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The article discusses a case of gestational trophoblastic neoplasia (GTN) in a cesarean scar following a hydatidiform mole. The patient underwent surgery and chemotherapy, with successful outcomes and no signs of recurrence. The management of GTN in cesarean scar sites presents challenges due to the lack of standardized guidelines, highlighting the importance of multidisciplinary collaboration in such cases. Surgical intervention may be necessary for high-risk or chemotherapy-resistant cases, emphasizing the need for individualized treatment approaches. [Extracted from the article]

Background: While, the number of Caesarean sections performed has grown, so too has the prevalence of caesarean scar ectopic pregnancies, a relatively uncommon type of extrauterine pregnancy. There is an increased risk of maternal hemorrhage, and in the worst-case scenario, maternal death associated with Caesarean scar ectopic pregnancies. Objective: We aimed to preserve the uterus and future fertility by detecting Caesarean scar ectopic pregnancies early and treating them to prevent uterine rupture and bleeding. Subjects and methods: A 23 years female pregnant with previous 2 Cesarean sections, 8 weeks gestational age based on Ultrasound with unsure of late menstrual period assessment. Results: Emergency U/S revealed that there was intrauterine content 5 x 4.7 cm with no vascularity with history of dilatation and curettage (D & C), lax abdomen and minimal vaginal bleeding, magnetic resonance imaging (MRI) in addition to Human chorionic gonadotrophin (HCG) level were requested. Conclusion: MRI revealed rupture of anterior uterine wall, with identification of the bladder dome, HCG at follow up decreased more than 50 % of the initial one. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to investigate the association between post-cesarean sonographic uterine measures, dysmenorrhea, and bleeding disorders. Methods: This is a cross-sectional study where 500 women with a history of only one cesarean section (CS) were recruited. A transvaginal transducer, GE RIC6-12-D was used for the acquisition of volumetric datasets 18 ± 7 months postpartum. Uterine length (UL), cervical length (CL), niche length (L), niche depth (D), niche width (W), fibrosis length (FL), fibrosis depth (FD), residual myometrial thickness (RMT), endometrial thickness (EM), scar to internal os distance (SO), anterior myometrial thickness superior (sAMT) and inferior (iAMT) to the scar, and the posterior myometrial thickness opposite the scar (PMT), superior (sPMT), and inferior to it (iPMT) were measured. Logistic regression with odds ratios (OR), 95% confidence intervals (CI) and ROC curves were utilized. Results: The proportion of patients with incident post-cesarean bleeding disorders and dysmenorrhoea was 36% (CI 32%, 40%) and 17% (CI 14%, 21%) respectively. Univariate logistic regression showed that only UL was associated with bleeding disorders [OR 1.04 (CI 1.01,10.7) p value 0.005], whereas dysmenorrhea was associated with RMT [OR 0.82 (CI 0.71,0.95) p value 0.008], SO [OR 0.91 (CI 0.86,0.98) p value 0.01], and RMT ratio [OR 0.98 (CI 0.97,0.99) p value 0.03]. Multivariate logistic regression for dysmenorrhoea including SO and RMT remains statistically significant with p values <0.05 and area under the curve of 0.66. Conclusion: There is an association between sonographic appearance of CS scars and dysmenorrhoea. Nevertheless, the association is weak and other biological post-cesarean characteristics should be explored as potential causes. [ABSTRACT FROM AUTHOR]

Cesarean scar ectopic pregnancy is a leading cause of life-threatening complications in the first trimester. It poses a diagnostic and management challenge; if not diagnosed and adequately treated in early pregnancy, it may lead to considerable maternal morbidity and mortality. We report a case series of cesarean scar ectopic pregnancies managed successfully by laparoscopy. Laparoscopic excision is the gold standard management approach for cesarean scar ectopic pregnancy.

Cesarean scar ectopic pregnancy is a leading cause of life‑threatening complications in the first trimester. It poses a diagnostic and management challenge; if not diagnosed and adequately treated in early pregnancy, it may lead to considerable maternal morbidity and mortality. We report a case series of cesarean scar ectopic pregnancies managed successfully by laparoscopy. Laparoscopic excision is the gold standard management approach for cesarean scar ectopic pregnancy. [ABSTRACT FROM AUTHOR]

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Objective: The pathophysiology of uterine scar dehiscence is not yet clear. The aim of this study was to investigate whether preoperative hemogram parameters can be used as predictive markers of uterine scar dehiscence, thus improving prediction and contributing to management of repeat Cesarean section. Material and Methods: Between 2015 and 2020, 36670 (47.6%) cesarean sections were delivered in our hospital and 16943 of them had a previous Cesarean section. All cases of uterine scar rupture detected during Cesarean section were identified, and a total of 40 patients were included after excluding cases with impairment of the systemic inflammatory response (SIR). Controls consisted of 40 randomly selected, ageand body mass index (BMI)-matched patients, and the groups were compared. Results: Age, BMI, and gravidity were similar (p>0.05). Although the gestational week and Apgar scores were similar between the groups (p>0.05), the birth weight amongst controls was significantly higher than the uterine dehiscence group (p=0.028). Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and other hemogram values were similar in both groups (p>0.05). Mean platelet volume (MPV) in the control group was significantly higher than in the uterine rupture group (p=0.049). Regression analysis found no significant result between hemogram parameters, birth weight, and dehiscence. Conclusion: In this study, which set out to identify predictors of the risk of uterine scar dehiscence with SIR parameters, only the MPV value was lower in the dehiscence group. [ABSTRACT FROM AUTHOR]

Background: One of the most popular surgical procedures is the cesarean section (CS), and one of the most prevalent side effects of this procedure is wound and scar issues. The aim of this prospective, short-term, placebo-controlled study was to evaluate the safety and effectiveness of a silicone-based medical device (Lecoxen cream, Ekuberg Pharma, Carpignano Salentino, Italy) in healing wounds and scars derived from cesarean sections in nulliparous women. Methods: Seventy-four nulliparous women, ranging in age from 18 to 45, and underwent CSs, were divided in two groups of treatment (Lecoxen cream or Vaseline). The quality of scar was examined using the Vancouver scar scale after 28 days, while wound healing was evaluated using the Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scale on the 14th day following CS. Results: The treatment with Lecoxen cream determined a statistically significant improvement (p < 0.001) of the wound healing state, in terms of redness, edema, ecchymoses and discharge. Even about Vancouver Scar Scale (VSS) score there was a significative improvement in the observed group in terms of vascularization, pigmentation, flexibility and height (p < 0.001). No adverse effects were reported from the use of Lecoxen cream in participants. Conclusions: Lecoxen cream proved to be a safe and efficient treatment for wounds from CSs, making it a valuable topical to accelerate the healing process and reduce the visibility of scars. Clinical Trial Registration: The study was registered with the ISRCTN registry (https://www.isrctn.com/), registration number: ISRCTN51125312.

