Localization Patterns of RAB3C Are Associated with Murine and Human Sperm Formation.

Background and Objectives: Septins (SEPTs) are highly conserved GTP-binding proteins and the fourth component of the cytoskeleton. Polymerization of SEPTs contributes to several critical cellular processes such as cytokinesis, cytoskeletal remodeling, and vesicle transportation. In our previous study, we found that SEPT14 mutations resulted in teratozoospermia with >87% sperm morphological defects. SEPT14 interactors were also identified through proteomic assays, and one of the peptides was mapped to RAB3B and RAB3C. Most studies on the RAB3 family have focused on RAB3A, which regulates the exocytosis of neurotransmitters and acrosome reactions. However, the general expression and patterns of the RAB3 family members during human spermatogenesis, and the association between RAB3 and teratozoospermia owing to a SEPT14 mutation, are largely unknown. Materials and Methods: Human sperm and murine male germ cells were collected in this study and immunofluorescence analysis was applied on the collected sperm. Results: In this study, we observed that the RAB3C transcripts were more abundant than those of RAB3A, 3B, and 3D in human testicular tissues. During human spermatogenesis, the RAB3C protein is mainly enriched in elongated spermatids, and RAB3B is undetectable. In mature human spermatozoa, RAB3C is concentrated in the postacrosomal region, neck, and midpiece. The RAB3C signals were delocalized within human spermatozoa harboring the SEPT14 mutation, and the decreased signals were accompanied by a defective head and tail, compared with the healthy controls. To determine whether RAB3C is involved in the morphological formation of the head and tail of the sperm, we separated murine testicular tissue and isolated elongated spermatids for further study. We found that RAB3C is particularly expressed in the manchette structure, which assists sperm head shaping at the spermatid head, and is also localized at the sperm tail. Conclusions: Based on these results, we suggest that the localization of RAB3C proteins in murine and human sperm is associated with SEPT14 mutation-induced morphological defects in sperm.

Low Maternal Serum 25-Hydroxyvitamin D Concentration Is Associated With Postpartum Hemorrhage: A Retrospective Observational Study.

Objective: The primary aim of this study is to investigate the relationship between vitamin D serum level and the incidence of postpartum hemorrhage (PPH). The secondary objective is to determine the relative risk of low vitamin D associated with PPH. Methods: This was a retrospective observational study. A total of 600 women who had delivered their babies in a single tertiary teaching hospital were enrolled. Serum blood test for 25(OH)D was performed at 35 + 0 to 36 + 6 weeks of pregnancy to measure vitamin D. A 25(OH)D level < 20 ng/mL was defined as vitamin D deficient, and a level 21-29 ng/mL as insufficient. Results: Vitamin D levels were deficient in 145 (24.1%) and insufficient in 254 (42.3%) of the women tested. Women with deficient and insufficient vitamin D levels were significantly younger than those with sufficient vitamin D levels (p < 0.001). The overall rates of PPH in the deficient and insufficient groups were 6.9% (10/145) and 6.7% (17/254), respectively, and were significantly higher than the rate of the normal vitamin D group (1.5%, p = 0.009). Women with sufficient vitamin D levels had significantly higher hemoglobin levels than those with low vitamin D levels. Higher vitamin D levels were associated with a significantly low risk of PPH (AOR: 0.93, CI: 0.89-0.98, p = 0.006). Conclusion: Our results suggest that a low vitamin D level is a risk factor for PPH. Low vitamin D also related to high risk of low hemoglobin before delivery. Thus, antepartum care should include vitamin D supplements for all women if possible.

Outcomes and complications of severe acute postpartum hemorrhage treated with or without transarterial embolization in a single tertiary referral center: A 20-year experience.

OBJECTIVE: PPH is usually unpredictable; and such fast, urgent and sudden massive life-threating hemorrhage. This study is to assess the efficacy of transarterial embolization (TAE) in treating severe PPH in a single institution over a period of 20 years. MATERIALS AND METHODS: From January 2000 to October 2019, all women with acute PPH more than 1500 cc and/or DIC were enrolled in this retrospective study. These women were divided into two groups according to whether they have received TAE as the second-line treatment. Group 1 (n = 27) included women without receiving TAE from January 1, 2000 to October 31, 2009, and group 2 (n = 30) included those who receiving TAE from November 1, 2009 to October 31, 2019. RESULTS: The overall success rate of TAE in control the PPH and preserved the uterus is 80%. The hemoglobin 12 h after PPH in group 2 is significantly lower than in group 1 (7.64 ± 1.6 vs. 8.58 ± 1.9, respectively. P = 0.05). Total unit of packed red blood cell (pRBC) transfusion is significantly higher in the group 2 than group 1 (9.8 ± 5.7 vs. 6.8 ± 3.9; p = 0.03). The rate of hysterectomy is significantly higher in group 1 than group 2 (46.7 vs. 20%; p < 0.001). CONCLUSION: In conclusion, TAE is safe and effective in control bleeding in PPH with a high success rate to preserve uterus and prevent DIC. TAE should be routinely used as a secondary line of treatment during PPH in all hospitals.

