scholarly journals The marks that humans’ leave are too often scars

2020 ◽  
Vol 9 (12) ◽  
pp. 5163
Author(s):  
Nandita Sushilkumar Kaushal ◽  
Shrikrushna Vasant Chavan ◽  
Arundhati Gundu Tilve ◽  
C. V. Hegde
Keyword(s):  
Caesarean Section ◽  
Surgical Technique ◽  
Chorionic Gonadotropin ◽  
Innovative Approach ◽  
Previous Caesarean Section ◽  
Caesarean Scar ◽  
Obstetric Emergency ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Products Of Conception

Caesarean scar ectopics are the newest member of this obstetric emergency. Although rare, are associated with torrential haemorrhage. Gravida 3 para 2 with previous two caesarean sections with spotting per vaginum. Ultrasound showed a pregnancy embedded in the scar of previous caesarean section. MRI confirmed it. Beta human chorionic gonadotropin (HCG) was 15000 which dropped to 5000 after. An innovative approach was taken to laparoscopically evacuate the pregnancy. The products of conception were removed and the incision sutured so as to achieve haemostasis. Beta HCG was 15000 which dropped to 5000. Patient was haemodynamically stable and discharged on day 3. An innovative approach with skilled surgical technique not only decreased the morbidity but also avoided an unnecessary hysterectomy.

CAESAREAN SCAR ECTOPIC -A RARE ENTITY

2021 ◽  
pp. 28-29
Author(s):  
Naina Yadav ◽  
Kalpana Tiwari ◽  
Priyanka Goel
Keyword(s):  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Previous Caesarean Section ◽  
Rare Entity ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy

Caesarean scar pregnancy (CSP) is an ectopic pregnancy implanted in (1) the myometrium at the site of a previous caesarean section scar Its incidence is rising with the increase in number of caesarean sections .Very rst case was reported in 1978

scholarly journals Atypical presentation of molar pregnancy

2018 ◽  
pp. bcr-2018-225545
Author(s):  
Ream Langhe ◽  
Bogdan Alexandru Muresan ◽  
Etop Akpan ◽  
Nor Azlia Abdul Wahab
Keyword(s):  
Hydatidiform Mole ◽  
Abdominal Distension ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Products Of Conception ◽  
Good General Condition ◽  
Uterine Curettage

The classic features of molar pregnancy are irregular vaginal bleeding, hyperemesis, enlarged uterus for gestational age and early failed pregnancy. Less common presentations include hyperthyroidism, early onset pre-eclampsia or abdominal distension due to theca lutein cysts. Here, we present a case of molar pregnancy where a woman presented to the emergency department with symptoms of acute abdomen and was treated as ruptured ectopic pregnancy. The woman underwent laparoscopy and evacuation of retained products of conception. Histological examination of uterine curettage confirmed the diagnosis of a complete hydatidiform mole. The woman was discharged home in good general condition with a plan for serial beta-human chorionic gonadotropin (beta-hCG) follow-up. Complete follow-up includes use of contraception and follow-up after beta-hCG is negative for a year.

scholarly journals Reduced pregnancy and live birth rates after in vitro fertilization in women with previous Caesarean section: a retrospective cohort study

2020 ◽  
Vol 35 (3) ◽  
pp. 595-604 ◽  
Author(s):  
J Vissers ◽  
T C Sluckin ◽  
C C Repelaer van Driel-Delprat ◽  
R Schats ◽  
C J M Groot ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Embryo Transfer ◽  
Vaginal Delivery ◽  
Live Birth ◽  
Clinical Pregnancy ◽  
Fertility Treatment ◽  
Previous Caesarean Section ◽  
Birth Rates ◽  
Caesarean Scar ◽  
Live Birth Rates

