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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.

Objective To compare the influence on caesarean section morbidity of uterine exteriorisation or in Design Randomised controlled trial.Setting Princess Anne Maternity Unit of the Royal Bolton Hospital, UK. Population One hundred and ninety-four women undergoing delivery by caesarean section.Methods Two intra-operative readings of arterial pulse rate, mean arterial blood pressure, and arterial haemoglobin oxygen saturation were obtained. Pre-operative and day-3 haemoglobin concentrations were determined. Intra-and post-operative complications, puerperal pain scores, and febrile and infectious morbidity were assessed. A postal questionnaire was used to assess morbidity six weeks after delivery.Main outcome measures Intra-operative changes in pulse rate, mean arterial blood pressure and oxygen saturarion; peri-operative changes in haemoglobin concentration; incidence of intraoperative vomiting, pain, intra-and post-operative complications, and febrile and infectious morbidity; immediate and late puerperal pain scores; satisfaction with the operation. ResultsNo clinically significant differences between uterine exteriorisation and in situ repair were found in pulse rate, mean arterial pressure, oxygen saturation and haemoglobin changes. Likewise, the incidence of vomiting and pain was similar. Vomiting occurred in 10% of all the women, and 57% of all pain complaints occurred at the initial skin incision. There was a trend towards higher immediate and late pain scores in the exteriorisation group, reaching statistical significance on day 3. Overall, pain scores averaged 6/10 on day 1 despite patient-controlled analgesia, and three-quarters of all women reported persisting pain on day 42. Intra-and postoperative complications, febrile and infectious morbidity, and duration of hospital stay were similar in both groups. ConclusionsWe have demonstrated that uterine exteriorisation and in situ repair have similar effects on peri-operative caesarean section morbidity. Intra-operative pain reflected adequacy of anaesthesia, while vomiting reflected adequacy of pre-operative preparation of patients.Exteriorising the uterus at caesarean section is a valid option.situ repair.

ObjectiveTo assess the impact of surgical management of endometrioma on the outcome of assisted reproduction treatment (ART).DesignA systematic review and meta-analysis.SettingDepartment of reproductive medicine at teaching university hospital, UK.PatientsSubfertile women with endometrioma undergoing ART.InterventionsSurgical removal of endometrioma or expectant management.Main outcome measuresClinical pregnancy rate, pregnancy rate, live birth rate, number of oocytes retrieved and number of embryos available and ovarian response to gonadotrophins.ResultsAn extensive search of electronic databases for articles published from inception to September 2016 yielded 11 eligible studies for meta-analysis. Meta-analysis was conducted comparing surgery versus no treatment of endometrioma. There were no significant differences in pregnancy rate per cycle, clinical pregnancy rate and live birth rate between women who underwent surgery for endometrioma and those who did not.ConclusionCurrent evidence suggests that women with endometriosis-related infertility have similar cycle outcomes to other patients going through ART. It is pertinent for clinicians to assess the risks of surgical intervention on ovarian reserve prior to initiating therapy.