Abdominal Disimpaction with Lower Uterine Segment Support as a Novel Technique to Minimize Fetal and Maternal Morbidities during Cesarean Section for Obstructed Labor: A Case Series

The adverse neonatal outcome is defined as the presence of birth asphyxia, respiratory distress, birth trauma, hypothermia, meconium aspiration syndrome, neonatal intensive care admission, and neonatal death. It is a major concern in developing countries, including Ethiopia. This study tried to identify predictors of adverse neonatal outcomes at selected public hospitals in Eastern Ethiopia. A hospital-based prospective follow-up study was conducted in three public hospitals in Eastern Ethiopia from June to October 2020. A total of 2,246 laboring women and neonates born at the hospitals were enrolled in the study. Data were collected through interviews, observation checklists, and clinical chart review. Reports were presented in relative risks with 95% CIs. The overall magnitude of adverse neonatal outcome was 20.97% (95% CI: 19.33- 22.71%). It was 24.3% for babies born through cesarean section (95% CI: 21.3%, 27.5). The presence of meconium in the amniotic fluid increased the risk for neonates delivered via cesarean section (ARR, 1.52 95% CI; 1.04, 2.22). Among neonates born via vaginal delivery, the risk of adverse neonatal outcome was higher among nullipara women (ARR, 1.42 95% CI; 1.02, 1.99) and among women diagnosed with abnormal labor or pregnancy such as APH, pre-eclampsia, obstructed labor, fetal distress, and mal-presentation at admission (ARR, 1.30 95%CI; 1.01, 1.67). The risk of adverse neonatal outcome was higher among babies born through the cesarian section than those born via vaginal delivery. Abnormal labor or pregnancy and being primiparous increased the risk of adverse neonatal outcome in vaginal delivery.

Download Full-text

Successful radiofrequency perforation and balloon decompression of cor triatriatum sinister using novel technique, a case series

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29686 ◽

2021 ◽

Author(s):

Benjamin A. Blais ◽

Jamil A. Aboulhosn ◽

Morris M. Salem ◽

Daniel S. Levi

Keyword(s):

Case Series ◽

Cor Triatriatum ◽

Novel Technique ◽

Cor Triatriatum Sinister ◽

Radiofrequency Perforation

Download Full-text

Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

BioMed Research International ◽

10.1155/2016/1765624 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Cuilan Li ◽

Shiyan Tang ◽

Xingcheng Gao ◽

Wanping Lin ◽

Dong Han ◽

...

Keyword(s):

Cesarean Section ◽

Combined Treatment ◽

Clinical Manifestations ◽

Abnormal Uterine Bleeding ◽

Lower Uterine Segment ◽

Improvement Rate ◽

Uterine Scar ◽

Lost To Follow Up

Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum.Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery.Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up.Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

Download Full-text

Sonographic lower uterine segment thickness after prior cesarean section to predict uterine rupture: A systematic review and meta‐analysis

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1111/aogs.13585 ◽

2019 ◽

Vol 98 (7) ◽

pp. 830-841 ◽

Cited By ~ 6

Author(s):

Brenna E. Swift ◽

Prakesh S. Shah ◽

Dan Farine

Keyword(s):

Systematic Review ◽

Cesarean Section ◽

Uterine Rupture ◽

Meta Analysis ◽

Lower Uterine Segment ◽

Prior Cesarean Section

Download Full-text

Diagnostic Accuracy of Lower Uterine Segment Scar Thickness ≤1.6mm in Prediction of Scar Dehiscence in patients

10.53350/pjmhs2115102682 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2682-2684

Author(s):

Fiza Asif ◽

Sobia Zafar ◽

Tehmina Zafar ◽

Tayyaba Majeed ◽

Zahid Mahmood

Keyword(s):

Cesarean Section ◽

Diagnostic Accuracy ◽

Gold Standard ◽

Lower Uterine Segment ◽

Transvaginal Sonography ◽

Cross Sectional ◽

Standard Material ◽

Lower Segment Cesarean Section ◽

Study Results ◽

Uterine Scar

Background: Cesarean section uterine scar dehiscence (CSD) is a rare but notable complication of Lower segment cesarean section (LSCS) surgery. The cause for a uterine scar dehiscence is based on the etiology behind the uterine scar defect or any event that would predispose the cesarean scar to dehisce. Globally accepted option for assessing the CS scar is transvaginal ultrasonography of the non-pregnant uterus. Objective: To determine the diagnostic accuracy of lower uterine segment scar thickness≤1.6mm in the prediction of scar dehiscence in patients with previous one LSCS who are undergoing repeat LSCS after trial of labour taking intraoperative findings as gold standard. Material and methods: This cross sectional study was conducted in Services Hospital, Lahore for 6 months. The Non probability consecutive sampling technique was used to include women with previous one LSCS at 36-38 weeks were asked to get their TVS done for scar thickness. Women with scar thickness≤1.6mm and scar thickness>1.6mm were identified. Their intraoperative findings of scar dehiscence were confirmed. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients was 29.87±6.07 years. The emergency LSCS was done in 599(49.1%) patients and elective LSCS was done in 621(50.9%) patients. The sensitivity, specificity & diagnostic accuracy of TVS was 98.31%, 99.05% & 98.69% respectively. Conclusion: According to our study results the TVS for uterine scar is a very useful and effective tool in the prediction of scar dehiscence in patients with previous one LSCS taking intraoperative findings as gold standard. Keywords: Transvaginal sonography, TVS, Uterine, Scar, dehiscence, LSCS, Intraoperative

Download Full-text

Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal

Acta Médica Portuguesa ◽

10.20344/amp.14001 ◽

2021 ◽

Vol 34 (4) ◽

pp. 266

Author(s):

Margarida Cal ◽

Carla Nunes ◽

Nuno Clode ◽

Diogo Ayres-de-Campos

Keyword(s):

Cesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Tertiary Care ◽

Case Series ◽

Morbidity And Mortality ◽

Team Approach ◽

Tertiary Center ◽

Placenta Accreta Spectrum ◽

Spectrum Disorders

Introduction: Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade.Material and Methods: Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included.Results: During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta.Discussion: Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes.Conclusion: This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

Download Full-text