This article comprehensively examines prenatal assessment and treatment strategies for re-pregnancy in the context of a scarred uterus. It underscores the significance of accurately evaluating the healing status of uterine scars and proposes a series of pre-pregnancy assessment methods and treatment interventions. The discussion delves into the various factors influencing scar healing following cesarean sections and myomectomies， and recommends corresponding assessment techniques， including transvaginal ultrasound， hysteroscopic contrast ultrasound， magnetic resonance imaging， and hysteroscopy.Furthermore， the article introduces a clinical grading system for cesarean scar diverticulum， which is a valuable reference for clinical decision-making. Additionally， it offers suggestions for the surgical management of poorly healing cesarean scars.
With the increase in the number of re-pregnancies， the risk of adverse pregnancy outcomes associated with scarred uterus after cesarean section increases significantly. Screening of high-risk groups， hierarchical management according to the degree of risk， individualized treatment plan， and dynamic monitoring can reduce the risk of complications and improve maternal and fetal outcomes.
With the adjustment of China′s fertility policies， the number of pregnant women with a scarred uterus who are undergoing a subsequent pregnancy has significantly increased. In such cases， the incidence of complications like uterine scar pregnancy， placenta previa， placenta accreta， and uterine rupture is on the rise， posing a threat to both maternal and fetal safety. This article discusses predictive models for complications in subsequent pregnancies with a scarred uterus， aiming to provide methods for assessing the risks of these complications in order to reduce pregnancy-related risks and achieve favorable pregnancy outcomes.
Trial of labor after cesarean （TOLAC） refers to the attempt of vaginal delivery in a woman who has previously undergone a cesarean section. This concept is both a focus and a challenge in the field of obstetrics. With the increasing rate of cesarean deliveries， TOLAC has gained significant attention as an important method for reducing cesarean rates. The medical team must conduct rigorous assessments and monitoring， including selecting appropriate candidates， evaluating the risk of uterine scar rupture， and managing interventions and potential complications during labor to ensure the safety of both mother and baby. Additionally， patient and family education and psychological support are crucial components for the successful implementation of TOLAC.
As the number of pregnant women with previous cesareans continues to grow， so too does the incidence of cesarean scar pregnancy （CSP）. Domestic and international guidelines and consensus recommend that a CSP should be terminated once diagnosed. Nevertheless， some pregnant women diagnosed with CSP request to continue the pregnancy for various reasons. Given the significant risks of adverse pregnancy outcomes associated with continuing a CSP， there is a pressing need to enhance our understanding of the relevant literature. The present study undertook a review of the literature on continuing a CSP over the past two decades， to generalize the outcomes of pregnancies. In addition， the association between ultrasound signs in the first trimester and the risks of placenta accreta spectrum disorders，postpartum hemorrhage， uterine rupture， and hysterectomy was also summarized. Furthermore， the appropriate time and method for terminating a CSP after expectancy were discussed. The present review aims to provide more references for better management of CSP.
To investigate the diagnosis and treatment of fulminant myocarditis in pregnancy.
Methods
The clinical data of a case of pregnancy complicated with fulminant myocarditis treated with ECMO life support in 2021 were retrospectively analyzed， and the literature was reviewed through Pubmed， Embase and CNKI databases.
Results
A 37-year-old pregnant woman was diagnosed with fulminant myocarditis at 31 +3 weeks of gestation. The patient received immunoregulation， anti-heart failure，anti-infection and ECMO treatment.During this period，fetal death occurred，and spontaneous labor occurred through vaginal delivery.On the 10th day of ECMO use， the cardiac function recovered well and ECMO was discontinued. Three relevant case reports were retrieved. Four cases， including this one， were analyzed. The gestational age of onset ranged from 22 to 31 weeks， and 2 cases had obvious prodromal symptoms. Rapid hemodynamic disturbance was found after onset of myocarditis， and related biomarkers and imaging examinations showed the characteristics of myocarditis. Myocardial biopsy was performed in 2 cases to confirm the pathological diagnosis. One patient was positive in pathogen screening. Four patients received ECMO life support， and one of them developed ECMO-related complications. Four patients were improved after treatment and discharged from hospital. 2 cases of fetal death occurred， 1 case of neonatal epileptic spasm.
Conclusion
Fulminant myocarditis in pregnancy has rapid onset and high maternal and neonatal mortality. Early recognition， early diagnosis， and multidisciplinary management including intensive care， obstetric management and ECMO are the keys to successful treatment.
A case of postpartum hemorrhage complicated with pulmonary hemorrhage was reported. The relevant clinical characteristics were analyzed based on a literature review to improve clinicians′ understanding of maternal pulmonary hemorrhage.
Methods
A patient with postpartum hemorrhage complicated with pulmonary hemorrhage admitted to the Third Affiliated Hospital of Guangzhou Medical University was retrospectively analyzed and the clinical data of 21 case reports related to perinatal pulmonary hemorrhage were retrieved through the database.
Results
The etiology，clinical manifestations，and diagnosis and treatment process of the 22 patients were different. Among the 22 patients， 12 patients（54.5%） developed during pregnancy， and 10 patients （45.5%） developed during puerperium. 17 cases（77.3%） were caused by immune factors， with systemic lupus erythematosus accounting for the majority.5 cases （22.7%） were caused by non-immune factors， with coagulation dysfunction most common. The first symptom was dyspnea in 18 cases （81.8%）， hemoptysis in 10 cases （45.5%）， fever in 6 cases（27.3%）， and cough in 7 cases （31.8%）.In terms of treatment，19 patients received hormone therapy，9 patients received plasma exchange therapy， and 3 patients received ECMO therapy， with good outcomes.Pregnancy outcomes included maternal death in 5 cases （22.7%）， fetal loss in 3 cases （13.6%），continued pregnancy in 2 cases （9.2%）， and the remaining 12 cases （54.5%） had good maternal and infant outcomes.This case and the 2 cases reported in the literature were pulmonary hemorrhages related to coagulation dysfunction. All three patients developed during the puerperium and had disseminated intravascular coagulation. Clinical manifestations included dyspnea， decreased blood oxygen saturation，and bloody secretions in the trachea. Based on treating the primary disease， some patients received supportive treatment measures such as plasma exchange and ECMO， and the outcome was good.
Conclusions
Pregnant women with pulmonary hemorrhage are in critical condition， with a high mortality rate and atypical clinical manifestations. It is necessary to improve obstetricians′ understanding and learning of this disease， and at the same time strengthen multidisciplinary cooperation.
