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Background: Caesarean scar ectopic pregnancy (CSEP) is associated with significant maternal and foetal morbidity. However, the optimal treatment remains unknown. Objectives: The aim of this study was to review outcomes reported in studies on CSEP treatment and outcome reporting quality. Search Strategy: We reviewed 1270 articles identified through searching PubMed, MEDLINE and Google Scholar from 2014 to 2024 using the search terms 'caesarean scar ectopic pregnancy and caesarean scar pregnancy'. Selection Criteria: We included all study types evaluating any form of CSEP treatment, with a sample size of ≥ 50, where diagnosis was described, and the article was in English. Data Collection and Analysis: Two authors independently reviewed studies and assessed outcome reporting and methodological quality. The relationship between outcome reporting quality and publication year and journal type was assessed with univariate and bivariate models. Main Results: A total of 108 studies, including 17 941 women, were included. 83% of all studies originated from China. Studies reported on 326 outcomes; blood loss (86%), need for additional intervention (77%) and time for serum hCG to normalise post treatment (69%) were the most common outcomes. A primary outcome was clearly defined in 11 (10%) studies. The median quality of outcome reporting was 3 (IQR 3–4). No relationship was demonstrated between outcome reporting quality and publication year (p = 0.116) or journal type (p = 0.503). Conclusions: This review demonstrates that there is a wide variation in outcomes reported in studies on CSEP treatment. Development and implementation of a core outcome set by international stakeholders which includes patients is urgently needed to enable high‐quality research that is both useful and relevant to patients. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean scar ectopic pregnancies (CSEPs) are associated with significant maternal morbidity and termination is often recommended in the early first trimester. Management of more advanced cases is challenging due to higher risks of major intraoperative hemorrhage. Hysterectomy is currently the intervention of choice for advanced cases. This study aimed to investigate if advanced live CSEPs could be managed effectively conservatively using suction curettage and interventional radiology. Material and methods: A retrospective single‐center cohort study was performed. A total of 371 women diagnosed with CSEP were identified between January 2008 and January 2023. A total of 6% (22/371) women had an advanced live CSEP with crown‐rump length (CRL) of ≥40 mm (≥10 weeks' gestation). Of these, 77% (17/22) opted for surgical intervention, whilst the remaining five continued their pregnancies. A preoperative ultrasound was performed in each patient. All women underwent suction curettage under ultrasound guidance and insertion of Shirodkar cervical suture as a primary hemostatic measure combined with uterine artery embolization (UAE) if required. The primary outcome was rate of blood transfusion. Secondary outcomes were estimated intraoperative blood loss, UAE, intensive care unit admission, reintervention, hysterectomy, hospitalization duration and rate of retained products of conception. Descriptive statistics were used to describe these variables. Results: Median CRL of the 17 patients included was 54.1 mm (range: 40.0–85.7) and median gestational age based on CRL was 12 + 3 weeks (range: 10 + 6–15 + 0). On preoperative ultrasound scan placental lacunae were recorded in 76% (13/17) of patients and color Doppler score was ≥3 in 67% (10/15) of patients. At surgery, Shirodkar cervical suture was used in all cases. It was successful in achieving hemostasis by tamponade in 76% (13/17) of patients. In the remaining 24% (4/17) patients tamponade failed to achieve complete hemostasis and UAE was performed to stop persistent arterial bleeding into the uterine cavity. Median intraoperative blood loss was 800 mL (range: 250–2500) and 41% (7/17) women lost >1000 mL. 35% (6/17) needed blood transfusion. No women required hysterectomy. Conclusions: Surgical evacuation with Shirodkar cervical suture and selective UAE is an effective treatment for advanced live CSEPs. [ABSTRACT FROM AUTHOR]