Fertility outcomes following pelvic embolization in women with acquired uterine arteriovenous malformation.

OBJECTIVE: Acquired uterine arteriovenous malformation (UAVM) is a rare, life-threatening disease. Angiography with uterine arterial embolization (UAE) is the diagnostic tool and a choice of fertility-sparing treatment. Here, we present a series of five successful pregnancies after embolization of UAVM. CASE REPORTS: Three reproductive aged women were treated for UAVM, resulting in five successful pregnancies. Their past history suggested that three cases had had previous uterine procedures, including second trimester abortion and elective dilatation and curettage. Intermittent heavy vaginal bleeding was the primary symptom of UAVM. One patient with anemia had two ineffective embolizations and achieved a singleton pregnancy after the third embolization. However, intrauterine fetal demise with severe fetal growth retardation was noted on the 28th gestation week. The other two women had temporary ovulation disorder after UAE. After Clomiphene Citrate (CC) treatment, successful pregnancies were achieved and carried to term uneventfully. CONCLUSION: UAE is an acceptable method for preserving fertility and treatment in women with symptomatic UAVMs.

Successful Transarterial Embolization of Uterine Arteriovenous Malformation: Report of Three Cases.

Uterine arteriovenous malformations (AVMs) are relatively rare disorders that can cause life-threatening vaginal bleeding. We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography. The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA). Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 39 weeks of gestation, and the baby was healthy.

The recommendations of the American Institute of Medicine (IOM) for normal and underweight women to reduce the risk of low birth weight.

OBJECTIVE: The recommendations of the American Institute of Medicine (IOM) were revised recently in order to enhance maternal and neonatal health. The aim of our study was to investigate the risk of low birth weight (LBW) among women who follow the IOM recommendations. MATERIALS AND METHODS: Gestational weight gain (GWG) and rate of weight gain (RWG) across the different periods of pregnancy among women who delivered LBW fetuses were analyzed retrospectively. The logistic regression was used to analyze the risk of LBW and to identify recommendations. RESULTS: From January 2008 to December 2009, 117 out of 4924 (2.4%) women delivered term LBW fetuses. After exclusions, 88 LBW and 91 control subjects were enrolled into the study. There was increased risk of cesarean delivery [odds ratio (OR) with 95% confidence interval (CI): 2.53 (1.33-4.83)] and neonatal asphyxia within 7 days of birth [OR 95% CI: 5.71 (1.21-26.83)] for the LBW group compared with the control group. Normal weight women [body mass index (BMI): 18.5-24.9 kg/m(2)] who followed the GWG and RWG recommendations of the IOM had no increased risk of LBW. However, there was a two-to three-fold increased LBW risk among normal weight women who followed the IOM guidelines when, during the 2(nd) trimester, their GWG was ≤7 kg [OR 95% CI: 2.21 (1.28-6.49)] or their RWG was ≤0.45 kg/week [OR 95% CI: 3.14 (1.32-7.47)]. Among underweight women (BMI < 18.5 kg/m(2)), if, during the 2(nd) and 3(rd) trimesters, they followed the lower range of the GWG and RWG recommendations of the IOM there was a five-fold increased risk of LBW if the GWG was ≤13 kg [OR 95% CI: 5.29 (1.61-25.51)]; or the RWG was ≤0.45 kg/week [OR 95% CI: 5.35 (1.61-24.66)]. CONCLUSION: For underweight women, it is suggested that they follow the upper range of the IOM recommendation in order to avoid LBW. For normal weight women, although the IOM guidelines provide a good basis, it is suggested that they carefully follow the recommended GWG and the RWG values during the 2(nd) trimester, which is a very important period for fetal growth.

Following the 2009 American Institute of Medicine recommendations for normal body mass index and overweight women led to an increased risk of fetal macrosomia among Taiwanese women.

