scholarly journals Evaluation of uterine scar healing by transvaginal ultrasound in 607 nonpregnant women with a history of cesarean section

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xingchen Zhou ◽  
Tao Zhang ◽  
Huayuan Qiao ◽  
Yi Zhang ◽  
Xipeng Wang
Keyword(s):  
Cesarean Section ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Cesarean Scar ◽  
Female Reproductive Health ◽  
Position Detection ◽  
The Difference ◽  
Uterine Scar ◽  
Group B ◽  
Scar Healing

Abstract Background Caesarean scar defect (CSD) seriously affects female reproductive health. In this study, we aim to evaluate uterine scar healing by transvaginal ultrasound (TVS) in nonpregnant women with cesarean section (CS) history and to build a predictive model for cesarean scar defects is very necessary. Methods A total of 607 nonpregnant women with previous CS who have transvaginal ultrasound measurements of the thickness of the lower uterine segment. The related clinical data were recorded and analyzed. Results All patients were divided into two groups according to their clinical symptoms: Group A (N = 405) who had no cesarean scar symptoms, and Group B (N = 141) who had cesarean scar symptoms. The difference in frequency of CS, uterine position, detection rate of CSD and the residual muscular layer (TRM) of the CSD were statistically significant between groups; the TRM measurements of the two groups were (mm) 5.39 ± 3.34 versus 3.22 ± 2.33, P < 0.05. All patients were divided into two groups according to whether they had CSDs: Group C (N = 337) who had no CSDs, Group D (N = 209) who had CSDs on ultrasound examination. The differences in frequency of CS, uterine position, TRM between groups were statistically significant (P < 0.05). In the model predicting CSDs by TRM with TVS, the area under the ROC curve was 0.771, the cut-off value was 4.15 mm. The sensitivity and specificity were 87.8% and 71.3%, respectively. Conclusions Patients with no clinical symptoms had a mean TRM on transvaginal ultrasonography of 5.39 ± 3.34 mm, which could be used as a good reference to predict the recovery of patients with CSDs after repair surgery.

Evaluation of uterine scar healing by transvaginal ultrasound in 607 nonpregnant women with a history of cesarean section

2020 ◽  
Author(s):  
Xingchen Zhou ◽  
Tao Zhang ◽  
Huayuan Qiao ◽  
Yi Zhang ◽  
Xipeng Wang
Keyword(s):  
Cesarean Section ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Cesarean Scar ◽  
Female Reproductive Health ◽  
Position Detection ◽  
The Difference ◽  
Uterine Scar ◽  
Group B ◽  
Scar Healing

Abstract Background: Caesarean scar defect (CSD) seriously affects female reproductive health. In this study, we aim to evaluate uterine scar healing by transvaginal ultrasound（TVS）in nonpregnant women with cesarean section（CS）history and to build a predictive model for cesarean section defects is very necessary. Methods: A total of 607 nonpregnant women with previous CS who have transvaginal ultrasound measurements of the thickness of the lower uterine segment . The related clinical data were recorded and analyzed. Results: All patients were divided into two groups according to their clinical symptoms: Group A (N=405) who had no cesarean scar symptoms, and Group B (N=141) who had cesarean scar symptoms. The difference in frequency of CS, uterine position, detection rate of CSD and the the residual muscular layer (TRM) of the CSD were statistically significant between groups; the TRM measurements of the two groups were (mm) 5.39±3.34 vs 3.22±2.33, P<0.05.All patients were divided into two groups according to whether they had CSDs: Group C (N=337) who had no CSDs , Group D (N=209) who had CSDs on ultrasound examination. The differences in frequency of CS, uterine position, TRM between groups were statistically significant (P<0.05). In the model predicting CSDs by TRM with TVS, the area under the ROC curve was 0.771, the cut-off value was 4.15 mm. The sensitivity and specificity were 87.8% and 71.3%,respectively.Conclusions: Patients with no clinical symptoms had a mean TRM on transvaginal ultrasonography of 5.39 ± 3.34 mm, which could be used as a good reference to predict the recovery of patients with CSDs after repair surgery.