Abstract Background Vaginal births after cesarean or elective repeat cesarean sections (CS) are the options for delivery after one cesarean scar. However, there is a lack of data regarding the preferred next mode of delivery in Ethiopia after a previous cesarean section. Thus, this study assessed the preferred mode of delivery and determinants after one previous CS in the antenatal clinic at the University of Gondar Comprehensive Specialized Hospital (UoGCSH). Methods An institutional-based cross-sectional study was conducted among pregnant mothers with one previous CS at UoGCSH from March to August 2022. Structured questionnaires were used to collect the data. The collected data were entered, cleaned, and edited using Epi-data 4.6 and exported to SPSS version 26 for analysis. A binary logistic regression was performed to assess the determinants of the preferred mode of delivery. A p-value of

Background: Ectopic pregnancy is associated with higher maternal morbidity and mortality. Early diagnosis and outcome predictors represented a crucial option to reduce such morbidity and mortality.Aim of the work: To evaluate the value of serum β-hCG for clinical outcome prediction in tubal and cesarean scar ectopic pregnancy.Patients and Methods: This retrospective study of 192 ectopic pregnancies [tubal and cesarean section scar]. The collected data included patient demographics, obstetric and past history. Data of clinical examination were also recorded. Serum concentration of β-hCG at admission and after 48 hours were documented. The ultrasound examination was performed to define of the site of ectopic and to ensure empty uterine cavity. All patients were followed-up for their outcome of ectopic pregnancy and for 2 months after discharge.Results: The outcome was significantly different between both groups [group II managed mainly by surgical wedge resection [96.9%] compared to none in group I. The highest β-hCG values were recorded for surgical wedge resection. 55.4% of those with doubling had no surgical wedge resection compared to 44.9% of those without doubling. The response to medical treatment was significantly associated with non-doubling of β-hCG [33.9% vs 12.3%]. β-hCG in tubal and cesarean scar ectopic pregnancy showed good predictive power [AUC > 0.75] with 100.0% sensitivity.Conclusion: High β-hCG at admission and after 48 hours and specifically doubling of values are significantly associated with low response to medical treatment in tubal ectopic pregnancy.

Introduction: After incomplete healing of the uterine cesarean section scar, a niche can be observed; 24% of the women develop large niches with a residual myometrial thickness <3 mm. In these cases a laparoscopic resection is possible. The effect of this new treatment on fertility outcome is not known yet. This paper describes reproductive outcomes 2 years after a laparoscopic niche resection and compares women with or without secondary infertility at baseline. Material and methods: A prospective cohort study was performed, with consecutive inclusion of women between 2011 and 2019. Women with a niche in the uterine cesarean scar, with a residual myometrial thickness of <3 mm and with a desire to become pregnant, were scheduled to undergo a laparoscopic niche resection because of one or more of the following problems (1) postmenstrual spotting; (2) midcycle intrauterine fluid accumulation diagnosed during the fertility workup or (3) difficulties with a previous embryo transfer and preferring a surgical therapy. The study is registered in the ISRCTN register (ref. no. ISRCTN02271575) on April 23, 2013. Results: There were 133 (62%) women included with a desire to become pregnant, 88 with secondary infertility. In all, 83 had an ongoing pregnancy at the 2‐year follow‐up. The ongoing pregnancy rate in patients with previous fertility problems was 60.2% compared with 66.7% in patients without infertility (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.32–1.7). The OR for live births was 0.57 (95% CI 0.02–1.2). Overall, 8.3% of the pregnancies resulted in miscarriages by the 2‐year follow‐up. Conclusions: The reproductive outcomes in women with and without previous fertility problems undergoing resection of a large niche are very promising and quite comparable in both groups. These results suggest, but do not prove, a beneficial effect of this therapy for these indications. The results support the design of future randomized controlled trials to evaluate the effect of niche resection vs expectant management to assess its additional value in women with or without fertility problems who desire pregnancy. [ABSTRACT FROM AUTHOR]

• Cesarean scar defects can result in secondary infertility and uterine rupture. • The defects showed thin residual myometrial thickness and/or complex shape. • Abdominal repair for cesarean scar defect had favorable reproductive outcomes. • Twin pregnancy (double blastocyst transfer) must be avoided in women with repair surgery. To clarify the reproductive outcomes of women who underwent abdominal repair surgery for cesarean scar defect (CSD). This is a retrospective observational study performed in a tertiary center. We retrospectively reviewed 20 women who underwent abdominal repair between 2007 and 2021. The indication for the repair was a minimal residual myometrial thickness (RMT) of ≦3.0 mm. We investigated surgical complications, changes in minimal RMT before and three-months after the repair, and reproductive outcomes. The median age at the time of repair was 36 years (27–40), with a median body mass index of 21.0 (17.7–28.7) and a median of 1 prior cesarean section (1–5). Twelve women reported secondary infertility, while eight women were concerned about the potential risk of uterine rupture in future pregnancies due to thin RMT. Additionally, one woman had a co-existing vesicouterine fistula, two had abscess and hematoma formation at the precedent cesarean section, and three showed remarkable dehiscence of the defect. The median minimal RMT significantly increased to 5.05 mm (range; 2.5–14.2 mm) after the repair. Seven women had a total of eight live births, with a median duration from the repair to a live-birth pregnancy of 11.5 months (range; 4–20 months). No surgical complications occurred during the repair, and there were no instances of uterine rupture in subsequent pregnancies. However, one woman who became pregnant with twins following double blastocyst transfer required a cesarean section at 25 weeks of pregnancy due to bulging towards the bladder side of the repaired CSD. Abdominal repair for CSD is feasible in women with thin RMT who experience secondary infertility. Twin pregnancies can promote thinning of the CSD repair site, potentially increasing the risk of uterine rupture. [ABSTRACT FROM AUTHOR]