Abstract STUDY QUESTION Does a previous Caesarean section affect reproductive outcomes, including live birth, in women after IVF or ICSI? SUMMARY ANSWER A previous Caesarean section impairs live birth rates after IVF or ICSI compared to a previous vaginal delivery. WHAT IS KNOWN ALREADY Rates of Caesarean sections are rising worldwide. Late sequelae of a Caesarean section related to a niche (Caesarean scar defect) include gynaecological symptoms and obstetric complications. A systematic review reported a lower pregnancy rate after a previous Caesarean section (RR 0.91 CI 0.87–0.95) compared to a previous vaginal delivery. So far, studies have been unable to causally differentiate between problems with fertilisation, and the transportation or implantation of an embryo. Studying an IVF population allows us to identify the effect of a previous Caesarean section on the implantation of embryos in relation to a previous vaginal delivery. STUDY DESIGN, SIZE, DURATION We retrospectively studied the live birth rate in women who had an IVF or ICSI treatment at the IVF Centre, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands, between 2006 and 2016 with one previous delivery. In total, 1317 women were included, of whom 334 had a previous caesarean section and 983 had previously delivered vaginally. PARTICIPANTS/MATERIALS, SETTING, METHODS All secondary infertile women, with only one previous delivery either by caesarean section or vaginal delivery, were included. If applicable, only the first fresh embryo transfer was included in the analyses. Patients who did not intend to undergo embryo transfer were excluded. The primary outcome was live birth. Multivariate logistic regression analyses were used with adjustment for possible confounders ((i) age; (ii) pre-pregnancy BMI; (iii) pre-pregnancy smoking; (iv) previous fertility treatment; (v) indication for current fertility treatment: (a) tubal, (b) male factor and (c) endometriosis; (vi) embryo quality; and (vii) endometrial thickness), if applicable. Analysis was by intention to treat (ITT). MAIN RESULTS AND THE ROLE OF CHANCE Baseline characteristics of both groups were comparable. Live birth rates were significantly lower in women with a previous caesarean section than in women with a previous vaginal delivery, 15.9% (51/320) versus 23.3% (219/941) (OR 0.63 95% CI 0.45–0.87) in the ITT analyses. The rates were also lower for ongoing pregnancy (20.1 versus 28.1% (OR 0.64 95% CI 0.48–0.87)), clinical pregnancy (25.7 versus 33.8% (OR 0.68 95% CI 0.52–0.90)) and biochemical test (36.2 versus 45.5% (OR 0.68 95% CI 0.53–0.88)). The per protocol analyses showed the same differences (live birth rate OR 0.66 95% CI 0.47–0.93 and clinical pregnancy rate OR 0.72 95% CI 0.54–0.96). LIMITATIONS, REASONS FOR CAUTION This study is limited by its retrospective design. Furthermore, 56 (16.3%) cases lacked data regarding delivery outcomes, but these were equally distributed between the two groups. WIDER IMPLICATIONS OF THE FINDINGS The lower clinical pregnancy rates per embryo transfer indicate that implantation is hampered after a caesarean section. Its relation with a possible niche (caesarean scar defect) in the uterine caesarean scar needs further study. Our results should be discussed with clinicians and patients who consider an elective caesarean section. STUDY FUNDING/COMPETING INTEREST(S) Not applicable. TRIAL REGISTRATION NUMBER This study has been registered in the Dutch Trial Register (Ref. No. NL7631 http://www.trialregister.nl).

scholarly journals Prediction of Placenta Accreta Using Hyperglycosylated Human Chorionic Gonadotropin

2018 ◽  
Vol 8 (2) ◽  
pp. 142-146
Author(s):  
Maad Mahdi Shalal ◽  
Shaymaa Kadhim Jasim ◽  
Huda Khalil Abd
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Chorionic Gonadotropin ◽  
Gestational Age ◽  
Human Chorionic Gonadotropin ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Control Group ◽  
Previous Caesarean Section ◽  
Hyperglycosylated Human Chorionic Gonadotropin

