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UACE combined with curettage was found to be an effective fertility-sparing treatment for CSP. Further, the approach did not seem to harm future reproductive ability.

Background Fetal growth restriction (FGR) is associated with a high fetal brain volume/liver volume (FBV/FLV) ratio. Ultrasound may not always be reliable, which has prompted further investigation of MRI techniques. Purpose To determine the relationship between FBV/FLV ratio, as measured by MRI, and gestational age (GA) in normal fetuses and those with FGR. Study Type Retrospective. Population One hundred and forty seven singleton pregnancies including 105 appropriate‐for‐gestational age (AGA) fetuses and 42 FGR fetuses. Field Strength/Sequence Three‐dimensional fast imaging employing steady‐state acquisition at 1.5 T. Assessment The FBV and FLV were measured by three radiologists. The inter‐ and intraobserver agreements, the correlation between FBV/FLV ratio, and advancing GA were evaluated; the diagnostic value of FBV/FLV ratio was evaluated and compared with head circumference/abdominal circumference (HC/AC) ratio measured by ultrasound. Statistical Tests Intraclass correlation coefficient (ICC) was used to determine inter‐ and intraobserver agreements. Regression analysis was used to assess the correlation between FBV/FLV ratio and advancing GA. The diagnostic value of the FBV/FLV ratio was examined by the area under the receiver operating characteristic (ROC) curve. Results The inter‐ and intraobserver agreements were excellent with an interobserver ICC of 0.984 and intra‐observer ICCs of 0.989, 0.994, and 0.995. The FBV/FLV ratio in AGA fetuses decreased significantly with advancing GA (Pearson correlation coefficient = −0.844). The FBV/FLV ratio in FGR fetuses was significantly higher than that in AGA fetuses. To identify fetuses at high risk for FGR using the FBV/FLV ratio, the area under the ROC curve was 0.978, with an optimal cut‐off value of 4.10. The sensitivity of FBV/FLV ratio in identifying FGR was significantly higher than that of HC/AC ratio (0.929 vs. 0.529). Data Conclusion An inverse correlation exists between FBV/FLV ratio and advancing GA in normal fetuses. A high FBV/FLV ratio may be used to ascertain fetuses at high risk for FGR. Level of Evidence: 3 Technical Efficacy Stage: 3

The steady rise in cesarean delivery rates has become one of the most serious topics in maternity care worldwide. In China, the rate of cesarean delivery increased rapidly from 6. 7% in 1993 to 20.6% in 2003 [1]. We report a rare lithopedion formation following rupture of a cesarean scar.A 34-year-old patient (G2, P1) is described. The patient underwent a cesarean delivery in 2001 owing to preterm labor of a breech position fetus in her first pregnancy. The neonate died on the second day of life as a result of congenital alveolar dysplasia. The patient became pregnant for the second time in 2004. At 21 weeks of pregnancy the patient presented to hospital with a 1-day history of lower abdominal pain and irregular vaginal bleeding after sexual intercourse. Subsequently, fetal movement stopped and the patient did not seek further medical care. Regular menstrual cycles resumed 3 months later. Although the patient did not use contraception, no subsequent pregnancies ensued. A strong desire for fertility led the patient to seek evaluation at our hospital in June 2009. A computerized tomography (CT) scan showed a calcified external surface and images of bones within a mass that appeared to partially include the uterus (Fig. 1).The patient underwent exploratory laparotomy, which revealed a large calcified oval tumor adherent to the fundus of the uterus. The uterus was equivalent in size to an 8-week-old gestation. A connection between the uterine and abdominal cavities was identified. Thorough exploration revealed a calcified fetal skull located in the uterine cavity, whereas the other body parts, including the spine and limbs, were situated in the abdominal cavity. A uterine incision surrounded by the old scar was observed in the anterior wall of the uterus. Hence, it seems likely that rupture of the cesarean scar had caused the fetus to partly enter into the abdominal cavity. The lithopedion and calcified ovular membrane, as well as the old uterine scar, were completely resected and the uterus was repaired with interrupted sutures. To accelerate the healing of the uterine endometrium, treatment with estrogen followed by progesterone was used for 3 months. A favorable reproductive outcome for the patient is anticipated.For the diagnosis of lithopedion, ultrasound is able to demonstrate an echogenic mass, but is unable to differentiate such a formation from other calcified masses, such as ovarian tumors, myomas, or epiploic calcifications [2]. CT has the advantage of identifying the position, content, and integration of a calcified mass. Our CT results, coupled with evidence from the literature [3], demonstrated the criteria for diagnosis of a lithopedion. The diagnostic criteria are as follows: a large well-defined calcified mass in the abdomen; regular or irregular images of bones observed in the mass; and ovular membranes surrounding the mass usually calcified and forming a hard eggshell like surface. Conflict of interestThe authors have no conflict of interest to disclose. References[1] Li X, Wu Z, Wang T. Caesarean...