Purpose: To review cases of uterine rupture and identify risk factors associated with adverse outcomes. Methods: This study is a retrospective cohort of complete uterine ruptures diagnosed in a large hospital system in Massachusetts between 2004 and 2018. Baseline demographics, labor characteristics and outcomes of uterine rupture were collected from medical records. Results: A total of 173 cases of uterine rupture were identified. There were 30 (17.3%) women with an unscarred uterus, while 142 (82.1%) had a scarred uterus. Adverse outcomes (n = 89, 51.4% of cases) included 26 (15.0%) hysterectomies, 55 (31.8%) blood transfusions, 18 (10.4%) bladder/ureteral injuries, 5 (2.9%) reoperations, 25 (14.5%) Apgar scores lower than 5 at 5 min and 9 (5.2%) perinatal deaths. Uterine rupture of a scarred uterus was associated with decreased risk of hemorrhage (OR 0.40, 95% CI 0.17–0.93), blood transfusion (OR 0.27, 95% CI 0.11–0.69), hysterectomy (OR 0.23, 95% CI 0.08–0.69) and any adverse outcome (OR 0.34, 95% CI 0.13–0.91) compared with unscarred rupture. Uterine rupture during vaginal delivery was associated with increased risk of transfusion (OR 6.55, 95% CI 1.53–28.05) and hysterectomy (OR 8.95, 95% CI 2.12–37.72) compared with emergent C-section. Conclusions: Although rare, uterine rupture is associated with adverse outcomes in over half of cases. Unscarred rupture and vaginal delivery demonstrate increased risk of adverse outcomes, highlighting the need for early diagnosis and operative intervention. [ABSTRACT FROM AUTHOR]

Background: Vaginal births after cesarean or elective repeat cesarean sections (CS) are the options for delivery after one cesarean scar. However, there is a lack of data regarding the preferred next mode of delivery in Ethiopia after a previous cesarean section. Thus, this study assessed the preferred mode of delivery and determinants after one previous CS in the antenatal clinic at the University of Gondar Comprehensive Specialized Hospital (UoGCSH). Methods: An institutional-based cross-sectional study was conducted among pregnant mothers with one previous CS at UoGCSH from March to August 2022. Structured questionnaires were used to collect the data. The collected data were entered, cleaned, and edited using Epi-data 4.6 and exported to SPSS version 26 for analysis. A binary logistic regression was performed to assess the determinants of the preferred mode of delivery. A p-value of < 0.05 at the 95% confidence level (CI) was considered statistically significant. Results: The majority, 71.5% (95% CI: 64.7, 77.1), of participants preferred the trial of labor after cesarean (TOLAC) as their mode of delivery. Mothers who were married (AOR = 4.47, 95% CI: 1.19–16.85), had a diploma educational level (AOR = 3.77, 95% CI: 1.84–12.36), had previous post-cesarean complications (AOR = 3.25, 95% CI: 1.08–9.74), and knew about the success of the trial of labor after cesarean (AOR = 13.56, 95% CI: 4.52–37.19) were found to prefer the trial of labor compared with their counterparts. Conclusion: This study concluded that most pregnant mothers preferred labor trials after one CS, which is a bit lower but comparable with recommended practice guidelines. Providing adequate information and counseling mothers to make informed decisions about their preferred mode of delivery could be substantial. [ABSTRACT FROM AUTHOR]

Objective: To evaluate our experience in treatment of Caesarean Scar Pregnancy (CSP). Study Design: Cross Sectional Descriptive study. Setting: Department of Gynecology and Obstetrics, Independent Medical College Faisalabad. Period: Jan 2016 to Jan 2021. Material & Methods: The data for this study retrospectively obtained from outpatient department, emergency ward and labor ward registers. Data was analyzed by simple descriptive statics. Diagnosis of CSP was made by using transvaginal ultrasound and color flow Doppler ultrasound. Treatment offered was either medical management as systemic methotrexate or surgical as D&C or laparotomy. The aim was to do conservative treatment for fertility sparing. Patient age, gestational age at time of presentation, number of previous Cesarean Section and success of overall management strategy was analyzed. Results: In this study we had 12 patients diagnosed to have CSP with at least one scar on uterus of previous caesarean section. The mean age of patients was 32.5± 2 years and the gestational age range was from 5 weeks and 3 days to 10 weeks and 2 day. The diagnosis was done by using transvaginal ultrasound and color flow Doppler ultrasound. Which showed high velocity and low impedance flow in sub trophoblastic area. Out of 12 patient's 58.33 percent were treated with systemic methotrexate and had successful outcome. These were followed by B-hCG levels till non pregnant serum level of B-hCG of <5.1IU was achieved. 16.66 percent patients underwent D&C, but due to hemorrhage they were treated with laparotomy as supplementary procedure. 41.55 percent Patients were treated by laparotomy as their primary management with aim of fertility sparing surgery. The laparotomy was found to be successful treatment in all the patients who underwent surgical management as their primary treatment. Conclusion: Prompt diagnosis has pivotal role in reducing morbidity and mortality associated with CSP. Medical management is found to be successful at early gestational age. Fertility sparing surgery is better option as gestation advances more than 8 weeks to avoid undesirable outcome like hemorrhage and hysterectomy. [ABSTRACT FROM AUTHOR]

Abstract Background The treatment of gestational trophoblastic neoplasia (GTN) is one of the success stories in medical oncology. GTN in the cesarean scar is a rare entity, but most cases need to be treated with hysterectomy or localized uterine lesion resection because of chemoresistant lesions and/or massive bleeding. We present a patient with post-molar GTN in the cesarean scar who was non-invasively treated with ultrasound-guided high intensity focused ultrasound (HIFU) to preserve the uterus and fertility. Case presentation A 32-year-old woman was diagnosed with low-risk GTN (FIGO Stage I: 2 prognostic score) after partial hydatidiform mole. The 5th cycle of chemotherapy was interrupted because of persistent hepatic toxicity and impaired ovarian reserve function. However, the uterine lesion persisted (diameter of residual uterine lesion in the cesarean scar: 2.0 cm). Therefore, ultrasound-guided HIFU treatment was performed. A significant gray-scale change was observed during the HIFU treatment. Color Doppler ultrasonography and contrast-enhanced ultrasound (CEUS) was performed to evaluate the ablation effectiveness. Color Doppler ultrasonography showed disappearance of the signal of vascularity and CEUS showed no perfusion in the lesion located in the cesarean scar. The uterine lesion was obviously shrunken one month after HIFU treatment. Menstrual cycle resumed 48 days after HIFU. HIFU treatment decreased the number of chemotherapy cycles and there was complete disappearance of the GTN lesion at 4-month follow-up. The patient has shown no signs of recurrence as of 58-month follow-up. Conclusion Ultrasound-guided HIFU may be a useful alternative to lesion resection for GTN in the cesarean scar in patients who show chemoresistance or are not suitable for chemotherapy. It has the potential to ablate the residual uterine lesion noninvasively to preserve the uterus and fertility, avoiding perioperative risks of lesion resection, especially acute bleeding.