scholarly journals Various Types of Niche Imaging by Sonohysterography: A Pictorial Review

2014 ◽  
Vol 8 (3) ◽  
pp. 311-315 ◽  
Author(s):  
Firoozeh Ahmadi ◽  
Farnaz Akhbari ◽  
Fatemeh Niknejad
Keyword(s):  
Cesarean Section ◽  
Transvaginal Ultrasound ◽  
Subsequent Pregnancy ◽  
Previous Cesarean Section ◽  
Cesarean Section Delivery ◽  
Cesarean Scar ◽  
Pictorial Review ◽  
Scar Region ◽  
Uterine Scar ◽  
Previous Cesarean

ABSTRACT Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. Recently cesarean section delivery has been raised around the world markedly; therefore women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual Spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy. Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs have been used as a powerful tool for detecting the uterine scar of a previous cesarean section. Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently. How to cite this article Ahmadi F, Akhbari F, Niknejad F. Various Types of Niche Imaging by Sonohysterography: A Pictorial Review. Donald School J Ultrasound Obstet Gynecol 2014;8(3):311-315.

Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position

2009 ◽  
Vol 34 (1) ◽  
pp. 85-89 ◽  
Author(s):  
C.-B. Wang ◽  
W.-W.-C. Chiu ◽  
C.-Y. Lee ◽  
Y.-L. Sun ◽  
Y.-H. Lin ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Clinical Symptoms ◽  
Defect Size ◽  
Cesarean Scar

scholarly journals Adrenaline and Dexamethasone, vs Adrenaline and Fluticasone, vs Adrenaline alone in Bronchiolitis: A Randomized Controlled Trial

2020 ◽  
pp. 20-28
Author(s):  
Jayendra R. Gohil ◽  
Atul M. Sheladiya ◽  
N. B. Adithya ◽  
Ratna D. Bhojak
Keyword(s):  
Hospital Stay ◽  
Clinical Symptoms ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Primary Objective ◽  
Assessment Instrument ◽  
Clinical Severity ◽  
Group A ◽  
The Difference ◽  
Group B

Background and Objectives: There is no consensus over which drug best reduces symptoms in Bronchiolitis syndrome. The primary objective of our study is to establish comparative effect of adrenaline nebulisation alone and combination of adrenaline nebulisation plus injectable dexamethasone and adrenaline nebulisation plus fluticasone nebulisation in the treatment of clinical cases of bronchiolitis. Methods: 100 patients diagnosed clinically as bronchiolitis were enrolled in study from 1 month to 24 months of age. Patients were enrolled by purposive sampling. Patients with respiratory distress assessment instrument score [RDAI] of 4 to 15 were chosen, randomized into three groups and treatment given till patient fullfilled discharge criteria. Group A (n=33) were given nebulised adrenaline alone, Group B (n=34) were given nebulised adrenaline plus injectable dexamethasone and Group C (n=33) were given nebulised adrenaline plus nebulised fluticasone. Results: The mean reduction in clinical severity-RDAI score was 1.75 ±0.86 in Group A, 2.30 ± 0.68 in Group B and 1.42 ± 0.9 in Group C when measured in terms of difference in clinical scores between day 1 and 2 (p=0.0003). Mean duration of hospital stay in the group A was (4.93±1.95 days), Group C (4.78±1.83) and Group B (3.91 ±1.37 days). The difference of stay between the Groups A and B was 1.02±0.58 days vs 0.87± 0.46 days in groups B and C (p-0.0048). Reduction in the length of hospital stay in group B was 22% compared to Group A & 19% compared to Group C (p-0.0048). Side effects were tachycardia in six patients. Conclusion: Combination of adrenaline nebulization and injectable dexamethasone was found significantly better as compared to nebulised adrenaline plus nebulised fluticasone and nebulised adrenaline alone in patients of clinical bronchiolitis in reducing severity of clinical symptoms and duration of hospitalization.

