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Objective: To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition.Design: A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS).Setting: 86 participating Early Pregnancy Units.Population: All women diagnosed in the participating units with CSP between November 2013 and January 2015.Methods: Cohort study of women identified through the UKEPSS monthly mailing system.Main Outcome Measures: Incidence, clinical outcomes and complications.Results: 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1-1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37-174) with expectant, 21 (range 10-31) with medical and 11 (range 4-49) with surgical management.Conclusions: Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up.Tweetable Abstract: Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Quenby S, Matthew A, Zhang J, Dawood F, Wray S. In vitro myometrial contractility reflects indication for caesarean section. BJOG 2011;118:1499-1506. Objective To assess the extent to which in vitro measurements of myometrial contractility reflect the clinical indication for caesarean section. Design A prospective, observational hypothesis-generating study. Setting Women were recruited from Liverpool Women's NHS Foundation Trust and experiments were performed in the Physiology Department at the University of Liverpool. Population Myometrial samples were taken from women undergoing a caesarean section during labour ( n = 50) or from women having a repeat nonlabouring caesarean section ( n = 70). Methods The demographic characteristics of the women and indications for current and previous caesarean sections were recorded. The force, frequency and duration of spontaneous contractions of myometrial strips, and changes in the intracellular calcium concentration of the strips, were measured. Kruskall-Wallis and post hoc tests were used to assess the significance of differences between groups. Results Samples from women whose caesarean section was for fetal distress/acidosis (scalp pH <7.2) contracted with more force than those from women whose caesarean section was for delay in the first stage of labour ( P < 0.001). For repeat, nonlabouring caesarean sections, samples from women whose first caesarean section was for fetal distress/acidosis also contracted with more force than did samples from women whose first caesarean section was for delay in the first stage of labour ( P = 0.03). Conclusions These findings suggest that the myometrium contracts with greater force in women who have a caesarean section for fetal distress. [ABSTRACT FROM AUTHOR]

Objective: To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition., Design: A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS)., Setting: 86 participating Early Pregnancy Units., Population: All women diagnosed in the participating units with CSP between November 2013 and January 2015., Methods: Cohort study of women identified through the UKEPSS monthly mailing system., Main Outcome Measures: Incidence, clinical outcomes and complications., Results: 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1-1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37-174) with expectant, 21 (range 10-31) with medical and 11 (range 4-49) with surgical management., Conclusions: Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up., Tweetable Abstract: Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up., (© 2018 Royal College of Obstetricians and Gynaecologists.)

Background: Endoplasmic reticulum (ER) resident protein 44 (ERp44) is a member of the protein disulfide isomerase family, is induced during ER stress, and may be involved in regulating Ca(2+) homeostasis. However, the role of ERp44 in cardiac development and function is unknown. The aim of this study was to investigate the role of ERp44 in cardiac development and function in mice, zebrafish, and embryonic stem cell (ESC)-derived cardiomyocytes to determine the underlying role of ERp44., Methods and Results: We generated and characterized ERp44(-/-) mice, ERp44 morphant zebrafish embryos, and ERp44(-/-) ESC-derived cardiomyocytes. Deletion of ERp44 in mouse and zebrafish caused significant embryonic lethality, abnormal heart development, altered Ca(2+) dynamics, reactive oxygen species generation, activated ER stress gene profiles, and apoptotic cell death. We also determined the cardiac phenotype in pressure overloaded, aortic-banded ERp44(+/-) mice: enhanced ER stress activation and increased mortality, as well as diastolic cardiac dysfunction with a significantly lower fractional shortening. Confocal and LacZ histochemical staining showed a significant transmural gradient for ERp44 in the adult heart, in which high expression of ERp44 was observed in the outer subepicardial region of the myocardium., Conclusions: ERp44 plays a critical role in embryonic heart development and is crucial in regulating cardiac cell Ca(2+) signaling, ER stress, ROS-induced oxidative stress, and activation of the intrinsic mitochondrial apoptosis pathway., (© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)

Objective: To assess the extent to which in vitro measurements of myometrial contractility reflect the clinical indication for caesarean section., Design: A prospective, observational hypothesis-generating study., Setting: Women were recruited from Liverpool Women's NHS Foundation Trust and experiments were performed in the Physiology Department at the University of Liverpool., Population: Myometrial samples were taken from women undergoing a caesarean section during labour (n = 50) or from women having a repeat nonlabouring caesarean section (n = 70)., Methods: The demographic characteristics of the women and indications for current and previous caesarean sections were recorded. The force, frequency and duration of spontaneous contractions of myometrial strips, and changes in the intracellular calcium concentration of the strips, were measured. Kruskall-Wallis and post hoc tests were used to assess the significance of differences between groups., Results: Samples from women whose caesarean section was for fetal distress/acidosis (scalp pH <7.2) contracted with more force than those from women whose caesarean section was for delay in the first stage of labour (P < 0.001). For repeat, nonlabouring caesarean sections, samples from women whose first caesarean section was for fetal distress/acidosis also contracted with more force than did samples from women whose first caesarean section was for delay in the first stage of labour (P = 0.03)., Conclusions: These findings suggest that the myometrium contracts with greater force in women who have a caesarean section for fetal distress., (© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.)