Women with a history of cesarean delivery combined with irregular perimenstrual bleeding should undergo combined hysteroscopy and ultrasound examination to detect latent scar defects. In diagnosed cases, in those who desired future pregnancies and had a residual myometrial thickness of <3.5 mm or a defect that accounted for ≥50% of the anterior uterine wall, laparoscopic surgical repair was performed with good postoperative anatomic outcomes. Women with residual myometrial thickness of ≥3.5 mm or a defect that accounted for <50% of the anterior uterine wall were treated with hysteroscopic surgery and had a relief of symptoms.

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Objectives This study was to investigate the clinical efficacy of a gonadotrophin‐releasing hormone agonist (GnRH‐a) combined with high‐intensity focused ultrasound (HIFU) ablation treatment for adenomyosis. Design A non‐randomized prospective study. Setting Gynaecological Minimally Invasive Centre in a single hospital. Population Patients with adenomyosis. Methods Seventy‐nine patients with adenomyosis were enrolled, including 55 patients in the control group treated with only HIFU and 24 patients in the study group treated with GnRH‐a combined with HIFU. All the patients follow up 6 months after the HIFU procedure. The related parameters in the two groups were assessed before and 3 months as well as 6 months after treatment including serum levels of tumor marker and cytokine, volumes of uterine, adenomyotic lesion, and menstrual blood, as well as dysmenorrheal scores. Main outcome measures Differences between the group treated with HIFU alone and the group treated with GnRH‐a combined with HIFU. Results Before HIFU treatment, no significant difference was observed in serum levels of CA125, CA19‐9, and interleukin‐6 (IL‐6), the volumes of uterine, adenomyotic lesion, and menstrual blood, as well as dysmenorrhea scores between the two groups. (P > 0.05). The serum CA125 levels significantly decreased in both groups after HIFU, but the serum CA125 levels in the study group were still significantly lower than those in the control group (P < 0.05). The volume of uterine and adenomyotic lesion significantly decreased in both groups after HIFU procedure, and decreased even more in the study group 3 and 6 months after treatment (P < 0.05). Dysmenorrhea scores and menstruation volumes significantly decreased in both groups after HIFU treatment. Moreover in the study group were significantly lower than those in the control group after 3 and 6 months (P < 0.05). No significant difference was observed in the rate of adverse effects between the two groups. Conclusions The short‐term follow‐up results indicate that the combination of GnRH‐a and HIFU treatment significantly decreased serum CA125 levels, volumes of uterine, adenomyotic lesion and menstrual blood, as well as dysmenorrhea scores, and improved the clinical outcomes compared with the HIFU ablation alone in patients with adenomyosis. However, the further follow‐up is needed to explore the long‐term effects. Tweetable abstract A combination of GnRH‐a with HIFU in the treatment of adenomyosis significantly decreased serum CA125 levels, uterine and adenomyotic lesion volumes, dysmenorrhea scores, and menstrual blood volumes.

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Aims: Persistent Cesarean scar pregnancy (PCSP) is a rare and special type of Cesarean scar pregnancy (CSP) which is resistant to conservative treatment. The treatment option is challenging. We report a case series to provide indications for further treatment. Methods: Ten women diagnosed as having a PCSP, seeking better treatment because of primary treatment failure, were admitted to a gynecologic minimally invasive center. Ultrasound combined with office hysteroscopy was used for preoperative evaluation, and then a further surgical strategy was selected. Clinical data were retrospectively studied. Results: Among ten PCSP patients, 4 were type I and 6 were type II. In the 4 type I cases, 2 were treated by laparoscopy and the other 2 by hysteroscopy; to stop bleeding in 1 of them, the uterine artery was occluded laparoscopically. All type II cases were successfully treated by laparoscopic excision. The mean operating time was 61.5 min. The mean blood loss was 83.5 ml. No complications occurred except one intraoperative hemorrage. Conclusions: Experience from this case series indicates that an individualized surgical plan based on a full preoperative evaluation provides useful information for choosing a suitable treatment for PCSP. Endoscopically guided surgical excision with experienced hands may be considered the most useful treatment.

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