Key content Incidence of caesarean scar pregnancy (CSP) is increasing because of a rising number of caesarean sections. Prompt diagnosis of the condition is required to reduce associated morbidity. A high index of suspicion is required for women with a suggestive history of CSP. Ultrasound scan is the diagnostic tool of choice. Management options include medical, surgical and interventional radiology. Appropriate patient selection is important for optimal results. Major haemorrhage and hysterectomy are the main risks associated with CSP. Therefore, adequate counselling and availability of surgical expertise and blood transfusion should be part of a comprehensive management strategy. Learning objectives Understand the clinical and ultrasound features of CSP and distinguish these from features of other low implantation pregnancies. Learn about available treatment options and the factors influencing treatment choices. Be aware of the ethical issues associated with the diagnosis of live CSP. Ethical issues Do women planning subsequent pregnancy after a resolved CSP require surgery to close the uterine defect in the scar to prevent recurrent scar ectopic pregnancy? Should the risk of CSP in a future pregnancy be routinely discussed prior to primary caesarean section?

Caution should be exercised when choosing expectant management in cases of viable CSPs, and if chosen, the patient should be counselled adequately for possible outcomes including loss of pregnancy and hysterectomy. Expectant management is acceptable in CSPs with no foetal cardiac activity. There is a need for prospective research on this topic with adequate reporting on possible prognostic markers, as well as a need to improve on the techniques to prevent loss of fertility during delivery.

Although uncommon, adrenal disorders in pregnancy are associated with severe complications, especially if undiagnosed or poorly managed. Some women are on long-term steroids (especially those known to suffer from adrenal insufficiency) that suppress endogenous adrenal function. Under stress, these can become insufficientparticularly around labour and the puerperium. Adrenal insufficiency, for example, has been associated with maternal and fetal morbidity and mortality if untreated, while phaeochromocytoma is associated with considerable maternal mortality. Clinical features, diagnosis and management of the disorders of the adrenals in pregnancy are discussed, including Cushing's syndrome, adrenal insufficiency, phaeochromocytoma and paragangliomas, primary aldosteronism and congenital adrenal hyperplasia. Learning objectivesTo understand the physiological changes in the adrenal system during pregnancy. To understand the clinical features of common adrenal problems in pregnancy and how they can be diagnosed and managed to minimise complications, especially acute adrenal insufficiency. To understand how the management of adrenal disorders is altered in pregnancy and the effect of adrenal diseases on pregnancy. Ethical issuesIs there a role for in utero therapy if a prenatal diagnosis is made? Does treatment of the mother affect the fetus? Is optimal treatment of the mother limited by concerns for the fetus?

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-1) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections, like most other viruses that affect the respiratory tract can cause severe maternal illness and adverse pregnancy outcomes. They are not only highly transmissible (acquired through droplets), but Host reservoirs such as dromedary camels for MERS-CoV and masked palm civet for SARS-CoV are critical links in the onset of outbreaks. Clinically they present with flu-like symptoms and therefore a high index of suspicion is required to ensure timely diagnosis and tailored management. Although there are not many reported series on these infections in pregnancy they seem to be associated with an increased risk of preterm delivery and maternal mortality. Diagnosis is made by PCR from nasopharyngeal swabs. There are currently no effective anti-viral agents for these viruses but following infections various agents have been administered to patients. The most important aspect of management should be early identification of deterioration and intensive support and prevention of transmission. Our understanding of the evidence of the impact of both infections on pregnancies suggests the potential for future repeat outbreaks, hence the importance of maintaining vigilance across healthcare systems.