Ultrasound diagnosis conditions of the uterus scar in pregnant and non-pregnant women

2020 ◽  
pp. 39-43
Author(s):  
N. Kovyda ◽  
◽  
N. Honcharuk ◽  
Keyword(s):  
Blood Flow ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Vascular Resistance ◽  
Ultrasound Examination ◽  
Ultrasound Diagnosis ◽  
Control Group ◽  
Previous Cesarean Section ◽  
Uterine Arteries ◽  
Previous Cesarean

The dynamic increase in the number of caesarean section in Ukraine and around the world remains one of the main topics of discussion, which is intensively discussing by leading scientists. The traditional assessment of the ability of the uterus scar during pregnancy, based mainly on the analysis of clinical and anamnestic data, is not high informative, and the ambiguous conclusions of the sonographic study indicate the need for further detailed study. Therefore, there is reason to believe that the development of criteria for ultrasound assessment of the condition of the uterus scar after previous cesarean section will use them to predict the possibility of spontaneous delivery in the future and remains relevant. The objective: study the features of ultrasound diagnosis of the condition of the scar on the uterus in pregnant and non-pregnant women. Materials and methods. Observations and retrospective analysis of medical records of pregnant women and birth histories in 150 women with a scar on the uterus after a previous cesarean section for the period from 2014–2019. Results. In women who became pregnant up to a year after the previous cesarean section, the most pronounced changes in blood flow were in the uterine arteries, especially during gestation 28–34 weeks. Also, in women with a failed uterus scar, changes in blood flow were most often observed in the uterine arteries at all levels and were significantly higher, compared with women with a capable uterus scar and women from the control group. In women with an insolvent uterus scar, the most pronounced changes in the indices of vascular resistance was observed in the uterine arteries, in particular the right uterine artery. Conclusion. The peculiarities of blood flow and vascular resistance in different vessels of the myometrium depending on the gestation period and the timing of pregnancy after a previous cesarean section. The obtained detailed ultrasound examination and mathematical calculation of the results of ultrasound examination of the uterus and postoperative uterus scar after previous cesarean section in non-pregnant women allowed to create a scale for assessing the condition of the uterus scar after previous cesarean section in non-pregnant women. Keywords: cesarean section, uterus scar, ultrasound, pre-pregnancy preparation of women.

scholarly journals Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatemeh Hadizadeh-Talasaz ◽  
Faezeh Ghoreyshi ◽  
Fatemeh Mohammadzadeh ◽  
Roghaieh Rahmani
Keyword(s):  
Decision Making ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Shared Decision Making ◽  
Mode Of Delivery ◽  
Decisional Conflict ◽  
Control Group ◽  
Shared Decision ◽  
Previous Cesarean Section ◽  
Previous Cesarean

Abstract Background The promotion of vaginal birth after cesarean section (VBAC) is the best method for the reduction of repeated cesarean sections. Nonetheless, the decisional conflict which often results from inadequate patient involvement in decision making, may lead to delayed decision making and regret about the choices that were made. The present study aimed to determine the effect of shared decision making on the mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section. Methods This randomized clinical trial was conducted on 78 pregnant women with a previous cesarean section referring to community health centers in Torbat-e Jam, Iran, in 2019. They were randomly assigned to two groups of intervention and control. During weeks 24-30 of pregnancy, the Decisional Conflict Scale (DCS) was completed by pregnant mothers. Apart from the routine care, the experimental group received a counseling session which was held based on the three-talk model of shared decision making. This session was moderated by a midwife; moreover, a complementary counseling session was administered by a gynecologist. During weeks 35–37 of pregnancy, DCS was completed, and the Decision Regret Scale (DRS) was filled out for both groups at the 8th weeks postpartum and they were asked about the mode of delivery. Data were analyzed in SPSS software (version 19) using the Mann-Whitney, Chi-squared and Fisher’s exact tests. p-value less than 0.05 was considered statistically significant. Results After the intervention, the decisional conflict score was significantly lower in the shared decision making (SDM) group, compared to that in the control group (14.90 ± 9.65 vs. 25.41 ± 13.38; P < 0.001). Moreover, in the SDM group, the rate of vaginal birth was significantly higher than that in the control group (P < 0.001). Two month after the delivery, the mean score of decision regret was lower in the SDM group, in comparison to that in the control group (15.67 ± 23.37 vs. 27. 30± 26.75; P = 0.007). Conclusions Based on the results of the study, shared counseling can be effective in the reduction of decisional conflict and regret, as well as rate enhancement of VBAC. Therefore, it can be concluded that this counseling method can be used in prenatal care to reduce the rate of repeated cesarean section. Trial registration IRCT20190506043499N1; Name of the registry: Iranian Registry of Clinical Trials; Registered 10. August 2019. URL of registry: https://en.irct.ir/trial/39538. Date of enrolment of the first participant to the trial: August 2019.