OBJECTIVE: This study aimed to investigate the risk of birth weights over 4000 g (macrosomia) in association with following the 2009 American Institute of Medicine (AIOM) recommendations. MATERIALS AND METHODS: Seventy-six nondiabetic women who delivered a singleton, term macrosomic fetus and 82 women who delivered a singleton, term fetus weighing <4000 g were analyzed retrospectively. The relationship between the risk of macrosomia and gestational weight gain in different periods of pregnancy was investigated using logistic regression. RESULTS: The incidence of macrosomia from January 2008 to December 2009 was 1.8% among the Taiwanese women. The incidences of cesarean delivery (54.5% vs. 18.2%, p < 0.001) and blood loss >1000 mL at delivery (35.5% vs. 6.1%, p < 0.0001) were associated with macrosomia. The risk of macrosomia among normal weight women with gestational weight gain greater than 13 kg increased four-fold [odds ratio (OR) = 4.88; 95% confidence interval (CI) 1.84-12.90]. For overweight women with total gestational weight gain >11.5 kg, the risk of macrosomia increased nine-fold (OR = 9.63; 95% CI 1.76-52.74). CONCLUSION: Macrosomia resulted in more cesarean deliveries and greater maternal blood loss at birth. In Taiwan, to prevent macrosomia, we suggest that the total gestational weight gain should be <11.5 kg among normal weight women and within 10 kg for overweight women.

Expression of a Hoechst 33342 efflux phenomenon and common characteristics of pluripotent stem cells in a side population of amniotic fluid cells.

OBJECTIVE: The aim of this study was to verify the existence of a side population (SP) of cells in second-trimester amniotic fluid. MATERIALS AND METHODS: Amniotic fluid samples (n = 35) were obtained, and the number and size of viable amniotic fluid cells (AFCs) were analyzed. Small AFCs (SAFCs) and large AFCs (LAFCs) were isolated using a sterile 10-microm pore size strainer. Hoechst 33342 dye exclusion assay, flow cytometry analysis, reverse transcriptase polymerase chain reaction and immunocytochemistry were used to analyze the characteristics of SAFCs and LAFCs. RESULTS: The mean concentration of viable AFCs from 16 to 21 weeks of gestation was 0.3 x 10(5), 0.8 x 10(5), 1.1 x 10(5), 1.3 x 10(5), 1.0 x 10(5) and 1.0 x 10(5) cells/mL respectively. The mean percentage of SAFCs from 16 to 21 weeks of gestation was 27.3%, 40.5%, 49.7%, 60.2%, 41.0% and 58.2%, respectively. The Hoechst 33342 efflux phenomenon was obvious among SAFCs but was rare in the LAFC population. Flow cytometry analyses showed that cell surface antigen expression on LAFCs and SAFCs were positive for CD29, CD44, CD73, CD90, CD166 and HLA-I, but negative for CD31, CD34, CD45, CD117 and HLA-II. Importantly, Nanog, Oct-4, ABCG2 and SOX2 expression in cells was easily detectable among the SAFC population. Expression of Nanog and ABCG2 was not observed among LAFCs. CONCLUSION: Amniotic fluid contains a SP that was found mostly among the SAFCs. Enriched SP cells isolated by the efflux of Hoechst 33342 could be a novel and promising source of pluripotent-like amniotic derived stem cells for cellular therapy in the near future.

Omental fat receptor interacting protein 140 mRNA expression in women with polycystic ovary syndrome.

BACKGROUND: Receptor interacting protein 140 (RIP140) is a co-repressor and essential for oocytes released by the ovary during ovulation. The aim of the study is to investigate adipose mRNA expression of RIP140 in women with polycystic ovary syndrome (PCOS) before and 3 months after laparoscopic ovarian electrocauterization (LOE). METHODS: Adipose tissues obtained from 15 women with PCOS before and after LOE were analyzed. Ten lean, age- and BMI-matched non-PCOS women served as controls. Gene expression of RIP140 was quantified by reverse transcriptase-polymerase chain reaction. RESULTS: The overall spontaneous ovulation rate was 73.3% in PCOS after the LOE procedure. However, no difference was found in the expression of RIP140 between women with PCOS before LOE and controls or between PCOS before and after LOE. No difference was found in RIP140 expression between obese and lean women with PCOS, or between obese PCOS and lean controls. Further, there was no correlation between RIP140 and fasting or 2-hour glucose or insulin, homeostasis model insulin resistance index (HOMA(IR)), and fasting glucose-to-insulin ratio (G(0)/I(0)) in women with PCOS. CONCLUSION: RIP140 gene does not play any pivotal role in the process of ovulation, insulin resistance or fat accumulation in women with PCOS.