Objectives: Hyperglycosylated human chorionic gonadotropin (hCG) is a variant of hCG. In addition, it has a different oligosaccharide structure compared to the regular hCG and promotes the invasion and differentiation of peripheral cytotrophoblast. This study aimed to measure hyperglycosylated hCG as a predictor in the diagnosis of placenta accreta. Materials and Methods: In general, 90 pregnant women were involved in this case-control study among which, 30 ladies (control group) were pregnant within the gestational age of ≥36 weeks with at least one previous caesarean section and a normal sited placenta in transabdominal ultrasound (TAU). The other 60 pregnant women (case group) were within a gestational age of ≥36 weeks at least, one previous caesarean section and placenta previa with or without signs of placenta accreta in TAU. Hyperglycosylated hCG and total hCG were measured in each group and the results of the surgery were followed up. Results: Hyperglycosylated hCG showed higher serum levels in patients with placenta accreta compared to those with placenta previa and control women. Hyperglycosylated hCG with an optimal cut point of (3) IU/L predicted placenta accreta in pregnant women with 90% specificity, 76.7% sensitivity, and 81.1% accuracy. Conclusions: The high specificity of the above approach makes it a good diagnostic tool (as a single test) for confirming placenta accreta in clinical settings. When this test is added to our established workup, its high positive predictive value makes it a suitable method within the algorithm of accreta confirmation when there is a high suspicion or insufficient evidence to the diagnosis of placenta accreta.

scholarly journals Maternal outcome in accreta cases. Conservative surgery and hysterectomy in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2017 to January 2018

2021 ◽  
Vol 29 (3) ◽  
pp. 129
Author(s):  
Fita Maulina ◽  
Mohammad Adya Firmansha Dilmy ◽  
Yudianto Budi Saroyo ◽  
Yuditiya Purwosunu
Keyword(s):  
Caesarean Section ◽  
Surgical Technique ◽  
Placenta Accreta ◽  
Conservative Surgery ◽  
Massive Bleeding ◽  
Maternal Outcome ◽  
Bladder Injury ◽  
Previous Caesarean Section ◽  
Intraoperative Bleeding ◽  
The Mean

HIGHLIGHT1. As the incidence of placenta accreta is increasing which seems to parallel the increasing cesarean delivery rate, advance planning should be made for the management of delivery. 2. Maternal outcome of placenta accreta cases in a national hospital was reported based on the surgical technique performed.3. No significant results of maternal outcome undergoing conservative surgery and conventional hysterectomy in managing accreta cases in the national hospital.ABSTRACTObjectives: To report maternal outcome based on surgical technique on the management of accreta. The study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from January 2017 to January 2018.Case Report: There were 1609 cases of pregnant women delivered during the study period. From these, the prevalence of previous caesarean section was 73 cases, including 20 cases of accreta. Total maternal mortality for 1 year in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was 11, and accreta contributed 3 cases. We reported 20 cases of accreta in pregnancy The maternal outcomes, including bladder injury, duration of operation, intraoperative bleeding, length of hospitalization, and mortality, were evaluated. From 20 cases, 8 patients had one previous caesarean history, 11 had second previous caesarean section, while 2 patient had third previous caesarean section history. Of women with placenta accreta, about 7 patients (35%) had delivery in fullterm pregnancies, while 13 (65%) had delivery in preterm pregnancy. Surgical technique in accreta management mostly was hysterectomy to override bleeding complication along the delivery. From 20 cases, 16 caesarean sections were followed-up with hysterectomy. Four cases were with conservative management. From all the hysterectomy performed, four were complicated with bladder injury. The mean intraoperative bleeding was 600 - 5500 cc of blood, while the mean of post-operative transfusion was 1000 -3000 cc. There were 2 maternal deaths in this study. Thirteen patients were admitted to the ICU after the procedure.Conclusion: Accreta increases morbidity due to massive bleeding. It is important to have algorithm for managing abnormal implantation of the placenta. Our cases revealed no significant results of maternal outcome between conservative surgery and conventional hysterectomy in managing accreta cases in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Ultrasound guided vacuum aspiration treatment of caesarean scar ectopic pregnancy

2021 ◽  
Vol 86 (3) ◽  
pp. 184-188
Author(s):  
Adrián Totka ◽  
◽  
Martin Gábor ◽  
Martin Alföldi ◽  
Ivana Kunochová ◽  
...  
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Previous Caesarean Section ◽  
Ultrasound Guided ◽  
Caesarean Scar ◽  
Vacuum Aspiration ◽  
Caesarean Scar Pregnancy ◽  
Aspiration Technique ◽  
History Of

Summary: Objective: To describe the case of ectopic pregnancy in the scar after caesarean section and its successful treatment using the technique of sonographically controlled vacuum aspiration. Case report: The case of a 35-year-old patient with a history of two caesarean sections referred by a district gynecologist in the 6th week of pregnancy with suspected pathological localization of pregnancy in a scar after a previous caesarean section. The procedure for the diagnosis and treatment of ectopic pregnancy in the scar after previous caesarean sections has been successfully resolved using sonographically controlled vaginal vacuum aspiration. Conclusion: Caesarean scar pregnancy occurs as a complication of previous caesarean section or other uterine instrumental performances. The use of the sonographically controlled vacuum aspiration technique appears to be a successful method of treating pregnancy in a scar after a caesarean section.

