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Background and Aims: Cesarean scar pregnancy (CSP) is a rare medical condition accounting for 1:2000 of all pregnancies with prior history of cesarean deliveries (CS). As the rate of CS is increasing worldwide, it is important to know the nature of CSP and its complications. Methods: In this retrospective case-control study, we evaluated 264 pregnant women; 86 cases with ultra-sonographic findings of CSP and 178 controls: normal pregnancies with gestational age less than 12 weeks. The variables consisted of demographic characteristics, the features and causes of the prior CS, the time distance to the current pregnancy, sonographic features, and the final management. All data analyzed using SPSS version 21. Results: There was a significant difference between the two study groups regarding to parity, abortions and D&Cs (p < 0.001). In the case group, 19.8% of patients had positive results for STDs versus 16.3% in the control group (p > 0.990). The mean average of intervals between the last CS and current pregnancies were 48.22 ± 37.03 in the case group versus 61.25 ± 36.25 months in the control group (p < 0.001). Regression Logistic analysis showed advanced maternal age (p < 0.001), positive history of abortions and D&C (p < 0.001), elective type of prior c/s (p < 0.001) and the short time interval between prior CS and current pregnancy (p < 0.001) could significantly predict the patients at higher risk of presenting CSP in the case group. Conclusions: Based on our findings, advanced maternal age, positive history of abortion, the elective type of the former CS, and short time intervals between previous CS and current pregnancy are the main risk factors of CSP.
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BACKGROUND: Several therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy. METHODS: This was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention. RESULTS: Ninety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p<0.001). Results were best in the SSNB group (p<0.001), and the IACI group showed better results than the PT group (p<0.001). CONCLUSIONS: Suprascapular nerve block is an effective therapy with long-term pain relief and increased mobility of the shoulder joint in patients with adhesive capsulitis.