scholarly journals Macrophage polarization in cesarean scar diverticulum

2021 ◽  
Author(s):  
Jinfa Huang ◽  
Xiaochun Liu ◽  
Yi Hou ◽  
Yixuan Liu ◽  
Kedan Liao ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Macrophage Polarization ◽  
Statistical Correlation ◽  
Cesarean Scar ◽  
M2 Polarization ◽  
Tnf Α ◽  
Significant Difference ◽  
Uterine Scar ◽  
Immunohistological Staining ◽  
Lower Expression

Abstract Aims: To determine immunohistochemical features and correlations between M1/M2 polarization status with disease severity of post-cesarean scar diverticulum（CSD）. Methods: Histological and immunohistological staining were performed and inflammatory (CD16, CD163, and TNF-α), fibrosis (α-SMA), and angiogenic (CD31) markers were examined in uterine tissues collected from patients with uterine scar diverticula (CSD) (n=37) and cesarean section (CS) (n=3). Results: CSD tissues have higher expression of α-SMA, TNF-α, CD16, and CD31 and lower expression of CD163 than CS tissue (P <0.05). Compared with adjacent tissues, thick-walled blood vessels, glands, and fibrotic sites have higher expression of α-SMA, TNF-α, and CD16. Statistical correlation was observed between the expression of CD16 and TNF-α (R = 0.693, P <0.001), α-SMA (R = 0.404, P <0.05), and CD31 (R = 0.253, P <0.05) in CSD tissues, especially with the ratio of CD16/CD163 (R = 0.590, P <0.01). A more significant difference was observed between the expression of CD16/CD163 and α-SMA (R = 0.556, P <0.001), TNF-α (R = 0.633, P <0.0001) and CD31 (R = 0.336, P <0.05) Statistical correlation. Conclusion: In this study, TNF-α, α-SMA, CD16, and CD31 proteins were overexpressed in all CSD cases, and CD16/CD163 was positively correlated with tissue inflammation, fibrosis, and neovascularization. Abnormal mononuclear macrophage infiltration may be involved in the origin and progression of CSD.

scholarly journals Heterogeneity analysis of COVID - 19 clinical phenotype in Wuhan

2020 ◽  
Author(s):  
Qin Yin ◽  
Jiao Xie ◽  
Jixian Zhang ◽  
Zhen Fu ◽  
Wangcai Zhu ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Clinical Characteristics ◽  
Muscle Soreness ◽  
Clinical Symptoms ◽  
Group A ◽  
Missed Diagnosis ◽  
The Difference ◽  
Group B ◽  
Loss Of Appetite ◽  
Group D

Abstract BackgroundSince the outbreak of coronavirus disease 2019 (COVID-19), some studies reported the clinical characteristics of COVID-19 patients in hospital. However, these studies did not investigate the clinical symptoms heterogeneity of COVID-19 patients in the outpatient. This study aimed to describe the heterogeneity of clinical characteristics of outpatient COVID-19 patients.MethodsCOVID-19 patients visiting the respiratory outpatient department of our hospital from January 1st to February 28st 2020 were retrospectively analyzed. Based on the complaints, the patients were classified into four groups including group A (patients without symptoms), group B (patients with fever), group C (patients with respiratory symptoms but without fever), and group D (patients with extra-respiratory symptoms but without fever). The difference of clinical characteristics, basic diseases, laboratory examination of outpatient, characteristics of chest CT imaging among all the groups were analyzed and compared.ResultsA total of 309 COVID-19 patients were included with 126 men and 183 women. The common symptoms included fatigue (59.87%, 95% CI: 54.17-65.38%), loss of appetite (51.13%, 95% CI: 45.41-56.83%), fever (50.81%, 95% CI: 45.09-56.51%), muscle soreness (41.42%, 95% CI:35.88-47.14%), and dry cough (35.28%, 95% CI:29.95-40.89%). The percentages of group A to group D were 2.91%, 50.81%, 18.12%, and 28.16%, respectively. The most common symptoms in Group D included fatigue, loss of appetite, muscle soreness. ConclusionThe heterogeneity of clinical symptoms for COVID-19 patients in the outpatient is significant. We should pay attention to patients without symptoms or those with only extra-respiratory symptoms, who are prone to missed diagnosis.