Objective: We present a case of spontaneous abdominal wall endometriosis presenting as a painless nodular mass in a woman with no prior history of abdominal surgery. Case report: Abdominal wall endometriosis (AWE) is an uncommon form of endometriosis, usually arising due to a past history of cesarean section or abdominal hysterectomy. However, in rare cases, abdominal wall endometriosis can arise in women with no prior history of abdominal surgery. A 48-year-old woman presented to our obstetrics and gynecology clinic with a painless nodular mass in the right lower quadrant of the abdomen. Abdominal wall ultrasound showed a hypoechoic heterogenous mass under the skin. Wide surgical resection of the mass was conducted and post-operative histopathological report revealed abdominal wall endometriosis. Conclusion: Spontaneous abdominal wall endometriosis is an uncommon pathologic condition in which accurate diagnosis is difficult. As an increasing number of obstetrical and gynecological procedures are conducted worldwide, surgeons should keep this clinical entity in the differential diagnosis of any abdominal mass in reproductive-aged females regardless of their past surgical history.

To report a patient with prolonged intermenstrual bleeding and a cystic mass at a cesarean scar treated with laparoscopic folding sutures and hysteroscopic canalization. A 4.0 cm-cystic mass formed at the uterine scar caused continuous menstrual blood outflow in the diverticulum and was treated with hysteroscopy combined with laparoscopy. University hospital. A 38-year-old woman of childbearing age who had undergone two cesarean sections and two abortions reported vaginal bleeding for 10 years, which began shortly after the second cesarean section. Curettage was performed, but no abnormality was found. The patient unsuccessfully tried to manage her symptoms with traditional Chinese medicine and hormone drugs. The muscular layer of the lower end of the anterior wall of the uterus was weak, and there were cystic masses on the right side. The bladder was stripped from the lower uterine segment under laparoscopy, and the surrounding tissue of the mass at the uterine scar was separated. The position of the cesarean scar defect was identified by hysteroscopy combined with laparoscopy, and the relationship between the uterine mass and surrounding tissues was analyzed. An electric cutting ring resection on both sides of the obstruction was performed to eliminate the valve effect. The active intima of the scar diverticulum was destroyed by electrocoagulation, followed by laparoscopic treatment of the uterine scar diverticulum mass. An intraoperative tumor incision revealed visible bloody fluid mixed with intimal material. The uterine scar diverticulum defect was repaired using 1–0 absorbable barbed continuous full-thickness mattress fold sutures. Finally, the bilateral round ligament length was adjusted so that the uterus tilted forward. Recovery of menstruation and anatomy of the uterine isthmus. The operation was successful, and the postoperative recovery was fast. There was no interphase bleeding at the 1-month follow-up, and the uterine scar diverticulum was repaired, with the thickness of the uterine scar muscle layer increasing to 0.91 cm. The simple, straightforward procedure to resolve the abnormal cystic, solid mass formed because of the continuous deposition of blood in the uterine scar diverticulum involved laparoscopic folding and docking sutures combined with hysteroscopic canal opening. [ABSTRACT FROM AUTHOR]

Objective: To analyze outcomes and postoperative complications in patients undergoing robot‐assisted isthmocele repair. Method: This retrospective cohort study included 33 patients who had robot‐assisted laparoscopic surgical management of an isthmocele between September 2013 and August 2020 in two French university hospitals. All charts were reviewed to identify patient characteristics, preoperative and postoperative anatomical findings, complications, and postoperative fertility and symptoms. Patients who had undergone this procedure were asked to complete a telephone questionnaire about their treatment satisfaction and symptoms. Results: The isthmocele was discovered most often as a result of subfertility (57.6%), but also ectopic pregnancy (18.2%), pelvic pain (15.2%), and postmenstrual bleeding (9.1%). Robot‐assisted repair of the isthmocele significantly improved myometrial thickness (from 1.55 mm before surgery to 4.26 mm after surgery [mean difference 2.71; 95% confidence interval, 1.91–3.51], P = 0.0005). Among 20 patients who still desired a child after surgery, 15 became pregnant and 14 had full‐term live births. Among the nine patients who had surgery for disabling symptoms, five had no persistent symptoms, three reported global improvement, and one had the same gynecologic discomfort. Seventeen patients agreed to complete the questionnaires (51.5%), and all stated that they would choose to have this surgery again. Conclusion: Robot‐assisted repair of an isthmocele is a viable minimally invasive procedure. Synopsis: Robot‐assisted repair of an isthmocele, while not standardized, is a viable minimally invasive procedure for women with an isthmocele and symptoms, and improves subfertility. [ABSTRACT FROM AUTHOR]

Purpose: Isthmocele or cesarean scar defect/niche and its consequences are becoming more common worldwide, which is unlikely to be because of improved diagnosis or rising cesarean rates. Objective: This study aimed to see how the development of niche and maternal problems were affected by the method of uterine incision extension. Subjects and Methods: A total of 280 women from Kasr Alainy Teaching Hospital's Labor and Delivery section were included in the study. Two groups were observed over 10 months: group A sharp extension group and group B blunt extension group (1:1). Results: There were no significant statistical differences between the two groups with respect to placental location, presentation, amniotic fluid, incision extension, and the presence of niche 6 weeks or 3 months postoperatively by transvaginal sonography. No significant differences were also found in scar thickness or surrounding myometrium thickness between the two groups. However, there were statistically significant variations between the two groups with respect to operational time, blood loss during closure, and uterine vascular damage. Conclusion: There was no difference in the establishment of a cesarean scar niche or scar thickness between sharp and blunt uterine incision extensions. Sharp incisions may be preferable to blunt incisions because they result in properly aligned myometrial layers. More clinical trials with bigger sample sizes are needed to assess the impact of the technique of extending the uterine incision on the establishment of cesarean niches. [ABSTRACT FROM AUTHOR]

Background: The treatment of gestational trophoblastic neoplasia (GTN) is one of the success stories in medical oncology. GTN in the cesarean scar is a rare entity, but most cases need to be treated with hysterectomy or localized uterine lesion resection because of chemoresistant lesions and/or massive bleeding. We present a patient with post-molar GTN in the cesarean scar who was non-invasively treated with ultrasound-guided high intensity focused ultrasound (HIFU) to preserve the uterus and fertility. Case presentation: A 32-year-old woman was diagnosed with low-risk GTN (FIGO Stage I: 2 prognostic score) after partial hydatidiform mole. The 5th cycle of chemotherapy was interrupted because of persistent hepatic toxicity and impaired ovarian reserve function. However, the uterine lesion persisted (diameter of residual uterine lesion in the cesarean scar: 2.0 cm). Therefore, ultrasound-guided HIFU treatment was performed. A significant gray-scale change was observed during the HIFU treatment. Color Doppler ultrasonography and contrast-enhanced ultrasound (CEUS) was performed to evaluate the ablation effectiveness. Color Doppler ultrasonography showed disappearance of the signal of vascularity and CEUS showed no perfusion in the lesion located in the cesarean scar. The uterine lesion was obviously shrunken one month after HIFU treatment. Menstrual cycle resumed 48 days after HIFU. HIFU treatment decreased the number of chemotherapy cycles and there was complete disappearance of the GTN lesion at 4-month follow-up. The patient has shown no signs of recurrence as of 58-month follow-up. Conclusion: Ultrasound-guided HIFU may be a useful alternative to lesion resection for GTN in the cesarean scar in patients who show chemoresistance or are not suitable for chemotherapy. It has the potential to ablate the residual uterine lesion noninvasively to preserve the uterus and fertility, avoiding perioperative risks of lesion resection, especially acute bleeding. [ABSTRACT FROM AUTHOR]

