Letters to the Editor because of the proliferation of peritrophoblastic vessels 6. Emergency hysterectomy may often be the only choice available because of profuse hemorrhaging due to uterine rupture 7. Medical treatment with methotrexate (MTX) is another option for a Cesarean scar pregnancy 8,9. The treatment of extrauterine pregnancies with MTX has long been advocated by several authors 10 and a single intramuscular dose of MTX has also been proposed to treat Cesarean scar pregnancies regardless of the thin uterine scar 8. Direct local injection of MTX into the embryo or amniotic sac under transabdominal ultrasound guidance is another treatment option 11 and has the advantage of avoiding the systemic side-effects of MTX. The same treatment principles have been used in cornual or cervical pregnancies 12. On the other hand, Robert et al. 13 described a case of a Cesarean scar pregnancy that was successfully terminated by the injection of hypertonic glucose directly into the sac at 5.5-6 weeks of gestation. Laparoscopy, although it had limited benefit in our patient, has also been reported to successfully treat a case of a Cesarean scar pregnancy 14. In conclusion, a Cesarean scar pregnancy can be diagnosed by sonographic examination at 5-6 weeks' gestation and the implantation into the scar should be clearly demonstrated. Methotrexate administration or local excision are the treatments of choice if an early diagnosis is made.

Objective: We evaluated placental alterations in different subtypes of fetal growth restriction (FGR) to determine any clinical associations. Methods: FGR placentas classified according to the Amsterdam criteria were correlated with clinical findings. Percentage of intact terminal villi and villous capillarization ratio were calculated in each specimen. Correlations of placental histopathology and perinatal outcomes were studied. 61 FGR cases were studied. Results: Early-onset-FGR was more often associated with preeclampsia and recurrence than late-onset-FGR; placentas from early-onset-FGR often had diffuse maternal (or fetal) vascular malperfusion and villitis of unknown etiology. Decreased percentage of intact terminal villi was associated with pathologic CTG. Decreased villous capillarization was associated with early-onset-FGR and birth weight below the second percentile. Avascular villi and infarction were more common when femoral length/abdominal circumference ratio was >0.26, and perinatal outcome was poor in this group. Conclusion: In early-onset-FGR and preeclamptic FGR, altered vascularization of villi may have a key role in pathogenesis, and recurrent FGR is associated with villitis of unknown etiology. There is an association between femoral length/abdominal circumference ratio >0.26 and histopathological alterations of placenta in FGR pregnancies. There are no significant differences in the percentage of intact terminal villi between different FGR subtypes by onset or recurrency.

Objective Evaluation of routine screening in the early pregnancy by transvaginal sonography (TVS) in an unselected population. Design and methods: A routine ultrasound examination was offered to every woman in the 12th week of her pregnancy. Besides a detailed survey of fetal anatomy, a measurement of nuchal translucency and karyotyping was performed as appropriate. Results In a five‐year period (from 1. Jan. 1995 – to 31. Dec. 1999) 9556 women were examined. Fetal anomalies were diagnosed in 54 cases at the 12th week of pregnancy: 63 morphological abnormalities and 16 chromosomal aberrations. The detection rate for structural and chromosomal abnormalities in early pregnancy was 50.5% (54/107) of all anomalies, which were diagnosed antenatally. Conclusions It is possible to detect fetal abnormalities very early in pregnancy. The ultrasound screening may increase the detection rate of chromosomal disorders. The interpretation of fetal anatomy in the first trimester requires comprehensive understanding of embryological development. The detection rate of fetal malformations is increased significantly by introducing an early pregnancy scan in addition to the mid‐trimester scan. The fetopathological examination can add more information to the clinicians and to genetic counselling.

Objective: To evaluate the possible connections of cardiotocography (CTG) signs with neonatal outcome and placental histopathology between growth restricted preterms. Materials and Methods: Placental slides, baseline variability, and acceleration patterns of cardiotocograms, and neonatal parameters were studied retrospectively. Placental histopathological changes were diagnosed according to the Amsterdam criteria; percentage of intact terminal villi and capillarization of villi were also studied. 50 cases were analyzed: 24 were early-onset fetal growth restriction (FGR), 26 were late-onset FGR. Results: Reduced baseline variability was related to poor neonatal outcome; lack of accelerations similarly had associations with poor outcomes. Maternal vascular malperfusion, avascular villi, VUE, and chorangiosis were more common in the background of reduced baseline variability and absence of accelerations. Lower percentage of intact terminal villi was significantly associated with lower umbilical artery pH, higher lactate levels, and reduced baseline variability on CTG; absence of accelerations was correlated with decreased capillarization of terminal villi. Conclusions: Baseline variability and absence of accelerations seem to be useful and reliable markers in predicting poor neonatal outcome. Maternal and fetal vascular malperfusion signs, decreased capillarization, and lower percentage of intact villi in placenta could contribute to pathologic CTG signs and poor prognosis.

Aim To evaluate the associations between placental histopathology (signs of maternal and fetal vascular malperfusion, delayed villous maturation, villitis of unknown etiology) and subtypes of preeclampsia by onset, clinical aspects of the disease and neonatal outcome. Methods Placental slides from preeclamptic pregnancies were retrospectively reviewed according to a uniform scheme. Information regarding obstetrical anamnesis, clinical data and perinatal outcome was collected from charts, and statistical analysis was performed in order to demonstrate associations between microscopic placental alterations and different aspects of preeclampsia. Results A total of 49 cases were studied. Diffuse signs of maternal vascular malperfusion and avascular villi were more common in early‐onset‐preeclampsia associated with worse prognosis. Preeclampsia with fetal growth restriction had more often diffuse signs of maternal and fetal vascular malperfusion and villitis of unknown etiology. Recurring preeclampsia was associated with more common perivasculitis. Umbilical and uterine artery Doppler indices were associated with medial hypertrophy and/or acute atherosis of maternal decidual vessels. Large foci of avascular villi correlated with extent of maternal 24‐h‐proteinuria which itself correlated with outcome of preeclampsia. Rate of capillarisation of villi was significantly lower in case of hypertension requiring a three‐drug combination of antihypertensive medications versus hypertension treated with one or two drugs, preeclampsia with growth restriction, and stillbirth versus live birth. Conclusions Early‐ versus late‐onset‐preeclampsia showed a markedly different profile of histopathological features and perinatal outcome, reflecting their distinguished pathogenesis and prognosis; preeclampsia complicated with fetal growth restriction also had distinctive features. Qualitative and quantitative changes define placental pathology of preeclampsia.