Omental fat expression of adiponectin and adiponectin receptors in non-obese women with PCOS: a preliminary study.

Adiponectin is regarded as a possible link between adiposity and insulin resistance. The aim of the study was to determine adipose levels of mRNA for adiponectin and adiponectin receptors (AdipoR) in non-obese women with polycystic ovary syndrome (PCOS), and to assess whether the cytokine and receptors are related to insulin resistance in PCOS. Adipose tissue obtained from eight non-obese women with PCOS [body mass index (BMI) <27 kg/m(2) as cut-off point] was analysed. Levels of mRNA for adiponectin, AdipoR1 and 2 were quantified using the semi-quantitative reverse transcriptase-polymerase chain reaction. Eight non-obese, age- and BMI-matched healthy women served as controls. The level of adiponectin mRNA in non-obese women with PCOS were lower than in controls, but the difference was not statistically significant. However, AdipoR1 and 2 mRNA levels in non-obese women with PCOS were significantly lower than in controls. There was a significant negative correlation between 2 h insulin levels and AdipoR1 or AdipoR2 mRNA levels in non-obese women with PCOS ( r = 0.45 and 0.52 respectively, P < 0.05). The present study demonstrates that adiponectin receptor expression is down-regulated by hyperinsulinaemia in non-obese women with PCOS, resulting in adiponectin resistance.

Effectiveness of double cervical cerclage in women with at least one previous pregnancy loss in the second trimester: a randomized controlled trial.

AIM: To evaluate the effect of double cervical cerclage on the prevention of preterm delivery, and perinatal and maternal outcomes in women with previous fetal loss in the second trimester. METHODS: Between January 2001 and December 2006 we conducted a prospective study in which patients with a previous preterm delivery at the second trimester who met clinical criteria for the diagnosis of cervical incompetence were randomly allocated to receive double cervical cerclage or traditional single cervical cerclage at a ratio of 1:2. RESULTS: The perinatal and maternal outcomes of the two groups were compared. A total of 17 women were allocated to the double cervical cerclage group, and 34 to the traditional single cervical cerclage group. The single cervical cerclage group had a higher incidence of preterm delivery at <28 weeks than the double cerclage group (29.4 vs 5.9%, respectively, P = 0.0528). The mean gestational age and birth weight in the double cervical cerclage group were significantly higher than in the traditional single cervical cerclage group (35.9 +/- 5.4 vs 32.9 +/- 7.5 weeks, respectively for gestational age, P = 0.045; 2696 +/- 911 vs 2242 +/- 1119 g, respectively for birth weight, P = 0.048). No significant differences in rates of neonatal survival (P = 0.241) and neonatal admission to the intensive care unit were found between the two groups. CONCLUSION: Our results demonstrated that double cervical cerclage may significantly improve perinatal outcome in women with at least one previous pregnancy loss in the second trimester.

Omental adipose tissue overexpression of fatty acid transporter CD36 and decreased expression of hormone-sensitive lipase in insulin-resistant women with polycystic ovary syndrome.

BACKGROUND: Elevated free fatty acids (FFAs) are involved in insulin resistance in polycystic ovary syndrome (PCOS). We investigated the role of fatty acid transporter CD36, hormone-sensitive lipase (HSL) and adipose triglyceride lipase (ATGL) in regulation of lipolysis in insulin-resistant women with PCOS. METHODS: CD36, HSL and ATGL proteins were analyzed in omental adipose tissue from 10 women with PCOS and 10 healthy, BMI- and age-matched controls by western blotting. RESULTS: Women with PCOS had higher fasting and 2 h insulin levels (P < 0.002, P < 0.029, respectively) and a higher homeostasis model insulin resistance index (P < HOMA(IR), 0.005) and a lower fasting glucose-to-insulin ratio (G(0)/I(0)) (P < 0.001) than controls. CD36 protein levels in the PCOS women were higher (268% of control levels, P < 0.05) and HSL protein levels were lower (43% of control levels, P < 0.05). However, ATGL protein levels were not different in the two groups. Fasting serum insulin levels showed a positive correlation with CD36 levels (P = 0.01, r = 0.875) and a negative correlation with HSL levels (P = 0.045, r = -0.73). Furthermore, a positive correlation was found between serum testosterone levels and CD 36 protein levels (P = 0.025, r = 0.817) but the correlation did not reach significance after controlling for HOMA(IR). After adjusting insulin resistance index of HOMA(IR) by analysis of covariance, only CD36 differed between PCOS and control (P = 0.026). CONCLUSIONS: Our results suggest that, in insulin-resistant women with PCOS, changes in CD36 and HSL expression may result in altered FFA uptake.