The possibility of high-precision ultrasound diagnosis of placenta ingrowth into the uterine scar after cesarean section

2020 ◽  
Author(s):  
V.N. Demidov, A.I. Gus, T.A. Yarygina
Keyword(s):  
Statistical Analysis ◽  
Cesarean Section ◽  
Pregnant Women ◽  
High Precision ◽  
Ultrasound Examination ◽  
Placenta Previa ◽  
Ultrasound Diagnosis ◽  
Lower Segment ◽  
Uterine Scar

Our statistical analysis, based on ultrasound examination of 7069 pregnant women, showed that both in the absence and in the presence of a scar on the uterus in the region of its lower segment, the placenta in the 3rd trimester of pregnancy was located extremely rarely, only in 0.1%. It was either primarily located in other parts of the uterus, or migrated from the lower segment of the uterus towards the bottom. In the case of the location of the placenta in this area, its ingrowth was not observed only in 2.3% of women. The main ultrasound signs of ingrowth of the placenta into the scar was the absence of its migration, as well as the presence of a combination of placenta previa with its localization in the scar zone. From the data obtained, it follows that the sensitivity of ultrasound diagnosis of placental accreta was 97.7%, and the specificity was 99.9%. According to our data, ingrown placenta in most cases can be delivered as early as 14–19 weeks, and the time spent on detecting this pathology usually does not exceed one minute.

The effect of placental elasticity on intraoperative bleeding in pregnant women with previous cesarean section

2020 ◽  
Vol 48 (3) ◽  
pp. 217-221 ◽  
Author(s):  
Harun Egemen Tolunay ◽  
Hasan Eroğlu ◽  
Onur Kaya ◽  
Dilek Şahin ◽  
Aykan Yücel
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Real Time ◽  
Strain Ratio ◽  
Tissue Elasticity ◽  
Previous Cesarean Section ◽  
Third Trimester ◽  
Intraoperative Bleeding ◽  
Tissue Elastography ◽  
Previous Cesarean

AbstractBackgroundWe aimed to evaluate the efficiency of placental elasticity in predicting the amount of intraoperative bleeding via real-time tissue elastography technique.MethodsPregnant women in the third trimester of pregnancy who had planned delivery via cesarean section due to the recurrent cesareans were enrolled in the research (n = 78). Elastographic measurements of placental tissues of all cases were carried out by real-time elastographic ultrasonography. It is a tissue elastography software (Esaote MyLabSeven) that uses a 8-1-MHz multifrequency AC2541 Probe.ResultsA significant relationship was found between placental elasticity and intraoperative bleeding. There was a significant correlation between alterations in the preoperative and postoperative hemoglobin (Hb) and hematocrit (Hct) levels and placental strain ratio (SR) (P < 0.001, r: 0.831; P < 0.001, r: 0.733, respectively).ConclusionThese findings may reflect an alteration at the tissue elasticity level. We hope that the use of real-time elastographic ultrasonography technique may give an idea about the amount of bleeding during the cesarean section.

Ultrasound examination at term for predicting the outcome of delivery in women with a previous cesarean section

2016 ◽  
Vol 29 (23) ◽  
pp. 3870-3874 ◽  
Author(s):  
Montse Comas ◽  
Belén Cochs ◽  
Laia Martí ◽  
Raquel Ruiz ◽  
Sònia Maireles ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Ultrasound Examination ◽  
Previous Cesarean Section ◽  
Previous Cesarean

scholarly journals Outcomes of induction in trial of labor after cesarean delivery

2019 ◽  
Vol 8 (3) ◽  
pp. 1076
Author(s):  
Anubha Varshney ◽  
Zehra Mohsin
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Mode Of Delivery ◽  
Neonatal Morbidity ◽  
Induction Of Labor ◽  
Control Group ◽  
Study Group ◽  
Previous Cesarean Section ◽  
Trial Of Labor ◽  
Previous Cesarean