Cesarean scar ectopic pregnancy (CSP) is a rare form of ectopic pregnancy, and treatment of CSP with uterine artery embolization (UAE) is a novel approach. With increasing numbers of cesarean sections being performed annually, the incidence of this condition is likely to increase. The authors became aware of an unusually high number of published studies originating in mainland China regarding this unusual treatment and sought to perform a meta-analysis to provide comprehensive evidence on this novel practice. Methods: We performed a thorough search and included all forms of quality studies on this topic that reported UAE as a part of first-line management of CSP. We included only studies originating in China. Ultimately, 37 studies were included for qualitative and quantitative synthesis of evidence. After screening retrieved records and extracting data from eligible studies, we pooled continuous data as a mean estimate and 95% confidence interval (CI), and dichotomous data as proportion and 95% CI. Results: CSP patients treated with protocols including UAE had a mean time of 30 days for serum β-hCG normalization, 95% CI [26.816, 33.881]. They had a mean estimated intraprocedural blood loss of 4.19 ± 3.76 mL, a mean hospital stay of nine days, 95%CI [7.914, 9.876], and a success rate of 93.4%, 95%CI [0.918, 0.951]. The severe complication rate was 1.2%, 95%CI [0.008, 0.017]. Conclusion: UAE, in combination with other procedures is being used effectively for the treatment of CSP in China. Protocols including UAE have a success rate of approximately 93.4%, and a severe complication rate of approximately 1.2%. This data's utility is limited by vast differences in the studied protocols and questionable feasibility outside of China. [ABSTRACT FROM AUTHOR]

Levonorgestrel-releasing intrauterine devices have been used for contraception and treatment of heavy menstrual bleeding. There is only limited data about the effect of this on isthmocele. Here, we aimed to evaluate the effect of levonorgestrel-releasing intrauterine devices in a larger study population with a longer follow-up as compared to the literature on symptomatic patients with isthmocele. A total of 29 patients with symptomatic isthmocele and inserted levonorgestrel-releasing device were included in this prospective study. All patients were included at January 2020 and followed for 18 months. Sociodemographic findings, laboratory parameters, premenstrual spotting, postmenstrual spotting, menorrhagia, dysmenorrhea, and pelvic pain related to isthmocele were recorded. In sonography, width, length, area of isthmocele, and residual myometrial thickness were determined. The frequency of symptoms during follow-up was compared between visits and also compared between groups according to residual myometrial thickness. Premenstrual spotting and pelvic pain were significantly reduced at 6th months (48.3 to 10.3%, p = 0.007 and 34.5 to 10.3%, p = 0.039, respectively) and no significant change was detected until the end of follow-up period. Postmenstrual spotting reduced at 6th months (96.6 to 34.5%, p < 0.001) and also significant change was detected between 6 and 12th months (34.5% vs 13.8%, p = 0.031). Menorrhagia and dysmenorrhea disappeared at 12th months. No association was found between residual myometrial thickness and the frequency of symptoms for each follow-up. Levonorgestrel-releasing intrauterine devices are useful and reliable therapeutic tools for symptomatic isthmocele patients who do not desire fertility, regardless of residual myometrial thickness. [ABSTRACT FROM AUTHOR]

Abstract Background The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions. Methods This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey’s scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair’s scoring system was used to evaluate intraperitoneal adhesions. Results The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value

Background & aim: Cesarean scar pregnancy is an ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar and is the rarest kind of ectopic pregnancy. The present study present a case of choriocarcinoma (CC) in the cesarean scar. The clinical course, findings, and treatment plan are discussed. Case report: A 41-years old multi-gravid woman with a history of one previous cesarean section and three subsequent abortions was admitted to the hospital. She suffered from an unknown abnormal vaginal bleeding for two months. Β-HCG titer was 1,000 IU/L and the report of sonography showed no gestational sac. Accordingly, the patient was diagnosed with ectopic pregnancy in the cesarean scar site and, therefore, weekly usage of methotrexate was prescribed for her. Since she did not respond to the treatment, she was referred to our department in the Faculty of Medicine. The evaluation showed mass invasion through the entire uterine wall. The uterus preservation was not possible, therefore, total hysterectomy was performed. The pathology report confirmed CC in the cesarean scar. Conclusion: Based on previous studies, as the number of cesarean sections increases, the possibility of complications rises, as well. Cesarean scars implantation of CC is one of the rare complications of caesarean section. The probability of a gestational trophoblastic disease should be considered in any woman during her pregnancy. Early detection and proper management of the complications can result in a decrease in morbidity and mortality.

The rising rate of cesarean deliveries has led to an increased incidence of long long-term complications, including niche formation in the uterine scar. Niche development is associated with various gynecologic complaints and complications in subsequent pregnancies, such as uterine rupture and placenta accreta spectrum disorders. Although uterine closure technique is considered a potential risk factor for niche development, consensus on the optimal technique remains elusive. We aimed to evaluate the effect of single-layer vs double-layer closure of the uterine incision on live birth rate at a 3-year follow-up with secondary objectives focusing on gynecologic, fertility, and obstetrical outcomes at the same follow-up. A multicenter, double-blind, randomized controlled trial was performed at 32 hospitals in the Netherlands. Women ≥18 years old undergoing a first cesarean delivery were randomly assigned (1:1) to receive either single-layer or double-layer closure of the uterine incision. The primary outcome of the long-term follow-up was the live birth rate; with secondary outcomes, including pregnancy rate, the need for fertility treatment, mode of delivery, and obstetrical and gynecologic complications. This trial is registered on the International Clinical Trials Registry Platform www.who.int (NTR5480; trial finished). Between 2016 and 2018, the 2Close study randomly assigned 2292 women, with 830 of 1144 and 818 of 1148 responding to the 3-year questionnaire in the single-layer and double-layer closure. No differences were observed in live birth rates; also there were no differences in pregnancy rate, need for fertility treatments, mode of delivery, or uterine ruptures in subsequent pregnancies. High rates of gynecologic symptoms, including spotting (30%–32%), dysmenorrhea (47%–49%), and sexual dysfunction (Female Sexual Function Index score, 23) are reported in both groups. The study did not demonstrate the superiority of double-layer closure over single-layer closure in terms of reproductive outcomes after a first cesarean delivery. This challenges the current recommendation favoring double-layer closure, and we propose that surgeons can choose their preferred technique. Furthermore, the high risk of gynecologic symptoms after a cesarean delivery should be discussed with patients. [ABSTRACT FROM AUTHOR]