Comparative study of conservative and surgical management for symptomatic moderate and severe hydronephrosis in pregnancy: a prospective randomized study.

BACKGROUND: To analyze the role of different measures in the treatment of acute moderate or severe symptomatic hydronephrosis in pregnancy. METHODS: Of the 18,130 women delivering at our institution between January 2000 and December 2004, 93 patients were admitted due to symptomatic hydronephrosis. Among these, 50 patients were diagnosed with moderate or severe hydronephrosis, and were randomly treated with conservative measures (25 patients) or double pigtail stent insertion (25 patients). Renal sonography, urinalysis, serum creatinine levels, white blood cell counts, and urine culture were done in all patients at first visit. The clinical and perinatal outcomes of the two groups were compared. RESULTS: The incidence of symptomatic hydronephrosis in pregnancy was 0.5% in our institution (93/18,130). The majority of the moderate or severe hydronephrosis (88%) cases were diagnosed after the first trimester. There were no statistically significant differences in the fetal body weight, Apgar score, preterm labor, and hospitalization day between the two groups. Among those receiving conservative treatment, five patients (5/25, 20%) failed to respond and were subsequently treated by double pigtail stent insertion successfully, compared with the surgical group, in which all patients were successfully relieved by double pigtail stent (p=0.018). Four patients receiving double pigtail stent insertion complained of stent discomfort and flank pain after the procedure (16%). CONCLUSION: Double pigtail stent insertion is effective for the treatment of moderate or severe symptomatic hydronephrosis in pregnancy, and showed a lower failure rate than the conservative treatment. However, due to the complications and discomfort with surgical treatment, conservative treatment should still be the first choice.

Thyroid cancer in pregnancy: a report of 3 cases.

BACKGROUND: Thyroid cancer in pregnancy presents a unique challenge to the thyroid specialist and the obstetrician. We report 3 cases of thyroid cancer diagnosed during pregnancy. CASES: Three cases of papillary thyroid carcinoma were diagnosed during pregnancy, at the 14th, 19th and 40th weeks of gestation. The first 2 cases underwent thyroidectomy immediately after the diagnosis, while in the third the operation was deferred until the postpartum period. All 3 women delivered healthy infants, who were 2 months to 8 years of age at the last follow-up visit. CONCLUSION: If well-differentiated thyroid cancer is diagnosed prior to the midtrimester, it is possible to carry out the surgical intervention in the midtrimester. During late pregnancy, resection after delivery is the option of choice. There is no indication for termination of pregnancy.

Vaginal cuff endometriosis resulting in a fistula between the vagina and abdominal cavity and presenting as peritonitis: a case report.

BACKGROUND: The specimen from a vaginal cuff fistula between the vagina and abdominal cavity revealed endometriosis. Culture of the fluid revealed Streptococcus viridans. CASE: A 44-year-old woman presented with lower abdominal pain for 1 week. She also had cyclic vaginal spotting that had started 1 month after she underwent laparoscopically assisted vaginal hysterectomy for a myoma 2 years earlier. One year prior to this admission, she was noted to have a right endometrioma on a sonographic examination; monthly follow-up revealed that the cyst was enlarging. The patient was admitted for surgery. On laparotomy, severe adhesions were noted. After adhesiolysis, a right adnexal cyst with chocolatelike contents mixed with malodorous, yellowish, mucoid fluid was noted. A vaginal cuff fistula between the vagina and abdominal cavity was also noted. The specimen from this area revealed endometriosis. Culture of the fluid showed Streptococcus viridans. CONCLUSION: Various laparoscopic complications are cited in the literature. Although rare, the risk of infection after laparoscopy can occur. In our case the infection may have been caused by the presence of vaginal cuff fistula in the presence of endometriosis.

[Abortion counseling: strategies for interdisciplinary service].

Abortion has long been an issue of concern for professional groups in many fields, such as medicine, nursing, religion, feminist rights, psychology, and social work. Although these groups hold differing views on abortion as well as eugenics health care law revision, they share a consensus that counseling services should be provided for abortion in order that women are sufficiently informed to make a sound decision on whether or not to have an abortion. Thus, this paper discusses in detail counseling service in terms of background, workflow and approaches, and interdisciplinary integration, as well as offers suggestions for future development. Hopefully, this can serve as a reference for concerned about women's reproductive health and obstetrics service quality.