Background: The objective of this study is to evaluate the outcomes of induction of labor in women attempting trial of labor after cesarean delivery and to compare maternal and neonatal morbidity and mortality in women who were induced to those delivering spontaneously.Methods: The prospective study was carried out in the Department of Obstetrics and Gynecology in collaboration with the Neonatal Section, Department of Pediatrics at J.N. Medical College and Hospital, AMU Aligarh. The sample included 280 women with one previous cesarean section, of whom 130 women underwent induction of labor (study group) and 150 were admitted with spontaneous onset of labor. Prostaglandin gel and intracervical Foley’s were used for cervical ripening in the study group. Indication of cesarean section, mode of delivery, maternal and neonatal outcome were studied in between groups.Results: Overall rate of vaginal delivery after cesarean section was 45.3% and 56% in both study and control group respectively. The rate of cesarean section were higher in women who were induced and having unfavorable cervix. Maternal and neonatal morbidity were not significantly higher as compared in both groups, however one case of scar rupture was found in study group.Conclusions: Induction of labor in women with previous cesarean section had higher rates of cesarean section however it does not adversely affect neonatal and maternal morbidity. Overall vaginal birth is safe and effective in women with previous cesarean section by prostaglandin gel or intracervical Foley’s. Authors cautiously suggest, induction of labor should be considered in preselected patient with strict monitoring.

The course of pregnancy, delivery and the condition of newborn in women with uterus scar after previous cesar section

2020 ◽  
pp. 42-46
Author(s):  
N. Kovyda ◽  
◽  
N. Honcharuk ◽  
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Retrospective Analysis ◽  
Vaginal Delivery ◽  
Early Pregnancy ◽  
Previous Cesarean Section ◽  
Pregnancy And Childbirth ◽  
Birth Record ◽  
History Of ◽  
Previous Cesarean

The objective: Analysis of pregnancy, delivery and the condition of newborns in women with uterus scar after previous Cesarean section. Materials and methods. Observations and retrospective analysis of individual maps of pregnant women, birth record and condition of newborns in 180 women with uterus scar after previous Cesarean section from 2014-2019. Results. It was found that women in I group had no history of miscarriage, and in II group this indicator was 6.7%. We were determined that the threat of early pregnancy was observed twice often in II group as in I group. Failure uterus scar during pregnancy was diagnosing in 21.1% of women of I group against 18.9% of women of II group, as well as during childbirth in 10% of women of II group against none of women of I group. In addition, 76.7% of women of I group were born by vaginal delivery against 24.4% of women of II group. In addition, 10% of newborns in women of I group on the Apgar scale were rated 6-7 points against 65.5% in a state of varying degrees of hypoxia in women of II group. Conclusion. Pregnancy and childbirth in women with uterus scar after previous Cesarean section were accompanying by complications of fetal and neonatal disorders. More pronounced changes were observing during pregnancy, delivery and changes in the condition of newborns in women of II group against with women of I group, which can be explaining by better pre-pregnancy preparation of women of I group and better monitoring during pregnancy. Keywords: сesarean section, pre-pregnancy preparation of women, the condition of newborns.

Features of hemodynamics of the mother–placenta–fetus system in the first half of pregnancy after the assisted reproductive technologies application

2018 ◽  
pp. 62-66
Author(s):  
L.M. Vygivska ◽  
◽  
I.V. Maidannyk ◽  
O.O. Chorna ◽  
V.F. Oleshko ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pregnant Women ◽  
Doppler Ultrasound ◽  
Uterine Artery ◽  
Umbilical Artery ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Control Group ◽  
Uterine Arteries ◽  
The Right