An ectopic pregnancy is classically thought of as an extrauterine pregnancy that implants within a fallopian tube. However, 5% of ectopic pregnancies are nontubal in origin. This article reviews 3 uncommon presentations of ectopic pregnancy, including cesarean-scar, cervical, and interstitial pregnancies. Literature related to the 3 aforementioned uncommon sites of ectopic pregnancy was reviewed using PubMed. Historically, nontubal ectopic pregnancies were associated with higher morbidity and mortality due to late diagnosis. However, earlier diagnosis is possible with advancements in imaging technology and high sensitivity ß-human chorionic gonadotropin enabling the development of conservative treatment approaches. For all 3 of these uncommon presentations, ultrasonography is most commonly used for diagnosis. As with tubal ectopic pregnancies, management can include medical or surgical approaches. Expectant management is generally not recommended. Success rates of conservative management are generally quite high, and there is a low number of complications. Cesarean-scar, cervical, and interstitial pregnancies are rare forms of ectopic pregnancy and can result in high morbidity and mortality if not diagnosed early. Thus, providers should have a high level of suspicion for these uncommon presentations, especially in patients with risk factors, so that early diagnosis and conservative management can be achieved. (J GYNECOL SURG 38:185) [ABSTRACT FROM AUTHOR]

Ovarian mucinous tumors are one of the common epithelial tumors in the ovary, but their recurrence is extremely rare. In a 37-year-old female patient who had had five operations in 7 years due to recurrent mucinous neoplasms, a mass extending to the umbilicus was recently detected during a routine examination. With this finding the patient underwent cystectomy, total abdominal hysterectomy, and left salpingooophorectomy. Two of the five operations were performed during cesarean delivery. In the recent surgical procedure, two cysts were removed. A 20 cm cyst in the pelvic region was diagnosed as a mucinous cystadenoma. The other cyst located in the myometrium was a mucinous cystadenoma with focal borderline change and arose in the previous cesarean scar. The authors present what is believed to be the first case of recurrent mucinous neoplasm arising within a cesarean scar. A review of the literature concerning the topic is also presented. [ABSTRACT FROM AUTHOR]

Abstract Depending on the developing laparoscopic technique and experience, the treatment of cesarean scar choriocarcinoma can be safely performed laparoscopically by experts.

Background: Ectopic pregnancy should be considered in any pregnant patient with vaginal bleeding or lower abdominal pain when intrauterine pregnancy has not yet been established. More than 95% of ectopic pregnancies occur in the tubes, especially the ampullary portion with 70% of cases. Other sites reported for ectopic pregnancies, although of marked rarity, are the abdomen, ovary and scar from a previous cesarean section. Although rare, ectopic pregnancy in a scar from a previous cesarean section has increased in parallel with the rise in cesarean section rates. Due to this rarity, case reports are important so that more evidence is investigated in order to systematize the management of the condition. Aim: To report a case of ectopic pregnancy in healing of a previous cesarean, as well as its management and outcome, with the aim of assisting in the management of new cases. Method: This is a single case report treated at the Gynecology and Obstetrics Service of the São Francisco University Hospital in Providência de Deus - HUSF, located in the city of Bragança Paulista, SP, Brazil. The patient in authorized the use of the data contained in her medical record by signing a Free and Informed Consent Term, and this research was approved by the HUSF Research Ethics Committee. Conclusion: The description of the patient allowed us to conclude that, due to the large number of problems and risks caused by pregnancy in a scar from a previous cesarean section, including uterine rupture and the death of the pregnant woman, an immediate diagnosis of the condition is necessary, because symptoms such as bleeding are nonspecific for cases of the type. USG is a very helpful diagnostic tool in cases of cesarean scar pregnancy, however, in certain cases, the diagnosis was not confirmed until an MRI was performed. Depending on the lesion and related morbidities, hysterectomy is the only option, as was done in the case reported here, thus avoiding the death of the pregnant woman. However, in cases where the patient still wants to have children, it is possible, albeit with certain risks, to avoid such a procedure, although there is a risk of recurrence. [ABSTRACT FROM AUTHOR]

Background and Objectives: To investigate the prevalence of a Cesarean section (CS) scar niche during pregnancy, assessed by transvaginal ultrasound imaging, and to relate scar measurements, demographic and obstetric variables to the niche evolution and final pregnancy outcome. Materials and Methods: In this prospective observational study, we used transvaginal sonography to examine the uterine scars of 122 women at 11+0–13+6, 18+0–20+6 and 32+0–35+6 weeks of gestation. A scar was defined as visible on pregnant status when the area of hypoechogenic myometrial discontinuity of the lower uterine segment was identified. The CS scar niche (“defect”) was defined as an indentation at the site of the CS scar with a depth of at least 2 mm in the sagittal plane. We measured the hypoechogenic part of the CS niche in two dimensions, as myometrial thickness adjacent to the niche and the residual myometrial thickness (RMT). In the second and third trimesters of pregnancy, the full lower uterine segment (LUS) thickness and the myometrial layer thickness were measured at the thinnest part of the scar area. Two independent examiners measured CS scars in a non-selected subset of patients (n = 24). Descriptive analysis was used to assess scar visibility, and the intraclass correlation coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners for scar measurements. Factors associated with the CS scar niche, including maternal age, BMI, smoking status, previous vaginal delivery, obstetrics complications and a history of previous uterine curettage, were investigated. Clinical information about pregnancy outcomes and complications was obtained from the hospital’s electronic medical database. Results: The scar was visible in 77.9% of the women. Among those with a visible CS scar, the incidence of a CS scar niche was 51.6%. The intra- and interobserver agreement for CS scar niche measurements was excellent (ICC 0.98 and 0.89, respectively). Comparing subgroups of women in terms of CS scar niche (n = 49) and non-niche (n = 73), there was no statistically significant correlation between maternal age (p = 0.486), BMI (p = 0.529), gestational diabetes (p = 1.000), smoking status (p = 0.662), previous vaginal delivery after CS (p = 1.000) and niche development. Uterine scar niches were seen in 56.3% (18/48) of the women who had undergone uterine curettage, compared with 34.4% (31/74) without uterine curettage (p = 0.045). We observed an absence of correlation between the uterine scar niche at the first trimester of pregnancy and mode of delivery (p = 0.337). Two cases (4.7%) of uterine scar dehiscence were confirmed following a trial of vaginal delivery. Conclusions: Based on ultrasonography examination, the CS scar niche remained visible in half of the cases with a visible CS scar at the first trimester of pregnancy and could be reproducibly measured by a transvaginal scan. Previous uterine curettage was associated with an increased risk for uterine niche formation in a subsequent pregnancy. Uterine scar dehiscence might be potentially related to the CS scar niche a subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Cesarean scar ectopic pregnancy (CSEP) is becoming more common worldwide. Here, we report a case of cesarean scar pregnancy successfully treated using transvaginal ethanol injection. A 31-year-old female (gravida 3, para 2) with two prior cesarean sections presented at 9 weeks and 3 days of pregnancy. Her serum human chorionic gonadotropin level was 91,798 mIU/mL. CSEP was confirmed by transvaginal ultrasonography, pelvic magnetic resonance imaging, and color Doppler ultrasonography. Transvaginal absolute ethanol local injection under transvaginal ultrasound guidance was performed. She was discharged 7 days after treatment with no complications and resumed normal menses 1 month after treatment. We describe a safe and successful treatment option for CSEP.