Ultrasonographic and hysteroscopic outcomes of uterine scar healing after cesarean section: Comparison of two types of single-layer suture

2012 ◽  
Vol 38 (11) ◽  
pp. 1302-1307 ◽  
Author(s):  
Oronzo Ceci ◽  
Clementina Cantatore ◽  
Marco Scioscia ◽  
Claudia Nardelli ◽  
Mini Ravi ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Single Layer ◽  
Uterine Scar ◽  
Scar Healing

scholarly journals Differential Diagnosis of Cesarean Scar Pregnancies and Other Pregnancies Implanted in the Lower Uterus by Ultrasound Parameters

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kangning Li ◽  
Qing Dai
Keyword(s):  
Differential Diagnosis ◽  
Cesarean Section ◽  
Transvaginal Ultrasound ◽  
Previous Cesarean Section ◽  
Cesarean Scar Pregnancy ◽  
Rare Type ◽  
Cesarean Section Delivery ◽  
Cesarean Scar ◽  
The Relationship ◽  
Previous Cesarean

Purpose. Cesarean scar pregnancy is an extremely rare type of ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar. On the other hand, pregnancies are considered low implantations if they are identified in the lower third of the uterus without the sac implanted into the scar and have a better prognosis. Early diagnosis of both types of pregnancies can help avoid serious complications. This study is aimed at investigating the significance of transvaginal ultrasound in the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Methods. Ninety-three patients with an average age of 32.7 years (range, 24–43 years) were enrolled in this study, including 66 cesarean scar pregnancies and 27 other pregnancies implanted in the lower uterus, and they were examined by transvaginal ultrasound. Results. We observed significant differences in the relationship between the cesarean sac and the scar, the source of the trophoblastic blood flow, and the thickness of the residual muscle between the cesarean scar pregnancy group and the lower uterus pregnancy group. We established the logistic model to improve the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Conclusions. Transvaginal ultrasound is recommended in early pregnancy, especially for patients who have undergone a previous cesarean section delivery.

scholarly journals EPIDURAL ANALGESIA DURING VAGINAL DELIVERY AT THE WOMEN WITH THE UTERINE SCAR. IS IT RISKY? POSSIBLE? NECESSARY?

2017 ◽  
Vol 11 (3) ◽  
pp. 182-188
Author(s):  
K. A Bozhenkov ◽  
T. A Gustovarova ◽  
A. N Ivanyan ◽  
V. L Vinogradov ◽  
E. M Shifman
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
Vaginal Delivery ◽  
Total Duration ◽  
Perinatal Outcomes ◽  
Pain Syndrome ◽  
Comparative Assessment ◽  
Group A ◽  
Uterine Scar ◽  
Group B

This paper will be concerned with the results of a prospective controlled longitudinal study which has involved 132 secundiparae (among them 69 patients are with the uterine scar after cesarean section). The parturient women have been divided into 3 groups. Group “A” includes 38 women with the uterine scar after cesarean section, in this group epidural analgesia was administered during vaginal delivery. Group “B” includes 32 secundiparae without uterine scar, in this group epidural analgesia was administered during vaginal delivery. Group “C” - 31 women with the uterine scar, no epidural analgesia was administered during vaginal delivery. Based on a comparative assessment of the pain syndrome intensity in labor according to the visual analogue scale, the research has proved that delivery at the women with the uterine scar is accompanied by statistically more significant pain than at the women without uterine scar. The necessity of analgesia during vaginal delivery at the women with the uterine scar has been proved. The effectiveness and safety of epidural analgesia at patients with the uterine scar have been analyzed. It has been proved that epidural analgesia provides anesthesia during vaginal delivery at the women with the uterine scar, while it does not affect the total duration and course of labor, maternal and perinatal outcomes, and does not mask the clinical picture of the uterine rupture threat.

