Cesarean scar pregnancy (CSP) is a rare complication involving the implantation of the gestational sac in a cesarean delivery scar. The authors report a case of unexpected placenta accreta spectrum (PAS) caused by late diagnosed CSP, necessitating emergent hysterectomy. A 28-year-old Japanese woman with two previous cesarean deliveries presented to our hospital at 11 weeks of gestation with abnormal transvaginal ultrasound findings obtained at another hospital;however, transabdominal ultrasound revealed that the fetus was already present in the uterine cavity at this time. At 28 weeks, there was no evidence of placenta previa. The woman developed preeclampsia at 29 weeks, and a cesarean section was conducted. Intraoperative findings confirmed PAS, and hysterectomy was conducted immediately.

Severe adhesions between the bladder and uterus necessitated an atypical incision in the cesarean section of a woman with endometriosis. This could not be predicted with pre‐surgery MRI. No methods in the literature are able to predict adhesions with true certainty; it is therefore still difficult to diagnose intra‐abdominal adhesions.

Introduction Pyoderma gangrenosum and myelodysplastic syndrome in pregnant women are both very rare, but can coexist. Here, we present a case of pyoderma gangrenosum in a cesarean section wound in a woman with myelodysplastic syndrome. Case A 34-year-old woman presented with thrombocytopenia and macrocytic anemia during pregnancy. The pregnancy was uneventful until 36 weeks of gestation, when premature rupture of membranes occurred and a cesarean section was performed for breech presentation. She presented four days later with redness and blisters at the wound site. Surgical site infection was diagnosed but did not improve with antibiotics, and multiple wound cultures were negative. Skin biopsy indicated pyoderma gangrenosum, and the redness and blisters responded to oral prednisolone. Post-partum bone marrow aspiration showed myelodysplastic syndrome. As the patient demonstrated no symptoms such as abnormal bleeding, no additional treatment was started, and she went on to receive regular follow-up for myelodysplastic disorder. Discussion This case shows the need for further assessment of hematological disorders diagnosed in pregnancy in women with pyoderma gangrenosum post-partum.

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Adhesions between the bladder and uterus necessitated an atypical incision in the cesarean section of a woman with endometriosis. This could not be predicted with pre-surgery MRI. .No methods in the literature are able to predict adhesions with true certainty; it is therefore still difficult to diagnose intra-abdominal adhesions