LAPAROSCOPIC MANAGEMENT OF AN ECTOPIC PREGNANCY IN A PREVIOUS CAESAREAN SECTION SCAR: A CASE REPORT

2021 ◽  
pp. 12-13
Author(s):  
Sonam Jadhav ◽  
Anshika Agarwal ◽  
Abhishek Mangeshkar
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Successful Treatment ◽  
Rare Case ◽  
Previous Caesarean Section ◽  
Laparoscopic Management ◽  
Caesarean Scar ◽  
Reproductive Capability ◽  
Timely Treatment

Caesarean scar ectopic is one of the rarest forms of ectopic pregnancy [3]. The diagnosis and treatment of it is challenging. It is important to diagnose the condition as early as possible in order to administer appropriate, timely treatment and to avoid complications. A rare case of laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar is reported here. Laparoscopy enabled the successful treatment of an unruptured ectopic pregnancy in a previous Caesarean scar and made it possible to preserve the patient’s reproductive capability. In this report we present a case of 30 year old gravida 2, para 1, living 1 with cesarean scar ectopic pregnancy managed laparoscopically.

scholarly journals Accuracy of Combined Measure of Serum Uric Acid and Beta Human Chorionic Gonadotropin (β hCG) Versus Serum Beta Human Chorionic Gonadotropin Alone as Prognostic Indicators of Pregnancy Outcome of Preeclampsia

2020 ◽  
pp. 1-9
Author(s):  
E. O. S. Aigere ◽  
D. O. Allagoa ◽  
E. L. Kotingo ◽  
L. Obagah ◽  
B. E. Kasia ◽  
...  
Keyword(s):  
Uric Acid ◽  
Pregnancy Outcome ◽  
Serum Uric Acid ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Prognostic Indicators ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
The Mean ◽  
Β Hcg

Background: Measurement of variety of biological, biochemical and biophysical markers in pregnancy implicated in the pathophysiology of preeclampsia have been proposed to predict its development. Aim: To evaluate the accuracy of combined measure of maternal serum uric acid level and quantitative serum beta hCG versus serum beta hCG alone as prognostic indicators of pregnancy outcome among preeclamptic patients at the Federal Medical Centre, Yenagoa. Methods: This is a hospital based prospective case control study by systematic sampling selection. The two groups comprised of 100 consecutive patients each, one with pre-eclampsia (study group) and the other without pre-eclampsia (control) admitted for management into the antenatal ward and labour ward over the seven-month period of the study. The values of their serum uric acid and beta hCG levels were evaluated on admission and followed up. Data entry and statistical analysis was done using statistical package for social science (windows version 22.0. SPSS Inc; Chicago, USA). Level of significance was set at P < 0.05. Results: The mean quantitative serum β hCG level amongst the subjects (26776.6 ± 19590.5) was statistically significantly higher (p < 0.001) than the mean quantitative serum β hCG level amongst the control (7973.6 ± 4193.7). The prognostic accuracy in predicting pregnancy outcomes were: HELLP syndrome (0.33, 0.44), Eclampsia (0.50, 0.39), Acute Renal Failure (0.44, 0.33), IUGR (0.43, 0.39), IUFD (0.38, 0.27) and Birth Asphyxia (0.49, 0.38) respectively for combined measure of serum uric acid and serum β hCG, and serum β hCG alone. Conclusion: Serum β hCG levels remains a useful prognostic indicator for feto-maternal outcome in preeclamptic women. However, combined measure of serum uric acid and serum β hCG level in prognosticating pregnancy outcome in preeclamptic women was shown to have a better accuracy than serum β hCG.  

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