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Objective To develop a standardized sonographic evaluation and reporting system for Cesarean scar pregnancy (CSP) in the first trimester, for use by both general gynecology and expert clinics. Methods A modified Delphi procedure was carried out, in which 28 international experts in obstetric and gynecological ultrasonography were invited to participate. Extensive experience in the use of ultrasound to evaluate Cesarean section (CS) scars in early pregnancy and/or publications concerning CSP or niche evaluation was required to participate. Relevant items for the detection and evaluation of CSP were determined based on the results of a literature search. Consensus was predefined as a level of agreement of at least 70% for each item, and a minimum of three Delphi rounds were planned (two online questionnaires and one group meeting). Results Sixteen experts participated in the Delphi study and four Delphi rounds were performed. In total, 58 items were determined to be relevant. We differentiated between basic measurements to be performed in general practice and advanced measurements for expert centers or for research purposes. The panel also formulated advice on indications for referral to an expert clinic. Consensus was reached for all 58 items on the definition, terminology, relevant items for evaluation and reporting of CSP. It was recommended that the first CS scar evaluation to determine the location of the pregnancy should be performed at 6–7 weeks' gestation using transvaginal ultrasound. The use of magnetic resonance imaging was not considered to add value in the diagnosis of CSP. A CSP was defined as a pregnancy with implantation in, or in close contact with, the niche. The experts agreed that a CSP can occur only when a niche is present and not in relation to a healed CS scar. Relevant sonographic items to record included gestational sac (GS) size, vascularity, location in relation to the uterine vessels, thickness of the residual myometrium and location of the pregnancy in relation to the uterine cavity and serosa. According to its location, a CSP can be classified as: (1) CSP in which the largest part of the GS protrudes towards the uterine cavity; (2) CSP in which the largest part of the GS is embedded in the myometrium but does not cross the serosal contour; and (3) CSP in which the GS is partially located beyond the outer contour of the cervix or uterus. The type of CSP may change with advancing gestation. Future studies are needed to validate this reporting system and the value of the different CSP types. Conclusion Consensus was achieved among experts regarding the sonographic evaluation and reporting of CSP in the first trimester. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Objective To study the association between the level of Cesarean hysterotomy and the presence of large uterine scar defects 6-9 months after delivery.Methods This was a two-center, randomized, single-blind trial of a surgical procedure with masked assessment of the principal outcome under study. Women without a history of Cesarean section (CS) who underwent emergency CS at cervical dilatation ≥ 5 cm were randomized to high or low incision. Hysterotomy was performed 2 cm above and 2 cm below the plica vesicouterina in the high and low incision groups, respectively. Women were examined using saline contrast sonohysterography to assess the appearance of the hysterotomy scar 6-9 months after delivery. The main outcome was presence of a large scar defect, defined as the remaining myometrial thickness over the defect being ≤ 2.5 mm. Secondary outcomes were perinatal outcome, operative complications within 8 weeks after delivery and long-term outcome in a subsequent pregnancy.Conclusion Low Cesarean hysterotomy level in women in advanced labor is associated with higher incidence of large scar defects detected by transvaginal ultrasound examination 6-9 months after delivery.Nivel de histerotomía por cesárea y presencia de grandes defectos cicatriciales: un ensayo aleatorizado ciego simple RESUMEN Objetivo Estudiar la asociación entre el nivel de histerotomía por cesárea y la presencia de grandes defectos de cicatrices uterinas a los 6-9 meses después del parto.Métodos Este fue un ensayo en dos centros de tipo aleatorizado y ciego simple de un procedimiento quirúrgico con evaluación encubierta del resultado principal que era el objeto de estudio. Las mujeres sin antecedentes de cesárea que se sometieron a una cesárea de emergencia con dilatación cervical ≥ 5 cm fueron asignadas al azar a una incisión alta o baja. La histerotomía se realizó 2 cm por encima y 2 cm por debajo del pliegue vesicouterino en los grupos de incisión alta y baja, respectivamente. Las mujeres se examinaron mediante sonohisterografía con contraste salino para evaluar la apariencia de la cicatriz de la histerotomía a los 6-9 meses después del parto. El resultado principal fue la presencia de un gran defecto de cicatriz, definido como el grosor restante del miometrio sobre el defecto de un tamaño ≤ 2,5 mm. Los resultados secundarios fueron el resultado perinatal, las complicaciones quirúrgicas dentro de las 8 semanas después del parto y el resultado a largo plazo en un embarazo posterior.Resultados De las 122 pacientes inscritas en el ensayo, 114 fueron examinadas mediante ecografía, de las cuales 55 fueron asignadas al azar a una incisión alta y 59 a una incisión baja en la cesárea. Se observaron defectos de cicatrices grandes en cuatro (7%) mujeres en el grupo de incisión alta y en 24 (41%) en el grupo de incisión baja (P<0.001; razón de momios 8.7 (IC 95%, 2.8-27.4)) No hubo diferencias entre los dos grupos en las complicaciones quirúrgicas o en los resultados perinatales. La mediana del tiempo de seguimiento fue de 4 años y 7 meses, durante los cua...

Background: It has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infection. Case presentation: A 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32 + 6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission. Conclusions: This case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.

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Objectives To determine intra-and interobserver reliability of evaluating the appearance and measurement of MTS and 0.96 (95% CI, for RMT, compared with 0.82 (95% CI, TVS. Intermethod ICC was 0.86 (95% CI, for measurement of MTS and 0.89 (95% CI,

The prediction model demonstrated poor accuracy for prediction of successful VBAC in our Swedish population. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

BackgroundHeterotopic pregnancy with a combination of a caesarean scar pregnancy and an intrauterine pregnancy is rare and has potentially life-threatening complications.Case presentationWe describe the case of a 27-year-old white woman who had experienced an emergency caesarean delivery at 39 weeks for fetal distress with no postpartum complications. This is a report of the successful expectant management of a heterotopic scar pregnancy. The gestational sac implanted into the scar area was non-viable. The woman was treated expectantly and had a normal vaginal delivery at 37 weeks of gestation.ConclusionExpectant management under close monitoring can be appropriate in small non-viable heterotopic caesarean scar pregnancies.