Outcomes and complications of laparoscopically assisted vaginal hysterectomy.

OBJECTIVE: To report whether operative time, intraoperative complications, and rate of conversion to laparotomy decreased after physicians had acquired an additional 4years experience with laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: Group 1 (n=462) included the women who underwent LAVH from May 1, 1994 to December 31, 1997, and group 2 (n=583) included those who underwent LAVH from January 1, 1998 to December 31, 2001. RESULTS: The mean duration of surgery in groups 1 and 2 was 146 and 114 min, respectively, and the difference was significant (P<0.0001). The overall complication rate in the last 4years of the study was 7.1%, which was significantly lower than the 13.4% calculated for the first 4years (P=0.001). CONCLUSION: Operative time as well as rates of surgical complications and conversion to laparotomy decreased with increased surgeon experience at performing LAVH.

A rapidly growing paraurethral myoma with profuse bleeding from a mucosal vessel: report of a case.

Paraurethral leiomyoma is rare. This is the first reported case of a woman with a 6 x 7 x 5 cm urethral leiomyoma with profuse vaginal bleeding. The site of bleeding was identified as the anterior vaginal mucosal vein, which we subsequently electrocauterized. Enucleation of the mass was performed smoothly with a Foley catheter to avoid damage to the urethra. Profuse bleeding from a paraurethral myoma is possibly due to increased vascularity and the prolapsed nature of the tumor in this area.

Clonal amniotic fluid-derived stem cells express characteristics of both mesenchymal and neural stem cells.

Recent evidence has shown that amniotic fluid may be a novel source of fetal stem cells for therapeutic transplantation. We previously developed a two-stage culture protocol to isolate a population of amniotic fluid-derived mesenchymal stem cells (AFMSCs) from second-trimester amniocentesis. AFMSCs maintain the capacity to differentiate into multiple mesenchymal lineages and neuron-like cells. It is unclear whether amniotic fluid contains heterogeneous populations of stem cells or a subpopulation of primitive stem cells that are similar to marrow stromal cells showing the behavior of neural progenitors. In this study, we showed a subpopulation of amniotic fluid-derived stem cells (AF-SCs) at the single-cell level by limiting dilution. We found that NANOG- and POU5F1 (also known as OCT4)-expressing cells still existed in the expanded single cell-derived AF-SCs. Aside from the common mesenchymal characteristics, these clonal AF-SCs also exhibit multiple phenotypes of neural-derived cells such as NES, TUBB3, NEFH, NEUNA60, GALC, and GFAP expressions both before and after neural induction. Most importantly, HPLC analysis showed the evidence of dopamine release in the extract of dopaminergic-induced clonal AF-SCs. The results of this study suggest that besides being an easily accessible and expandable source of fetal stem cells, amniotic fluid will provide a promising source of neural progenitor cells that may be used in future cellular therapies for neurodegenerative diseases and nervous system injuries.

Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy.

BACKGROUND: To assess pregnancy course and outcome after conservative treatment of a cesarean scar pregnancy. METHODS: During an 8-year period, 15 cases of cesarean scar pregnancies were diagnosed at our institution. Seven of the 14 patients for whom we successfully preserved the uterus became pregnant within 3 years after termination of the scar pregnancy. The year of diagnosis, conservative method and gestational age for these five patients were recorded. Delivery method, time interval between the scar pregnancy and subsequent pregnancy, and maternal and neonatal outcome were evaluated. RESULTS: Seven pregnancies (eight live and one dead baby) were noted. The mean interval between the ectopic pregnancy and subsequent pregnancy was 13.3 months (range 0-34 months). One patient, who became pregnant 3 months after the scar pregnancy was found, suffered uterine rupture at 38.3 weeks' gestational age. Two patients with placental accrete, and one of them who continued the existing intrauterine twin pregnancy after transvaginal sono-guided aspiration of the scar pregnancy received a cesarean hysterectomy at 32 weeks of gestation. The remaining four pregnancies were uneventful, followed by early cesarean sections at 36 weeks. CONCLUSION: The results of this first series of seven subsequent pregnancies after conservative treatment of scar pregnancies are promising. An early cesarean section before over-extension of the uterus and spontaneous labor can help to prevent uterine rupture. Placenta accrete is another severe morbidity of these patients in addition to uterine rupture. Thus a cesarean hysterectomy may be the choice of treatment.