A. McIndoe

Standardized approach for imaging and measuring Cesarean section scars using ultrasonography

Incomplete healing of the scar is a recognized sequel of Cesarean section (CS) and may be associated with complications in later pregnancies. These complications can include scar pregnancy, a morbidly adherent placenta, scar dehiscence or rupture. To date there is uncertainty relating to the factors that lead to poor scar healing and how to recognize it. In recent years, there has been an increase in studies using ultrasound that describe scars as deficient, or poorly, incompletely or inadequately healed with few data to associate the morphology of the scar with the functional integrity of the lower segment of the uterus. There have been multiple attempts to describe CS scars using ultrasonography. Different terminology, methods and results have been reported, yet there is still no consensus regarding the prevalence, clinical significance or most appropriate method to describe the appearances of these scars. Developing a test that can predict the likelihood of women having problems associated with a CS scar is becoming increasingly important. On the other hand, understanding whether the ultrasound appearances of the scar can tell us anything about its integrity is not well supported by the research evidence. In this article we present an overview of ultrasound‐based definitions and methods used to describe CS scars. We also present information relating to the performance of alternative techniques used to evaluate CS scars. Having examined the current evidence we suggest a standardized approach to describe CS scars using ultrasound so that future studies can be meaningfully compared. Copyright

Abdominal radical trachelectomy in West London

Please cite this paper as: Saso S, Ghaem‐Maghami S, Chatterjee J, Naji O, Farthing A, Mason P, McIndoe A, Hird V, Ungar L, Del Priore G, Smith J. Abdominal radical trachelectomy in West London. BJOG 2012;119:187–193.

Triaging women with ovarian masses for surgery: observational diagnostic study to compare RCOG guidelines with an International Ovarian Tumour Analysis (IOTA) group protocol

Please cite this paper as: Van Calster B, Timmerman D, Valentin L, McIndoe A, Ghaem‐Maghami S, Testa A, Vergote I, Bourne T. Triaging women with ovarian masses for surgery: observational diagnostic study to compare RCOG guidelines with an International Ovarian Tumour Analysis (IOTA) group protocol. BJOG 2012;119:662–671.

Predicting successful vaginal birth after Cesarean section using a model based on Cesarean scar features examined by transvaginal sonography: TVS of Cesarean scar to predict successful vaginal birth

To develop a model to predict the success of a trial of vaginal birth after Cesarean section (VBAC) based on sonographic measurements of Cesarean section (CS) scar features, demographic variables and previous obstetric history.

Visibility and measurement of Cesarean section scars in pregnancy: a reproducibility study

To evaluate the visibility of Cesarean section (CS) scars by transvaginal sonography (TVS) in pregnant women, to apply a standardized approach for measuring CS scars and to test its reproducibility throughout the course of pregnancy.

Placental site trophoblastic tumours and the concept of fertility preservation

Please cite this paper as: Saso S, Haddad J, Ellis P, Lindsay I, Sebire N, McIndoe A, Seckl M, Smith J. Placental site trophoblastic tumours and the concept of fertility preservation. BJOG 2011; DOI: 10.1111/j.1471‐0528.2011.03230.x.

Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer.

To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer.

Fertility‐sparing surgery for young women with early‐stage cervical cancer

Sir, Robert Fraser finds our effort to conduct a randomised controlled trial on acupuncture for the induction of labour a waste of energy. His argument is based only on a quotation from 2002 by Dr Renckens. We therefore find another quotation from the same issue of BJOG appropriate, this one by Dr Zeisler and Dr Husslein. It states that, ‘acupuncture in obstetrics is drug-free, clinically effective and cost-effective’. Furthermore, the recent conclusion by Dr Smith and Dr Cochrane justifies further studies on acupuncture. It states that, ‘evidence is beginning to consolidate that acupuncture may assist with the management of some complaints during pregnancy. However, definitive conclusions about its effectiveness cannot be reached and further research is therefore justified.’ j

OC26.05: Longitudinal measurements of Caesarean section scar size and residual myometrial thickness in pregnancy as predictors of scar appearance at repeat Caesarean delivery

O. Naji1, A. Daemen2, Y. Abdallah1, A. Smith1, A. Pexsters3, C. Stalder1, S. Saso1, S. Ghaem-Maghami1, A. McIndoe1, D. Timmerman3, T. Bourne1,3 1Obstetrics and Gynaecology, Imperial College London, London, United Kingdom; 2Department of Electrical Engineering (ESAT), K.U. Leuven, Leuven, Belgium; 3Department of Obstetric and Gynaecology, Katholieke Universiteit Leuven, University Hospitals, University Hospitals, Leuven, Belgium

OP10.08: The relationship between previous elective or emergency Caesarean section and time-to-next-pregnancy interval on Caesarean scar size and residual myometrial thickness in subsequent pregnancy

Methods: The amount of gastric volume was estimated in 20 preterm infants with the use of three-dimensional ultrasound (3DUS) volumetry method (VOCAL). The procedure of gastric emptying was determined by three volume measurements of the gastric volume after routine feeding (0-, 30and 60minute-volumes). In the control group 0-, 30and 60minute gastric volumes were measured in the same infants with the same volumetric method one day before the ophthalmologic examination. The preterms were born at the 30.50 ± 2.67 gestational week with an average of 1454.50 ± 400.23 g birth weight. Tropicamide and phenylephrin hydrochlorid were used in a dose of 0.25 mg and 0.15 mg three times before the eye examination. Results: Contrary to earlier reports the authors did not find significantly delayed gastric emptying with the doses of mydriatics. At the time of the second and third measurement the authors found 64.98% and 40.02% of gastric volume in the control group and a 68.51% and 44.27% of gastric volume after instillation of mydriatics, respectively. Conclusions: Current dose of mydriatics does not seem to delay gastric emptying significantly, the doses administered in routine clinical practice can be used safely on the day of screening examinations for ROP. The gastric volume measurement in preterm infants using 3D-US volumetry is rapid, painless, reproducible, and non-invasive.