AimCesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. The gestational sac is implanted in the myometrium at the site of a previous cesarean section. Mothers with CSP are faced with risks of unpredictable massive bleeding or more fatal complications. The purpose of this retrospective study was to assess the feasibility, efficacy, and reliability of the intraoperative ultrasound‐guided vacuum aspiration method as an effective treatment option for CSP.MethodsWe undertook a retrospective analysis of CSP patients who had undergone the vacuum aspiration method, by reviewing patient records from the period October 2015 to January 2018. All of the operations were carried out under general anesthesia, with patients in the lithotomy position, using suprapubic ultrasonography guidance. A vacuum aspirator was used to aspirate the whole pregnancy material without perforating the previous cesarean section scar.ResultsTen women with CSP were managed successfully by ultrasound‐guided vacuum extraction without complications or further interventions, such as reoperation or methotrexate administration. Three of the 10 patients needed uterine Foley catheter tampon (50 cc) for 4 h after vacuum extraction alone was applied. During the study period, two additional patients who did not meet the criteria for the vacuum extraction method alone were managed with methotrexate plus vacuum application. Because of the rarity of the condition, the majority of CSPs are case reports or small case series reported in published works, with no consensus on the preferred course of treatment.ConclusionThe vacuum extraction method seems to be a good and practical way of treating CSP. Comparisons of efficacy should be undertaken but large sample sizes are required. We hope this study brings a new perspective for larger sample‐sized studies, considering the technique is feasible and applicable.

INTRODUCTIONIntraoperative injury of obturator nerve is a rare complication of gynecologic surgeries, it has been reported especially in patients with endometriosis and genitourinary malignancies. Gynecologic patients undergoing open lymphadenectomy are at increased risk of obturator nerve injury.PRESENTATION OF CASEA 60-year-old woman with FIGO stage II Grade II endometrial adenocarcinoma underwent bilateral pelvic paraaortic lymphadenectomy. During right obturator lymph node dissection, the right obturator nerve was inadvertently transected with Harmonic scalpel sealing system. The graft was used to anastomose epyneurium of distal segment of obturator nerve to its counterpart in the proximal segment with 10–0 prolen suture.DISCUSSIONIn case of iatrogenic nerve transection, microsurgical end to end tension-free coaptation is advocated. In case of the obturator nerve is fixed and because of the thermal injury end to end alignment can not be achieved, nerve grafting is necessary.CONCLUSIONAccording to our knowledge, successful immediate grafting of iatrogenically damaged obturator nerve during pelvic lymphadenectomy in our patient is the third report of such a case, but also it has a unique feature of being the first obturator nerve repairing case after dissected with tissue sealing system which causes large sealed area that does not make it possible to make end-to-end anastomosis without nerve harvesting.

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Ektopik gebelik ilk trimesterde morbidite ve mortalitenin en sık nedenidir. İnterstisyal gebelik ektopik gebeliğin en nadir formlarından olup tüm ektopik gebeliklerin %2-4'ünü oluşturmaktadır. Bu yazımızda girişime gerek kalmadan sistemik Metotreksat ile başarılı şekilde tedavi edilmiş interstisyal gebelik olgusunu tartıştık. Seri β-hCG ölçümlerinde yeterli regresyon izlendi ve operasyona ihtiyaç kalmadı. Klinik deneyimimize göre hemodinamik olarak stabil, batında ve pelviste ağrısı olmayan interstisyal gebeliği olan hastalarda sistemik MTX tedavisi seri β-hCG ölçümleri ile izlem yapılarak uygulanması cerrahiye gereksinimi azaltmakta ve de böylece morbidite ve mortaliteye de olumlu yönde katkıda bulunmaktadır. AbstractEctopic pregnancy is the most common cause of morbidity and mortality in the first trimester of pregnancy. Interstitial pregnancy is one of the rarest form of ectopic pregnancies that constitutes of 2-4% of ectopic pregnancies. In this paper, we discussed the case of the interstitial pregnancy that successfully treated with systemic Methotrexate without requiring operation. Serial β-hCG were regressed without any need to further manipulations including operation. According to our clinical experience, in cases of interstitial pregnancies that hemodynamically stabilized and not having severe abdominal nor pelvic pain, systemic MTX treatment could be applied under serial USG and β-hCG follow-ups, that contribute low morbidity and mortality rates and lesser requirement to surgical approach Anahtar Kelimeler: Dış gebelik, interstisyal gebelik, Metotreksat