Faculty Bibliography

This review concentrates on 2 consequences of cesarean deliveries that may occur in a subsequent pregnancy. They are the pathologically adherent placenta and the cesarean scar pregnancy. We explored their clinical and diagnostic as well as therapeutic similarities. We reviewed the literature concerning the occurrence of early placenta accreta and cesarean section scar pregnancy. The review resulted in several conclusions: (1) the diagnosis of placenta accreta and cesarean scar pregnancy is difficult; (2) transvaginal ultrasound seems to be the best diagnostic tool to establish the diagnosis; (3) an early and correct diagnosis may prevent some of their complications; (4) curettage and systemic methotrexate therapy and embolization as single treatments should be avoided if possible; and (5) in the case of cesarean scar pregnancy, local methotrexate- and hysteroscopic-directed procedures had the lowest complication rates.

OBJECTIVE: The diagnosis and treatment of cesarean scar pregnancy (CSP) is challenging. The objective of this study was to evaluate the diagnostic method, treatments, and long-term follow-up of CSP. STUDY DESIGN: This is a retrospective case series of 26 patients between 6-14 postmenstrual weeks suspected to have CSP who were referred for diagnosis and treatment. The diagnosis was confirmed with transvaginal ultrasound. In 19 of the 26 patients the gestational sac was injected with 50 mg of methotrexate: 25 mg into the area of the embryo/fetus and 25 mg into the placental area; and an additional 25 mg was administered intramuscularly. Serial serum human chorionic gonadotropin determinations were obtained. Gestational sac volumes and vascularization were assessed by 3-dimensional ultrasound and used to monitor resolution of the injected site and outcome. RESULTS: The 19 treated pregnancies were followed for 24-177 days. No complications were observed. After the treatment, typically, there was an initial increase in the human chorionic gonadotropin serum concentrations as well as in the volume of the gestational sac and their vascularization. After a variable time period mentioned elsewhere the values decreased, as expected. CONCLUSION: Combined intramuscular and intragestational methotrexate injection treatment was successful in treating these CSP.

Anatomy, pathology, and developmental changes of the fetal central nervous system (brain and spine) can be studied by prenatal sonography, using a transabdominal, or, and preferably, later in pregnancy in a cephalic presenting fetus, a transvaginal approach, with the possibility of obtaining coronal and sagittal views through the acoustic window provided by the fontanels and sutures of the skull. In a 3-dimensional sonography, both approaches may generate images in all 3 classic scanning planes (longitudinal, sagittal, and coronal). Guidelines exist concerning standard fetal anatomical survey, which includes fetal brain and spine as well as specific central nervous system examination, both basic and advanced. Normal anatomy of the fetal brain and spine in their various planes will be described with only few details on congenital anomalies.