scholarly journals Purse String Double Layer Closure in Cesarean Section (Turan Technique) : a Novel Approach to Reduce Cesarean Scar Defect

2020 ◽  
pp. 129-134
Author(s):  
Aditya Prabawa ◽  
A A Ngurah Jayakusuma ◽  
A A Gede P. Wiradnyana
Keyword(s):  
Cesarean Section ◽  
Double Layer ◽  
Transvaginal Ultrasound ◽  
Control Group ◽  
Study Group ◽  
Purse String ◽  
Cesarean Scar ◽  
Uterine Incision ◽  
Number Of Patients ◽  
Closure Method

Objective : To compare cesarean scar defect incidence and other parameters between Turan technique and Conventional techniqueMethod : Literature ReviewResult : The Turan technique uses a purse-string double-layer closure method, which can shorten the incision length and reduce the incidence of postpartum cesarean scar defect that can be detected by ultrasound. Uterine incisional defects are etiologic factor of postoperative pelvic adhesion, placenta previa and accreta, uterine rupture, abnormal uterine bleeding and dysmenorrhea. This means that decrease in the incidence of uterine incisional defects is essential to prevent cesarean-related complications. In 51 patients in the study group (closure the uterine incision with Turan technique) and 65 patients in the control group collected within 6 weeks postoperative for transvaginal ultrasound, the length of the uterine incision closure in the study group shorter than control group (p= 0.0001, 95% IK = 2,854-6,876). Significantly, the number of patients with cesarean scar defect was 12 (23.5%) in the study group and 39 in the control group (76.5%) with P = 0.0001.Conclusion : Turan technique is new uterine closure method technique on CS. This technique can reduce the incidence of cesarean scar defect.Keyword : Turan Technique, Cesarean Section, uterine incision Abstrak Tujuan : Untuk membandingkan angka kejadian defek jaringan parut uterus dan parameter lain antara teknik Turan dan teknik konvensionalMetode : Kajian PustakaHasil : Teknik Turan menggunakan metode penutupan purse-string double layer, dimana dapat memperpendek insisi dan mengurangi insidensi defek jaringan parut uterus postpartum yang dapat dideteksi dengan ultrasonografi. Defek insisional uterus merupakan faktor etiologi dari adhesi pelvis paska operasi, plasenta previa dan akreta, ruptur uteri, kehamilan ektopik pada parut uterus, perdarahan uterus abnormal dan dismenore. Ini berarti penurunan kejadian defek insisional uterus sangat penting untuk mencegah terjadinya komplikasi terkait seksio sesarea. Pada 51 pasien kelompok studi (teknik Turan) dan 65 pasien pada kelompok kontrol yang dilakukan pemeriksaan ultrasonografi transvaginal 6 minggu paska operasi didapatkan data bahwa panjang insisi uterus lebih pendek pada kelompok studi (P = 0.0001, 95% IK = 2.854–6.876). Secara signifikan, jumlah pasien dengan defek parut bekas operasi (Cesarean Scar Defect) adalah 12 orang (23.5%) pada kelompok studi dan 39 orang pada kelompok kontrol (76.5%) dengan nilai P = 0.0001Kesimpulan : Teknik Turan adalah teknik baru mengenai metode penjahitan pada insisi operasi SC. Secara signifikan tehnik ini mampu menurunkan insidensi defek parut bekas operasi.Kata kunci : Teknik Turan, Seksio Sesarea, Insisi uterus  

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