-8. Review.

63. Gun M. and Mavrogiorgis M. Cervical ectopic pregnancy: a case report and literature review. Ultrasound Obstet Gynecol. 2002; 19: 297-301.

64. Avery DM, Wells MA, Harper DM. Cervico-isthmic corporeal pregnancy with delivery at term: a review of the literature with a case report. Obstet Gynecol Surv. 2009 May; 64(5): 335-44. doi: 0.1097/OGX.0b013e31819f95ff. Review.

65. Sharma A, Ojha R, Mondal S, Chattopadhyay S, Sengupta P. Cervical intramural pregnancy: Report of a rare case. Niger Med J. 2013 Jul; 54(4): 271-3. doi: 10.4103/0300-1652.119670

66. Weichert A., Thomas A., Henrich W., Köhler C., Dudenhausen J.W., Kalache K.D. Cervico-isthmic pregnancy with cervical placenta accrete. Perinat. Med. 2012; 1(1-2): 11-14.

67. Kung F.T., Lin H., Hsu T.Y., Chang C.Y., Huang H.W., Huang L.Y., Chou Y.J., Huang K.H. Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection. Fertil Steril. 2004; Jun; 81(6): 1642-9.

68. Kayem G, Deis S, Estrade S, Haddad B. Conservative management of a near-term cervico-isthmic pregnancy, followed by a successful subsequent pregnancy: A case report. Fertil Steril. 2008; 89: 1826.e13-5.

69. Sakai A, Fujita Y, Yumoto Y, Fukushima K, Kobayashi H, Wake N. Successful management of cervico-isthmic pregnancy delivered at term. J Obstet Gynaecol Res. 2013; Jan; 39(1): 371-4. case report.

70. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound in Obstetrics & Gynecology. 2003; 21(3): 220-7.

71. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004; 23: 247-53.

72. Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication. Human Reproduction Update. 2004; 10(6): 515-23.

73. Parker VL, Srinivas M. Non-tubal ectopic pregnancy. Arch Gynecol Obstet. 2016 Jul; 294(1): 19-27.

74. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006; 107: 1373-81.

75. Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012; 207: 44.

76. Timor-Tritsch IE, Monteagudo A, Cali G, Vintzileos A, Viscarello R, Al-Khan A, Zamudio S, Mayberry P, Cordoba MM and Dar P, Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol. 2014; 44: 346-353.

77. Zosmer N., Fuller J., Shaikh H., Johns J. and Ross J. A. Natural history of early first-trimester pregnancies implanted in Cesarean scars. Ultrasound Obstet Gynecol. 2015; 46: 367-375.

78. Alfirevic Z., Tang A.-W., Collins S. L., Robson S. C., Palacios-Jaraquemada J. Pro forma for ultrasound reporting in suspect ed abnormally invasive placenta (AIP): an international consensus. Ultrasound Obstet Gynecol. 2016; 47: 276-278.

79. Timor-Tritsch IE, Monteagudo A, Cali G, El Refaey H, Kaelin Agten A, Arslan AA. Easy sonographic differential diagnosis between intrauterine pregnancy and cesarean delivery scar pregnancy in the early first trimester. Am J Obstet Gynecol. 2016 Aug; 215(2): 225.e1-7.

80. Salomon L.J. Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, Lau TK, Papageorghiou AT, Raine-Fenning NJ, Stirnemann J, Suresh S, Tabor A, Timor-Tritsch IE, Toi A, Yeo G. ISUOG Practice Guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013 Jan; 41(1): 102- 13. doi: 10.1002/uog.12342.

81. Marchiole P, Gorlero F, De Caro G. Intramural pregnancy embedded in a previous cesarean section scar treated conservatively. Ultrasound in Obstetrics & Gynecology. 2004; 23(3): 305-9.

82. Fylstra DL. Hysteroscopy and suction evacuation of cesarean scar pregnancies: a case report and review. J Obstet Gynaecol Res. 2014; 40: 853-7.

83. Mollo A, Conforti A, Alviggi C, De Placido G. Successful direct bipolar resection of 6th week cesarean scar pregnancy: case report and literature review. Eur J Obstet Gynecol Reprod Biol. 2014; 179: 229-31.

84. Wang G, Liu X, Bi F, Yin L, Sa R, Wang D, et al. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy. Fertil Steril. 2014; 101: 1501-7.

85. Hoshino T, Miyamoto T, Yoshioka S. Resection of Cesarean Scar Pregnancy at Six Weeks of Gestation with Laminaria Cervical Dilatation under Sonographic and Hysteroscopic Guidance. Case Rep Obstet Gynecol. 2015; 2015:685761.

86. Berhie SH, Molina RL, Davis MR, Anchan RM, Wang KC. Beware the scar: Laparoscopic hysterectomy for 7-week cesarean delivery scar implantation pregnancy. Am J Obstet Gynecol. 2015; 212:247.

87. Jurkovic D. Cesarean scar pregnancy and placenta accrete. Ultrasound Obstet Gynecol. 2014; 43: 361-362.

88. Timor-Tritsch IE, Khatib N, Monteagudo A, Ramos J, Berg R, Kovács S. Cesarean scar pregnancies: experience of 60 cases. J Ultrasound Med. 2015; 34: 601-10.

89. Chetty M, Elson J. Treating non-tubal ectopic pregnancy. Best Practice & Research. Clinical Obstetrics & Gynaecology 2009; 23(4): 529-38.

90. Yamaguchi M, Honda R, Uchino K, Tashiro H, Ohba T, Katabuchi H. Transvaginal methotrexate injection for the treatment of cesarean scar pregnancy: efficacy and subsequent fecundity. J Minim Invasive Gynecol. 2014; 21: 877-83.

91. Maymon R, Svirsky R, Smorgick N, Mendlovic S, Halperin R, Gilad K, et al. Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy. J Ultrasound Med. 2011; 30: 1179-84.


Для цитирования:


МАКУХИНА Т.Б., МАКУХИНА В.В. ЭКТОПИЧЕСКАЯ СТЕНОЧНАЯ БЕРЕМЕННОСТЬ. Кубанский научный медицинский вестник. 2017;(6):150-160. https://doi.org/10.25207/1608-6228-2017-24-6-150-160

For citation:


MAKUKHINA T.B., MAKUKHINA V.V. ECTOPIC MURAL PREGNANCY. Kuban Scientific Medical Bulletin. 2017;(6):150-160. (In Russ.) https://doi.org/10.25207/1608-6228-2017-24-6-150-160

Просмотров: 204


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 1608-6228 (Print)
ISSN 2541-9544 (Online)