Background: Tubal ectopic pregnancy (TEP) is a common gynaecological emergency. Several medical and surgical treatment options exist, but it is not clear which is the safest and most effective treatment. Objectives: To compare the effectiveness of expectant, medical and surgical treatment options for TEP using a systematic review and network meta‐analysis. Search Strategy: MEDLINE, EMBASE, and CENTRAL from inception till September 2022. Selection Criteria: Randomised trials that evaluated any treatment option for woman with a TEP. Data Collection and Analysis: We performed pairwise and network meta‐analyses using a random effect model. We assessed the studies' risk of bias, heterogeneity and network inconsistency. We reported primarily on TEP resolution and treatment failure using relative risk (RR) and 95% confidence‐intervals (CI). Main Results: We included 31 randomised trials evaluating ten treatments (n = 2938 women). Direct meta‐analysis showed no significant benefit for using methotrexate compared to expectant management for TEP resolution. Network meta‐analysis showed similar effect‐size for most conservative treatment options compared to expectant management for TEP resolution (glucose intra‐sac instillation vs. expectant RR 0.84, 95% CI 0.63–1.12; methotrexate intra‐sac instillation vs. expectant RR 0.91, 95% CI 0.75–1.10; multi‐dose methotrexate vs. expectant RR 1.00, 95% CI 0.88–1.15; prostaglandin intra‐sac instillation vs. expectant RR 0.75, 95% CI 0.53–1.07; salpingotomy vs. expectant RR 0.99, 95% CI 0.84–1.16; single dose methotrexate vs. expectant RR 0.97, 95% CI 0.85–1.10; single dose methotrexate + mifepristone vs. expectant RR 1.09, 95% CI 0.89–1.33). All treatment options showed a higher risk of failure compared to salpingectomy. Conclusions: There is insufficient evidence to support the use of any medical treatment option for TEP over expectant management. [ABSTRACT FROM AUTHOR]

Objective: To develop core outcome sets (COS) for miscarriage management and prevention. Design: Modified Delphi survey combined with a consensus development meeting. Setting: International. Population: Stakeholder groups included healthcare providers, international experts, researchers, charities and couples with lived experience of miscarriage from 15 countries: 129 stakeholders for miscarriage management and 437 for miscarriage prevention. Methods: Modified Delphi method and modified nominal group technique. Results: The final COS for miscarriage management comprises six outcomes: efficacy of treatment, heavy vaginal bleeding, pelvic infection, maternal death, treatment or procedure‐related complications, and patient satisfaction. The final COS for miscarriage prevention comprises 12 outcomes: pregnancy loss <24 weeks' gestation, live birth, gestation at birth, pre‐term birth, congenital abnormalities, fetal growth restriction, maternal (antenatal) complications, compliance with intervention, patient satisfaction, maternal hospitalisation, neonatal or infant hospitalisation, and neonatal or infant death. Other outcomes identified as important were mental health‐related outcomes, future fertility and health economic outcomes. Conclusions: This study has developed two core outcome sets, through robust methodology, that should be implemented across future randomised trials and systematic reviews in miscarriage management and prevention. This work will help to standardise outcome selection, collection and reporting, and improve the quality and safety of future studies in miscarriage. [ABSTRACT FROM AUTHOR]

Introduction: The number and invasion depth of endometriotic bowel lesions, total length of bowel affected by endometriosis, lesion‐to‐anal verge distance, and extent of pouch of Douglas obliteration are important factors in preoperatively determining risk and complexity of endometriosis surgery. The intra‐ and interobserver reproducibility of transvaginal ultrasound in the evaluation of many of these parameters has not yet been investigated. Our study aimed to assess the intra‐ and interobserver reproducibility of transvaginal ultrasound between an experienced and less experienced examiner for all of these parameters. Material and methods: This prospective observational cross‐sectional study was conducted between July 2019 and November 2020. Fifty consecutive premenopausal women who underwent transvaginal ultrasound examination in our clinic for the first time, were examined by the same two operators during the same attendance. Outcomes of interest were the inter‐rater reproducibility of transvaginal ultrasound for detecting the presence, number, depth and size of bowel endometriotic nodules, lesion‐to‐anal‐verge distance, total length of bowel affected, and pouch of Douglas obliteration. The intraobserver reproducibility was assessed for the continuous parameters. Cohen's kappa (κ) statistic, Cohen's weighted kappa (κ), proportions of agreement, intraclass correlation coefficient (ICC) and Bland–Altman limits of agreement were used to assess the reproducibility of the parameters. Results: The inter‐rater agreement and reliability were very good for identifying bowel endometriosis, the number and invasion depth of bowel nodules, determining whether the maximum nodule length was <3 cm, and lesion‐to‐anal‐verge distance <8 cm (proportion of agreement 0.92, 0.94, 0.97, 0.94, 0.96; κ 0.92, 0.91, 0.92, 0.82, 0.89). The inter‐rater agreement and reliability were good for assessing pouch of Douglas obliteration (proportion of agreement 0.86, κ 0.80). The intra‐rater reliability for the mean nodule diameter (ICC 0.93 and 0.97) and total length of bowel affected (ICC 0.94 and 0.91) were excellent for operators A and B, respectively. The inter‐rater reliability for the mean nodule diameter was good (ICC 0.80), and moderate for the total length of bowel affected (ICC 0.70). The Bland–Altman limits of agreement demonstrated clinically acceptable ranges for these two parameters. Conclusions: This study demonstrated a high intra‐ and inter‐rater reproducibility of transvaginal ultrasound in the diagnosis of bowel endometriosis and measurement of its various components. [ABSTRACT FROM AUTHOR]