With an increased cesarean delivery rate, the incidence of abnormal placentation is steadily rising, and it is estimated to be around 1.7 per 1000 pregnancies for cesarean scar pregnancy and 1 per 500 pregnancies for placenta accreta spectrum disorder. Current evidence considers cesarean scar pregnancy and placenta accreta spectrum as being the same condition, with different aspects, of the same spectrum, having higher risks with advancing gestation. We present 7 cases, diagnosed and managed in our hospital, at different gestational ages. Early diagnosis is essential for appropriate counseling and subsequent management, and an ultrasound examination is the reference standard for diagnosis. Screening for an abnormally implanted placenta in the first trimester of pregnancy might improve the perinatal outcome and reduce maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Aims: To introduce the treatment experience of fractional CO2 laser for cesarean scar under the guidance of multiple evaluation methods. Methods: Cesarean scar patients receiving fractional CO2 laser therapy between January 2016 and January 2020 were retrospectively analyzed in this study. The demographic characteristics and treatment protocols, the Vancouver Scar Scale (VSS), the University of North Carolina "4P" Scar Scale (UNC4P), and the Antera3D score of all the enrolled patients were recorded. Results: Altogether, 79 cesarean scar patients were involved in this study, with the average age of 28.1 years, the average scar age and length of 26.5 (range, 24‐30) months and 8.5 (range, 7‐11) cm, respectively. Significant improvements were observed in VSS (t = 16.75, P <.05), UNC4P (t = 15.63, P <.05), and Antera3D score (color:t = 13.19, P <.05; texture: t = 13.12, P <.05; melanin: t = 3.89, P <.05; hemoglobin: t = 2.28, P <.05). No long‐term complication was reported during the follow‐up visits. Conclusions: Fractional CO2 laser therapy is an effective treatment for cesarean scar. The multiple evaluation methods, including the combined application of VSS, UNC4P, and Antera3D score, can be potentially used for guiding treatment protocols and evaluating efficacy. Meanwhile, rhGM‐CSF hydrogel provides another choice for laser wound management. [ABSTRACT FROM AUTHOR]

The cesarean operation represents a major surgery, with a higher risk of postoperative complications and longer postoperative recovery than vaginal delivery. Due to the increasing frequency of cesarean sections, the ultrasound imaging of the uterine scar has become a particularly useful tool in identifying its potential long-term complications. This should be done pre-conceptively and quarterly or whenever necessary during pregnancy. Currently, there are only few histopathological studies on the uterine scar, trying to assess the myometrial repair and certain factors that influence the quality of the scar. The study was performed on a batch of 123 patients with previous C-sections, with multiple ultrasound exams during pregnancy and post-operative pathologic evaluation of the uterine scar in order to assess the possibility of a new prognostic score by correlating these two factors. Our study found solid evidence related to possible correlations between histopathological and ultrasound data on the cesarean section scar, which could lead to a possible predictive algorithm with implications for both prognostic and therapeutic fields.

Abstract Background Cesarean scar pregnancy is rare but may be related to early uterine rupture and may result in massive hemorrhage. Nowadays, most cesarean scar pregnancies are diagnosed early and can be managed properly. However, diagnoses of cesarean scar pregnancies that develop in the obstetrical area are sometimes delayed. Case presentation A 28-year-old Asian woman visited our institution because of suspected cesarean scar pregnancy. Ultrasonography and computed tomography confirmed a cesarean scar pregnancy with a live fetus with a crown-rump length of 4.83 cm, corresponding to 11 weeks 6 days of gestation. Initially, we injected 50 mg of methotrexate in the amniotic sac under transabdominal ultrasonographic guidance. However, fetal cardiac activity was still observed 2 days later. We decided to perform open laparotomy because of the possibility of massive bleeding. The gestational sac was removed, as well as most of the trophoblastic tissues that were adherent and invading the wall of the lower uterine segment. She was discharged in good condition 5 days after the operation. Conclusions Despite the popular use of ultrasonography in prenatal care, diagnosis of cesarean scar pregnancy is still delayed. Surgical treatment with local methotrexate injection could be an option for the management of advanced cesarean scar pregnancy.

A cesarean scar can cause abnormal uterine bleeding including prolonged menstruation or postmenstrual spotting. Our patient showed massive uterine bleeding from a cesarean scar and needed blood transfusion for hemorrhagic shock. A cesarean section had only been performed once for delivery stop 9 years ago. Recurrent hemorrhage could not be controlled by conservative treatment, and we performed laparoscopic scar resection and repair. The abnormal uterine bleeding was successfully stopped, and the menstrual cycle was normalized after surgical treatment. We should be aware that even an uneventful cesarean section may have a risk of massive hemorrhage postoperatively as in the present case.

