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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., (© 2018 Royal College of Obstetricians and Gynaecologists.)

Aims/hypothesis: The prevalence of births worldwide complicated by diabetes mellitus is increasing. In the UK, for example, <25% of diabetic women have a non-instrumental vaginal delivery. Strikingly, more than half the Caesarean sections (CS) in these patients are non-elective, but the reasons for this are not understood. We have tested the hypothesis that poor myometrial contractility as a consequence of the disease contributes to this high CS rate., Methods: We compared spontaneous, high K depolarisation and oxytocin-induced contractions from diabetic and matched control patients having an elective CS. To investigate the mechanism of any differences we measured intracellular Ca, and performed western blotting and compared the tissues histologically., Results: There was significantly decreased contraction amplitude and duration in uteri from diabetic compared with control patients, even when possible confounders such as BMI were analysed. Reduced intracellular calcium signals and expression of calcium entry channels were found in uteruses from diabetic patients, which, along with a reduction in muscle content found on histological examination, could explain the reduced force. Myometrium from diabetic patients was responsive to oxytocin, but still did not reach the levels found in non-diabetic patients., Conclusions/interpretations: These are the first data investigating myometrium in diabetic patients and they support the hypothesis that there is poorer contractility even in the presence of oxytocin. The underlying mechanism is related to reduced Ca channel expression and intracellular calcium signals and a decrease in muscle mass. We conclude that these factors significantly contribute to the increased emergency CS rate in diabetic patients.

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.)

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]