Introduction: The natural history of endometriosis is poorly understood, and despite numerous studies, the rate of the disease progression and optimal treatment planning in women who are asymptomatic or experience mild symptoms not requiring treatment are unknown. The aim of this study was to assess the behavior of deep endometriosis in women who are managed expectantly without any medical or surgical intervention. Material and methods: A retrospective cohort study of women diagnosed with deep endometriosis on transvaginal ultrasound scan at the Department of Gynecology, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK, from April 2007 to April 2022. All women attended for at least two ultrasound scans which were carried out by a single expert ultrasound examiner and at least 6 months apart. The number and position of endometriotic nodules were recorded, and the mean diameter of each nodule was calculated from measurements taken in three orthogonal planes. Results: During the study period, 1922 women were found to have moderate or severe deep endometriosis on pelvic ultrasound examination. A total of 135 premenopausal women who were managed expectantly fitted the inclusion criteria. The median number of endometriotic nodules per woman at the initial visit was 2 (range: 0–7), and the median follow‐up time was 666 days (181–2984). In the follow‐up period, 50/135 women (37%, 95% CI: 29–46) developed additional nodules or experienced an increase in nodule size, and 17/135 women (13%, 95% CI: 8–19) had a regression in the number or size of the nodules. In the remaining 68/135 women (50%, 95% CI: 42–59) the disease remained static during the follow‐up. The median change in mean diameter of nodules during the study period per woman was +0.13 mm (−11.67 − +5.83), with an annual growth rate of +0.09 mm/year (−6.65 − +6.45). Conclusions: In our study we found evidence of deep endometriosis progression in just over a third of women. In view of this, asymptomatic or mildly symptomatic women diagnosed with deep endometriosis could be reassured that their disease is unlikely to worsen with time. [ABSTRACT FROM AUTHOR]

Introduction: Ectopic pregnancy is an important health condition which affects up to 1 in 100 women. Women who present with mild symptoms and low serum human chorionic gonadotrophin (hCG) are often treated with methotrexate (MTX), but expectant management with close monitoring is a feasible alternative. Studies comparing the two treatments have not shown a statistically significant difference in uneventful resolution of ectopic pregnancy, but these studies were too small to define whether certain subgroups could benefit more from either treatment. Material and methods: We performed a systematic review and individual participant data meta‐analysis (IPD‐MA) of randomized controlled trials comparing systemic MTX and expectant management in women with tubal ectopic pregnancy and low hCG (<2000 IU/L). A one‐stage IPD‐MA was performed to assess overall treatment effects of MTX and expectant management to generate a pooled intervention effect. Subgroup analyses and exploratory multivariable analyses were undertaken according to baseline serum hCG and progesterone levels. Primary outcome was treatment success, defined as resolution of clinical symptoms and decline in level of serum hCG to <20 IU/L, or a negative urine pregnancy test by the initial intervention strategy, without any additional treatment. Secondary outcomes were need for blood transfusion, surgical intervention, additional MTX side‐effects and hCG resolution times. Trial registration number: PROSPERO: CRD42021214093. Results: 1547 studies reviewed and 821 remained after duplicates removed. Five studies screened for eligibility and three IPD requested. Two randomized controlled trials supplied IPD, leading to 153 participants for analysis. Treatment success rate was 65/82 (79.3%) after MTX and 48/70 (68.6%) after expectant management (IPD risk ratio [RR] 1.16, 95% confidence interval [CI] 0.95–1.40). Surgical intervention rates were not significantly different: 8/82 (9.8%) vs 13/70 (18.6%) (RR 0.65, 95% CI 0.23–1.14). Mean time to success was 19.7 days (95% CI 17.4–22.3) after MTX and 21.2 days (95% CI 17.8–25.2) after expectant management (P = 0.25). MTX specific side‐effects were reported in 33 MTX compared to four in the expectant group. Conclusions: Our IPD‐MA showed no statistically significant difference in treatment efficacy between MTX and expectant management in women with tubal ectopic pregnancy with low hCG. Initial expectant management could be the preferred strategy due to fewer side‐effects. [ABSTRACT FROM AUTHOR]