Objective: To study the validity of sonographic lower uterine segment (LUS) thickness in predicting intraoperative cesarean scar defect (CSD) and thin incision sites in term pregnancy. Methods: This was a cross-sectional study involving 111 full-term pregnant women who were scheduled for repeat cesarean delivery from April, 2019 to January, 2020. The sonographic myometrial LUS thickness was measured prior to surgery. The cesarean scar was assessed using the morphologic classification system as either grade 1 (a normally formed LUS), grade 2 (a thin LUS, but without visible content), or grade 3 (a thin LUS with visible content). Then, the ophthalmic caliper was used to measure the incision site’s uterine-wall thickness. The correlations between the sonographic measurements and intraoperative findings were reported. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: There were two cases (1.8%) of grade 3 CSD. The overall correlation between the sonographic and intraoperative incision-site thickness showed r=0.559 with p-value < 0.001. The sonographic cut-off value of 1.5 mm could predict CSD and a thin incision-site uterine wall with sensitivity, specificity, PPV, NPV of 50.0%, 90.8%, 9.1%, 99.0%, and 37.5%, 94.6%, 54.5%, 90.0%, respectively. A receiver operating characteristic curve was generated to determine the optimum cut-off value at 2.5 mm with a sensitivity of 76.5% and a specificity of 73.3%. The area under the curve was 0.8 (a 95% confidence interval, 0.718-0.885). Conclusion: Abdominal sonography is a valuable tool for the preoperative prediction of CSD. A myometrial LUS thickness of more than 1.5 mm is associated with a lower likelihood of cesarean scar dehiscence.

Objective: To study the validity of abdominal sonographic lower uterine segment (LUS) thickness in predicting intraoperative cesarean scar defect (CSD) and thin incision-site uterine wall thickness in term pregnancy. Methods: This was a cross-sectional study involving 111 full-term pregnant women who were scheduled for repeat cesarean delivery from April, 2019 to January, 2020. The abdominal sonographic myometrial LUS thickness was measured prior to surgery. The cesarean scar was assessed using the morphologic classification system as either grade 1 (a normally formed LUS), grade 2 (a thin LUS, but without visible content), or grade 3 (a thin LUS with visible content). Then, the ophthalmic calipers was used to measure the incision-site uterine wall thickness. The correlations between the abdominal sonographic measurements and intraoperative findings were reported. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: There were two cases (1.8%) of grade 3 CSD. The overall correlation between the abdominal sonographic and intraoperative incision-site uterine wall thickness showed r=0.559 with p value < 0.001. The sonographic cut-off value of 1.5 mm could predict CSD and a thin incision-site uterine wall thickness with sensitivity, specificity, PPV, NPV of 50.0%, 90.8%, 9.1%, 99.0%, and 37.5%, 94.6%, 54.5%, 90.0%, respectively. A receiver operating characteristic curve was generated to determine the optimum cut-off value at 2.5 mm with a sensitivity of 76.5% and a specificity of 73.3%. The area under the curve was 0.8 (a 95% confidence interval, 0.718-0.885). Conclusion: Abdominal sonography is a valuable tool for the preoperative predicting of CSD. A myometrial LUS thickness of more than 1.5 mm is associated with a lower likelihood of cesarean scar dehiscence. [ABSTRACT FROM AUTHOR]

Background: The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions.Methods: This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey's scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair's scoring system was used to evaluate intraperitoneal adhesions.Results: The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value < 0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of < 0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value < 0.001)]. The Davey's and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001).Conclusion: Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions. [ABSTRACT FROM AUTHOR]

Depending on the developing laparoscopic technique and experience, the treatment of cesarean scar choriocarcinoma can be safely performed laparoscopically by experts. [ABSTRACT FROM AUTHOR]

Objective: Lateral wall ruptures in women with a history of cesarean section are less common but more complicated than anterior wall ruptures. Residual myometrial thickness (RMT) is believed to be valuable for assessing the probability of ruptures. This study aimed to assess the utility of OmniView (a sonographic reslicing technique) in evaluating the lateral uterine wall after cesarean section and evaluate the relationship between lateral and anterior wall RMT using OmniView and sagittal two-dimensional ultrasound.Study Design: This cross-sectional study examined changes in both the anterior and lateral uterine wall in women with a history of cesarean section in the past 12-18 months. OmniView with volume contrast imaging with a 2-mm slice thickness was used to generate coronal planes, and the OmniView RMT (OV-RMT) was calculated as a percentage. Blinded to the OV-RMT results, sonographic multiplanar views were used to acquire the optimum sagittal plane for evaluating the RMT, and the sagittal RMT (S-RMT) was calculated as a percentage. The reproducibility of OV-RMT and S-RMT between two observers was tested using interclass correlation (ICC). The relationship between two variables was tested using Spearman's rank correlation.Results: In 208 recruited patients, the prevalence of lateral uterine wall defects was 79 %. The interobserver and intraobserver reproducibility of S-RMT and OV-RMT had ICC coefficients over 0.9 with a p-value <0.001. S-RMT and OV-RMT did not follow a normal distribution, and the medians were significantly different (55.5 and 85.7, respectively). Spearman's rank correlation between OV-RMT and S-RMT had a rho (ρ) value of 0.24 (p < 0.05). Passing-Bablok regression had an intercept of 47.95 and a slope of 0.65.Conclusion: OmniView can be used to assess lateral uterine wall defects, and OV-RMT is a reproducible and reliable method for quantifying this assessment. The RMT on the coronal plane was independently more intact than that on the sagittal plane, which might account for the lower incidence of lateral ruptures. Further studies could reveal a critical OV-RMT value that is safe for a trial of labor. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to evaluate the consequences of repeated cesarean section and we focused on cervical length. We wanted to assess by ultrasound the correlation between caesarean scar and cervical length in patients with previous cesarean section. We realized a prospective study at "Bucur" Maternity "St. John", Hospital, Bucharest between 2016-2020 that included patients with cesarean scar who were monitored during pregnancy in our department. The patients were evaluated by ultrasound for the cervical length in each trimester of pregnancy and after birth. The study included 69 patients with cesarean scar aged between 18 and 41 years, with a mean age of 29.26 years. In the first trimester of pregnancy the mean value for cervical length was 35.48 mm (standard deviation 4.85, CI: [34.31; 36.64]). For women monitored in the second trimester, the length of the cervix recorded values was 33.11 mm (standard deviation 2.81, CI: [32.34; 33.87]). It is observed that for women with uterine contractions in the 30-34 weeks of pregnancy, the length of the cervix measured in the second trimester is slightly shorter than in pregnant women without contractions. Thus, they had an average cervical canal length of 31.33 mm (standard deviation 2.00, CI: [29.80; 32.87]), respectively 34.44 mm (standard deviation 2.76, CI: [33.35; 35.54]). Ultrasound evaluation of cervical length in the first trimester of pregnancy proved that cervix is shorter in older patients. Cervicometry in the second trimester of pregnancy registered lower values than compared with the first trimester. [ABSTRACT FROM AUTHOR]