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02 August 2018, Volume 34 Issue 8 Previous Issue    Next Issue

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Sonographic diagnosis of cesarean scar pregnancy and cesarean scar diverticulum and its clinical significance. XIE Hong-ning，LIN Mei-fang 2018, 34(8): 838-841.  DOI: 10.19538/j.fk2018080102 Abstract ( )   A series of problems related to the long-term complications of cesarean scar，which was caused by high rate of previous cesarean delivery，become prominent as the second-child policy was released.Among them，cesarean scar diverticulum（CSD）and cesarean scar pregnancy（CSP）are the most common clinical problems.This article mainly discusses the sonographic features and clinical significance of ultrasound diagnosis，aiming to attach great importance to these two diseases and improve their early detection rate，which can help clinicians to manage them early and reasonably.

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Transvaginal surgical management of cesarean scar pregnancy. CHEN Shu-qin，LI Jin-bo 2018, 34(8): 841-844.  DOI: 10.19538/j.fk2018080103 Abstract ( )   Transvaginal surgery is an effective and safe management option for cesarean scar pregnancy（CSP）patients；it is suitable for patients with gestational age＜10 weeks and gestational mass＜6cm，and no pretreatment is needed before surgery.More researches about transvaginal surgical management of CSP should be conducted，focusing on the influence on future pregnancy，related failure factors and the comparison with other first-line treatments.

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Laparoscopic surgery for cesarean scar pregnancy. CHEN Zhi-long，WANG Wu-liang 2018, 34(8): 844-847.  DOI: 10.19538/j.fk2018080104 Abstract ( )   Cesarean scar pregnancy（CSP）is a specific type of ectopic implantation within the previous delivery section scar，which is associated with a high risk of serious complications.The diagnosis and treatment of CSP have no unified standard.The main objectives in the clinical management of CSP should be the prevention of massive blood loss and the conservation of the uterus to maintain further fertility.In recent years，the level of laparoscopic techniques has been continuously improved，laparoscopic management of CSP now becomes more and more popular.

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Transcatheter embolization therapies for caesarean scar pregnancy. WANG Qiao，ZHAO Xia 2018, 34(8): 847-850.  DOI: 10.19538/j.fk2018080105 Abstract ( )   Transcatheter embolization therapies play significant roles in treatment of caesarean scar pregnancy.Uterine artery embolization has a great clinical value in prevention of massive hemorrhage.It is widely used in comprehensive treatment for CSP，which combines UAE with surgical treatment such as curettage and hysterectomy.As some studies report，CSP with blood flow signals is one of the most important indications for preventive UAE.Even though most of current researches have reported undergoing surgery in 24-72 hours after UAE，the best interval between UAE and following surgery is still an ongoing topic of research.Thus，more advancing researches are needed to guide the rational application of transcatheter embolization therapies.

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Advantages and disadvantages of the expectant treatment for cesarean scar pregnancy. JIN Li 2018, 34(8): 850-854.  DOI: 10.19538/j.fk2018080106 Abstract ( )   Cesarean scar pregnancy is a special kinds of ectopic pregnancy in which the embryo implants in the iatrgentic cesarean scar left in the uterus.This ectopic pregnancy definition is time-limit，for as the pregnancy goes on to the second or third trimester，the fetus will grow up into the cavity of uterus，the placenta implanting into the cesearean scar or complicating with placenta precia.This special pregnancy may have the high risk of severe complications，such as heavy homeorrhage，uterus rupture，and emergency hysterectomy.Therefore，the basic rules of treatment should be to diagnose and terminate it as early as possible.There is no standard treatment.At present，the therapeutic methods include medicine，surgery，uterine artery embolism or the combination of all.The medical  treatment has some limits，and it will take a long time to recover and is with high rate of failure，so it is not recommended as the first line therapy for CSP.

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Hysteroscopic surgery for caesarean scar pregnancy. HONG Li 2018, 34(8): 854-858.  DOI: 10.19538/j.fk2018080107 Abstract ( )   With the implementation of the two-child policy and the increase of cesarean section rate，there has been an increase in the incidence of CSP，which endangers the lives of reproductive-age women.The treatments for CSP include drug therapy，laparoscopic surgery，uterine artery embolization，etc.Laparoscopic surgery has dual function of diagnosis and treatment because of its advantage of being minimally invasive，visual and accurate.This review focuses on the indications，contraindications，complications and surgical skills in performing hysteroscopic surgery for CSP.

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Pathogenesis and diagnosis of post-cesarean section scar diverticulum. WANG Sha，DUAN Hua 2018, 34(8): 858-861.  DOI: 10.19538/j.fk2018080108 Abstract ( )   Post-cesarean section scar diverticulum（CSD）is a long-term complication of cesarean section.With the continuous rise of the cesarean section rate，the incidence of CSD also increases.Some patients suffer from abnormal uterine bleeding（AUB）or cesarean section scar pregnancy（PSD），and even have such complications as massive haemorrhage，uterine rupture and pernicious placenta previa during pregnancy，which threatens the life of mothers and infants.The pathogenesis of CSD is unclear.There is no exact data on the rate of its occurrence.An international consensus has not emerged on the diagnosis of CSD.The diagnosis is mainly based on past history，clinical manifestation and accessory examinations.Imaging examination and diagnostic hysteroscopy are the major diagnostic method of CSD.Pathogenesis and diagnosis of CSD are reviewed in this article.

