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Cesarean scar pregnancies confer serious risk and severe morbidity. Appropriate management is the key to preventing complications. Although expectant management is usually contraindicated, the ideal combination of medical or surgical treatments is unclear and must be tailored to the patient's preferences and stability, provider skill, and the available resources. In this article, we present a combined medical and surgical approach that was successfully employed for the termination and excision of a cesarean scar pregnancy at 12 weeks' gestation in a patient desiring uterine preservation. A video is included, demonstrating the surgical steps of a laparoscopic approach used to safely resect the pregnancy and cesarean delivery scar with minimal blood loss. The management technique described can be utilized to effectively resolve cesarean scar pregnancy, to possibly decrease the risk of recurrence, and preserve future fertility with a minimally invasive outpatient surgery.

Biochar has been promoted as a soil amendment that enhances soil quality and agronomic productivity and reduces greenhouse gas production. However, these benefits are not always realized. A major hurdle to the beneficial use of biochar is our limited knowledge regarding the mechanisms directing its effects on soil systems. This project aimed to eliminate some of this uncertainty by examining the biological responses (plant productivity, greenhouse gas production, soil microbial community structure) of a suite of soils (10) to the addition of biochars produced by different processes (pyrolysis, gasification, burning) from a range of feedstocks (corn stalks, hardwood, grass). Results indicated that these three responses were not significantly impacted by the addition of pyrolysis biochars from different feedstocks at 1 and 5% (w/w) addition levels. On the other hand, both an open-air burned corn stalk (5%) and raw corn stalks (1 and 5%) additions did alter the measured soil functionality. For example, the 5% burnt corn stalks addition reduced total above ground plant biomass (∼30%), increased observed N2O production by an order of magnitude, and altered soil bacterial community structure. The bacterial groups that increased in relative abundance in the burnt corn stalks-amended soils included families associated with cellulose decomposition (Chitinophagaceae), plant pathogens (Xanthomonadaceae), and biochar/charcoal-amended media (Gemmatimonadetes). In contrast, the abundance of these bacterial groups was not impacted by the pyrolysis biochars. Therefore, this research suggests that pyrolysis biochar represents a stabilized form of carbon that is resistant to microbial mineralization and has negligible effects on soil biological responses.

In this month's issue, the journal continues to bring new insights from Cochrane systematic reviews to the readers of Obstetrics & Gynecology. This month, we highlight the use of intrauterine progestins for the treatment of endometrial hyperplasia and an overview review of interventions to prevent gestational diabetes. The summaries are published below. The complete references with hyperlinks are listed in Box 1.