Recurrent Cesarean scar pregnancy: case series and literature review.

OBJECTIVES: To determine the rate of recurrent Cesarean scar pregnancy (CSP) in our clinical practices and to evaluate whether the mode of treatment of a CSP is associated with the risk of recurrent CSP, as well as to review the published literature on recurrent CSP. METHODS: We performed a retrospective search of our six obstetric and gynecological departmental ultrasound databases for all CSPs and recurrent CSPs between 2010 and 2019. We extracted various data, including number of CSPs with follow-up, number of cases attempting and number achieving pregnancy following treatment of CSP and number of recurrent CSPs, as well as details of the treatment of the original CSP. After analyzing the clinical data, we evaluated whether the mode of treatment terminating the previous CSP was associated with the risk of recurrent CSP. We also performed a PubMed search for: 'recurrent Cesarean scar pregnancy' and 'recurrent Cesarean scar ectopic pregnancy'. Articles were reviewed for year of publication, and extraction and analysis of the same data as those obtained from our departmental databases were performed. RESULTS: Our database search identified 252 cases of CSP. The overall rate of clinical follow-up ranged between 71.4% and 100%, according to treatment site (mean, 90.9%). Among these, 105 women had another pregnancy after treatment of the previous CSP. Of these, 36 (34.3%) pregnancies were recurrent CSP, with 27 women having a single recurrence and three women having multiple recurrences, one with two, one with three and one with four. We did not find any particular single or combination treatment mode terminating the previous CSP to be associated with recurrent CSP. The literature search identified 17 articles that yielded sufficient information for us to evaluate their reported prevalence of recurrent CSP. These reported 1743 primary diagnoses of CSP, of which 944 had reliable follow-up. Data were available for 489 cases that attempted to conceive again after treatment of a previous CSP, and on the 327 pregnancies achieved. Of these, 67 (20.5%) were recurrent CSP. CONCLUSIONS: On the basis of our pooled clinical data and review of the literature, recurrent CSP is apparently more common than was previously assumed based upon mostly single-case reports or series with few cases. This should be borne in mind when counseling patients undergoing treatment for CSP regarding their risk of recurrence. We found no obvious causal relationship or association between the type of treatment of the previous CSP and recurrence of CSP. Patients who become pregnant after treatment of a CSP should be encouraged to have an early (5-7-week) first-trimester transvaginal scan to determine the location of the gestation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Olaparib for the treatment of ovarian cancer.

Olaparib, an oral poly(ADP-ribose) polymerase (PARP) inhibitor, is the first FDA-approved drug in its class for patients with ovarian cancer, specifically in a subset of patients with BRCA mutations and prior chemotherapy treatments. PARP inhibitors have had other implications in different solid tumor types including breast, gastric and pancreatic malignancies. In light of the recent FDA approval of olaparib for the treatment of ovarian cancer, this article aims to outline the mechanisms and implications of the drug. With a favorable adverse event profile and improved outcomes, including progression-free survival, olaparib has demonstrated augmentation to therapeutic options in the treatment of ovarian cancer.

Basic as well as detailed neurosonograms can be performed by offline analysis of three-dimensional fetal brain volumes.

OBJECTIVES: To evaluate the feasibility and the processing time of offline analysis of three-dimensional (3D) brain volumes to perform a basic, as well as a detailed, targeted, fetal neurosonogram. METHODS: 3D fetal brain volumes were obtained in 103 consecutive healthy fetuses that underwent routine anatomical survey at 20-23 postmenstrual weeks. Transabdominal gray-scale and power Doppler volumes of the fetal brain were acquired by one of three experienced sonographers (an average of seven volumes per fetus). Acquisition was first attempted in the sagittal and coronal planes. When the fetal position did not enable easy and rapid access to these planes, axial acquisition at the level of the biparietal diameter was performed. Offline analysis of each volume was performed by two of the authors in a blinded manner. A systematic technique of 'volume manipulation' was used to identify a list of 25 brain dimensions/structures comprising a complete basic evaluation, intracranial biometry and a detailed targeted fetal neurosonogram. The feasibility and reproducibility of obtaining diagnostic-quality images of the different structures was evaluated, and processing times were recorded, by the two examiners. RESULTS: Diagnostic-quality visualization was feasible in all of the 25 structures, with an excellent visualization rate (85-100%) reported in 18 structures, a good visualization rate (69-97%) reported in five structures and a low visualization rate (38-54%) reported in two structures, by the two examiners. An average of 4.3 and 5.4 volumes were used to complete the examination by the two examiners, with a mean processing time of 7.2 and 8.8 minutes, respectively. The overall agreement rate for diagnostic visualization of the different brain structures between the two examiners was 89.9%, with a kappa coefficient of 0.5 (P < 0.001). CONCLUSIONS: In experienced hands, offline analysis of 3D brain volumes is a reproducible modality that can identify all structures necessary to complete both a basic and a detailed second-trimester fetal neurosonogram.

Prematurity in twin pregnancies.

Preterm birth (PTB) is a leading cause of adverse perinatal outcome, including both neonatal morbidity and mortality. This condition has been directly associated with the consistently rising incidence of multiple gestations over the past three decades. Twin gestation, the most common form of multiple gestation, represents a unique subgroup of fetuses at high risk for prematurity. Extensive research has been dedicated to understanding the pathophysiological pathways leading to preterm birth as well as to developing efficient screening tests and treatments aimed to prevent or to halt it. This review summarizes epidemiological data regarding the etiology and outcomes associated with the different subtypes of PTB in twin gestations. Additionally, we provide information regarding both the different screening modes available for early detection, as well as the modalities for either prevention or treatments available for this condition.

Calcium carbimide in alcoholism treatment. Part 2: Medical findings of a short-term, placebo-controlled, double-blind clinical trial.

Drug-induced toxicity in chronic alcoholics who participated in a 4-month placebo (Pl)--controlled clinical trial of the efficacy of calcium carbimide (CC) is reported. Daily monitoring of patients' compliance indicated that 85% of study medications were taken, and very little drinking took place during the study. Patients did not report more symptoms or experience more medical problems during CC administration than during placebo administration. There was no evidence of hepatotoxicity, or behavioural toxicity. Mean white blood cell count was slightly increased during CC treatment, and returned to baseline values when CC was stopped. Thyroid function was not affected by CC in patients with normal pretreatment function. However one patient with pretreatment reduced thyroid function became hypothyroid after CC administration, which indicates a need for systematic monitoring. We conclude that CC is safe for use in alcoholics with normal thyroid function, and may be the preferred alcohol-sensitizing drug in some situations.

Calcium carbimide in alcoholism treatment. Part 1: A placebo-controlled, double-blind clinical trial of short-term efficacy.

A randomized, double-blind, placebo-controlled single cross-over study of the alcohol sensitizing drug, calcium carbimide (CC), was conducted in 128 patients with alcohol dependence. Seventy-one (55%) completed the 4-month study. Patients reported drinking and pill-taking behaviour, and submitted urines (for analysis of alcohol and the tablet marker riboflavin) on 97%, and 91% of treatment days, respectively. All of the 69 analyzable completers were abstinent on at least 85% of days, and 58% (40) were alcohol-free during the study. Medications were taken on at least 85% of days. Symptoms and adverse clinical findings were not increased in frequency during CC, compared to placebo. Seventy-eight per cent of the patients believed they had received CC throughout the study, suggesting that CC exerts a strong psychological deterrent effect. Alcohol consumption was significantly reduced to the same extent with CC and placebo, compared to pre-treatment levels.