Key Content: Accessory cavitated uterine malformations (ACUMs) are isolated cavitated lesions within the lateral aspect of the myometrium, inferior to the attachment of the round ligament.They are a rare Müllerian anomaly and are increasingly recognised as a cause for severe dysmenorrhoea and pelvic pain.ACUMs can be diagnosed with ultrasound and magnetic resonance imaging, where they appear as well‐defined lesions with a central cavity containing haemorrhagic content, surrounded by a myometrial mantle. On histological examination, the cavity is lined by functional endometrial glands and stroma.Recognised treatments include hormonal suppression, destruction of the endometrial lining by alcohol sclerotherapy, or complete surgical excision, which has demonstrated curative results. Learning Objectives: To know what ACUMs are and recognise them as a cause of dysmenorrhoea and pelvic pain.To be able to diagnose an ACUM with the use of ultrasound, MRI and histological findings if surgically excised.To be able to counsel patients with ACUMs on the different management options, including conservative, medical and surgery. Ethical issues: All women with ACUMs are currently offered surgical excision, but is it appropriate to offer this, to patients as young as 13 years old, with no long‐term data on the effect of surgery on future fertility? [ABSTRACT FROM AUTHOR]

Chronic pelvic pain (CPP) is a major health issue which blights the lives of one in five women around the world.[1] This persistent and often debilitating condition can have a profound negative impact on the quality of life for women which affects their physical, emotional, and social well-being. What can be done for the patient suffering from endometriosis associated pain, who has no benefit from either surgery or medication? Understanding and addressing female pelvic pain - a multifaceted challenge. [Extracted from the article]

Background: Endometriosis, fibroids and gynecological malignancy can all impact the pelvic ureters. Ureteric involvement is likely to be an important factor in determining the extent and timing of surgery in women with these conditions and assessment of the pelvic ureters is now a recommended component of the imaging work-up for women with endometriosis. The aim of this paper is to provide a step-by-step guide for the identification and assessment of the distal ureters during pelvic ultrasound. We hope that this detailed explanation of the examination technique will help ultrasound examiners to develop this skill and enable them to integrate assessment of the pelvic urinary tract into their routine ultrasound examination.Content: In this paper, we describe a '6 step' detailed approach to ultrasound assessment of the ureters during pelvic ultrasound examination. We discuss tips and common examination findings.Conclusion: The pelvic segments of normal ureters can be identified in almost all women on transvaginal ultrasound examination and the method described is useful in detecting urinary tract abnormalities. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

Serous surface papillary borderline ovarian tumors (SSPBOTs) are a rare morphologic variant of serous ovarian tumors that are typically confined to the ovarian surface, while the ovaries themselves tend to appear normal in size and shape. In this report, we describe the findings from five premenopausal women diagnosed with SSPBOTs, in whom ultrasound showed grossly normal ovaries that were partially or wholly covered with irregular solid tumors. In all five cases, histologic examination showed evidence of borderline serous tumors. These findings demonstrate that SSPBOTs can be diagnosed on a preoperative sonographic examination, which could facilitate conservative, fertility-sparing surgery in young women affected by this condition. [ABSTRACT FROM AUTHOR]

Objective: To compare endometrial tissue samples from cesarean scar (CS) sites and from the posterior uterine wall to better understand the pathophysiology of implantation into a CS.Methods: Endometrial samples were taken from both a CS site and the posterior wall in premenopausal women with CSs, and from the posterior wall in premenopausal women who had spontaneous vaginal deliveries (SVDs) only.Results: In the secretory phase, there were significantly fewer leukocytes at CS sites than in the endometrium of women who had SVDs only (P<0.05). Significant differences in leukocytic infiltration and cell proliferation between the proliferative and secretory phases were only found in women who had SVDs only (P<0.05).Conclusion: Leukocyte recruitment to the endometrium during the secretory phase may be affected by the presence of a CS. [ABSTRACT FROM AUTHOR]

Both authors underline the need for a uniform evaluation of the CS scar, establishing an internationally accepted definition of a niche. In our Delphi study, it was agreed that a niche should be defined as an indentation at the site of the CS scar with a depth of at least 2 mm. 2 Scioscia M, Iannone P, Morano D, Pontrelli G, Greco P. Comment on "Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single- or double-layer uterotomy closure: a randomized controlled trial". [Extracted from the article]

Provides information on the application of non-surgical treatment in managing miscarriage. Discussion on spontaneous abortion; Diagnostic tests in miscarriage prevention; Physiologic effect of antiprogestins and prostaglandins among pregnant women.

The article provides information on diagnosis of tubal pregnancy.

The article discusses the launch of the United Kingdom Early Pregnancy Surveillance Service (UKEPSS) in February 14, 2014 which aimed to investigate uncommon disorders in emergency gynaecology and early pregnancy in Great Britain. It states the use of UKEPPS platform in the nationwide collaboration to improve knowledge and provide better care in women. It also mentions the significant of research outputs and improvement in patient care under the healthcare system National Health Service (NHS).