Doppler study is one of the main methods for assessing the condition of placental blood circulation and fetal hemodynamics. Doppler blood flow in the uterine arteries demonstrates the broad capabilities of the method for predicting pregnancy complications such as gestosis, fetal development delay, preterm birth, as well as for diagnosing adverse perinatal consequences. However, there is still no clear opinion about the feasibility of using Doppler as a screening test, as well as about the optimal pregnancy period for this type of study. The objective: is to study the hemodynamic features in pregnant women after assisted reproductive technologies (ART) application in the dynamics of the first part of pregnancy. Materials and methods. 299 pregnant women were examined – the main group included 249 women whose pregnancy occurred as a result of ART application. The control group consisted of 50 pregnant women with spontaneous pregnancy and its physiological course. I group – 94 women with tubal-peritoneal factor of infertility, II group – 87 women with endocrine factor of infertility, III group - 68 women whose infertility was caused by the male factor. Doppler ultrasound examination of the uterine arteries, arteries of the umbilical cord and middle cerebral arteries of the fetus were conducted. Results. It was found that the highest intensity of hemodynamics in the uterine artery basin at 11–12 weeks of gestation was recorded in a group of patients with a physiological course of pregnancy. The systolic-diastolic ratio in the right and left uterine arteries in these patients was 1.9 (1.8–2.7) and 2.1 (1.9–2.6), respectively. In contrast to women in the control group, pregnant women after ART application analyzed indicators were higher (1.6–1.9 times; p<0.0001). The systolic-diastolic ratio in the right uterine artery in III group was 3.0 (2.4–3.5), I group – 3.3 (3.1–3.4). Similar data were obtained analyzing the curves of blood flow rates in the left uterine artery – 2.9 (2.1–3.5) and 3.0 (2.7–3.6), respectively. The highest peripheral resistance, both in the right (3.6 (3.4–3.7) and left (3.5 (3.2–3.8) uterine arteries, was naturally registered in pregnant women of II group. In 36 (72%) patients with uncomplicated course and successful gestation at 11–12 weeks of pregnancy, blood flow was not recorded in the intervellon space. In the vast majority – 50 (73.5%) pregnant women of I group, two types of blood flow were registered in the intervellar space: pulsating arterial and continuous venous. Only in 18 (26.5%) patients of this group the blood flow in intervellon space was not determined. As a result of the obtained data analysis, it was found that at 16-17 weeks of gestation, the highest intensity of blood flow in the uterine artery pool was recorded in the control group. Thus, the systolic-diastolic ratio of the right and left uterine arteries in these subjects was 1.6 (1.5–1.8) and 1.8 (1.6–2.0). In pregnant women of the main group, the indicators were significantly higher (1.2-2.0 times; p<0.0001). The systolic-diastolic ratio in the uterine arteries in group III was 2,1 (1,9–2,6); 2,2 (1,9–2,5), in the II group – 3,1 (2,5–3,3); 2,2 (1,9–2,5), in the I group – 2,6 (2,5–3,2); 2,7 (2,5–2,9). In contrast to the control group, in which the systolic-diastolic ratio in the fetal umbilical artery was 3.4 (3.3–3.5), in III group patients, there was a significantly higher intensity of umbilical blood flow (S/D – 3.3 (3.5–3.6), p=0.03). At the same time, feto-placental hemodynamics in II and I groups patients was characterized by a significant increase in the numerical values of blood flow in the umbilical arteries (S/D – 4.5 (4.4–4.7), p=0.0001 and 3.5 (3.5–3.6), p=0.03, respectively). In patients of the control group, the systolic-diastolic ratio of the middle cerebral artery of the fetus at 16–17 weeks of gestation was 3.4 (3.4–3.5), almost completely coinciding with the same indicator in the umbilical artery (S/D – 3.4 (3.3–3.5). Patients of group III had a higher blood flow intensity, as evidenced by significantly lower (S/D 3.2 (3.1–3.3), compared with the control group (S/D 3.4 (3.4–3.5) absolute values of the systolic-diastolic ratio. An increase in the intensity of blood flow in the fetal medial artery (against the background of increased vascular resistance in the umbilical artery) was also recorded in the group of subjects of group II (S/D – 2.8 (2.7–2.9). High absolute values of systolic-diastolic ratio in the indicated vessel (4.4 (4.3–4.5) were found in the fetuses of the examined group and group, which characterize a significant decrease in the intensity of cerebral blood flow, compared with all the analyzed groups. Conclusions. Thus, the results of the study allow us to attribute Doppler ultrasound to highly informative research methods that make it possible to predict hemodynamic changes in the mother-placenta-fetus system, depending on the type of infertility, take preventive measures and start correction in time. Keywords: pregnancy, assisted reproductive technologies, Doppler ultrasound, uterine arteries, systolic-diastolic ratio.

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