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Timing of subsequent pregnancy and operation of cesarean scar diverticulum. MENG Shi-hui，FENG Li-min 2018, 34(8): 861-865.  DOI: 10.19538/j.fk2018080109 Abstract ( )   To investigate the impact of cesarean scar defect（CSD）and the time of subsequent pregnancy，and based on untreated CSD and operated CSD，the article discusses the possibility and the timing of subsequent pregnancy on the basis of CSD healing，depth of lower uterine segment，maternal and fetal outcomes.According to extensive researches，the impacts of CSD on subsequent pregnancy are secondary infertility，cesarean scar pregnancy，placental invasion and uterine rupture.Time of subsequent pregnancy in untreated patients depends largely on the clinical manifestations and depth of lower uterine segment.Operated patients should be judged by surgical and modes instruments.

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Hysteroscopic surgery treatment for cesarean scar diverticulum. LI Wang，ZOU Ling-xiao 2018, 34(8): 865-869.  DOI: 10.19538/j.fk2018080110 Abstract ( )   Cesarean scar diverticulum（CSD）is one of the long-term complications after cesarean section，and it is formed by poor healing of the uterine incision in cesarean section.The reasons for its formation are complicated.There are many misunderstandings about CSD.The treatment for CSD is not needed for the asymptomatic CSD generally，however，it varies when it comes to the symptomatic CSD.Therefore，how to choose the appropriate treatment for CSD is not only related to the understanding of gynecologists but also directly affects its therapeutic efficacy.There is a special type of CSD that has a flap at the lower edge of the incision scar that prevents the menstrual blood flowing out of the diverticulum due to the flap action，causing symptoms（usually prolonged menstruation）.The asynchronism of the growth of ectopic endometrium in the diverticulum and the eutopic endometrium in the uterine cavity may also lead to abnormal vaginal bleeding.Nowadays，academic community has a professional term for this particular type of CSDs，that is the previous cesarean scar defect（PCSD）.For the PCSDs whose residual muscular layer is thick enough，hysteroscopic resection of the valve located at the lower edge of the cesarean scar and coagulation of the ectopic endometrium in the diverticulum may achieve therapeutic efficacy.For the CSDs without the characteristics of PCSD，hysteroscopic surgery is less effective，and hysteroscopic surgery is generally not recommended.This article will elaborate on the issues related to hysteroscopic surgery for PCSD.

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Laparoscopic surgery for cesarean section scar diverticulum. BI Fang-fang，WANG Dan-dan 2018, 34(8): 869-872.  DOI: 10.19538/j.fk2018080111 Abstract ( )   Cesarean scar defect（CSD）is one of the long-term complications after cesarean section surgery.Because of the inadequate drainage of menstrual blood in the diverticulum，it causes a series of clinical symptoms，such as secondary infertility，cesarean scar pregnancy，and uterine rupture.Transvaginal ultrasound，sonohysterography and hysteroscopy can be used to diagnose CSD.Surgery  is a common treatment choice for CSD，including hysteroscopy，vaginal repair and laparoscopy.Laparoscopic repair of cesarean section scar defect can radically solve the problem of muscular weakness of lower uterine segment，improve clinical symptoms and fertility，and reduce the risk of uterine rupture during forward pregnancy.

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Treatment for post-caesarean section scar diverticulum by transvaginal surgery. ZHAO Qian，GUO Rui-xia 2018, 34(8): 872-875.  DOI: 10.19538/j.fk2018080112 Abstract ( )   With the continuous increase of cesarean section rate in recent years，the morbidity of post-caesarean section scar diverticulum（CSD），which was one of the long-term complications of CSD， rises gradually.Currently，there are many treatment methods for CSD，including drug therapy，hysteroscopic surgery，transabdominal or laparoscopic surgery and transvaginal caesarean section diverticulectomy.Vaginal surgery is a feasible and effective method to treat CSD with many advantages，such as being simple，excellent effect and little trauma.This article aims to describe the treatment for CSD through vaginal surgery.

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Hysteroscopic-laparoscopic treatment for cesarean scar diverticulum. XU He-yang，HUA Ke-qin 2018, 34(8): 875-879.  DOI: 10.19538/j.fk2018080113 Abstract ( )   Cesarean scar diverticulum（CSD）is a long-term complication of cesarean section.In hysteroscopy-assistant laparoscopic repair the diverticulum is located with the help of hysteroscopy，and the lesion is excised completely under laparoscope and the wall of isthmus re-sutured.It is an effective technique to treat the disease.A variety of methods can be used to treat CSD，so it is required to make a comprehensive assessment preoperatively and perform the surgery for indicated patients.It is also required to follow up the symptom improvement and anatomic repair after surgery.