Optimizing pre-pregnancy management of patients with post-cesarean section uterine scar

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.

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CLINICAL, ECHOGRAPHIC, MORPHOLOGICAL AND IMMUNOLOGICAL CRITERIA FOR EVALUATING A WELL-FOUNDED SCAR ON THE UTERUS AFTER CESAREAN SECTION

UZBEK MEDICAL JOURNAL ◽

10.26739/2181-0664-2021-si-1-10 ◽

2021 ◽

Vol Special issue (1) ◽

pp. 57-61

Author(s):

Venera Kurbaniyazova ◽

Keyword(s):

Correlation Analysis ◽

Cesarean Section ◽

Correlation Coefficient ◽

Significant Relationship ◽

Strong Correlation ◽

Type I Collagen ◽

Morphological Features ◽

Average Degree ◽

Type I ◽

Uterine Scar

The results of the conducted studies 102 of the manufacturer testify to the presence of essential clinical and echographic, immunological and morphological features of the "wealthy" or "insolvent" scar on the uterus after the cesarean section. The correlation analysis with the calculation of the Correlation coefficient of Gamma (G) indicates a statistically significant relationship between the average degree between the way of the delivery and the scar thickness (G = 0.55, p = 0.001), strong correlation between the ultrasound data (G = 0.74 , p = 0.002) and antibodies to type I collagen (G = 0.93, p = 0.003). Determining the level of antibodies to the type I collagen is the mostimportant criterion confirming the usefulness of the scar on the uterus.Keywords: cesarean section, uterine scar, pregnancy

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Vernix Caseosa Peritonitis after Vaginal Delivery

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s12771 ◽

2013 ◽

Vol 6 ◽

pp. CCRep.S12771 ◽

Cited By ~ 2

Author(s):

Shameema A. Sadath ◽

Fathiya I. Abo Diba ◽

Surendra Nayak ◽

Iman Al Shamali ◽

Michael F. Diejomaoh

Keyword(s):

Cesarean Section ◽

Acute Abdomen ◽

Vaginal Delivery ◽

Vacuum Extraction ◽

Unusual Complication ◽

Case Presentation ◽

Vernix Caseosa ◽

First Case ◽

Surgical Emergencies ◽

Uterine Scar

Introduction Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Twenty-seven cases have been reported, and all occurred after cesarean section. Case presentation We present a case of VCP following vaginal delivery; this may be the first case reported after vaginal delivery. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP. Conclusion Clinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.

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ULTRASOUND PREDICTABILITY OF LOWER UTERINE SEGMENT CESAREAN SECTION SCAR THICKNESS

10.36106/ijsr/3520656 ◽

2020 ◽

pp. 9-11

Author(s):

Madhu Kumari ◽

Kumari Bibha ◽

Abha Sinha ◽

Debarshi Jana

Keyword(s):

Cesarean Section ◽

Gestational Age ◽

Statistical Significance ◽

P Value ◽

Chi Square ◽

Medical College ◽

Chi Square Test ◽

Uterine Scar ◽

Age Range ◽

The Given

Objective: The objective of this study is to find out association between scar thickness, assessed sonographically, and intraoperative findings (IOF). Study Design: Descriptive study. Place and Duration of Study: Department of Obstetrics and Gynecology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from June 2019 to May 2020. Methodology: A total of 70 pregnant patients were included in this study. Transabdominal ultrasound was done for scarred uteri. Sonographic findings were co-related with introperative findings. All the given data were entered on SPSS version 23. Age was expressed as mean ± SD. Parity, gestational age, and interval between cesarean sections were expressed as frequencies with percentages. Statistical analysis was done by using Chi-square test for categorical data for association between sonographic scar thickness and intraoperative findings. The statistical significance was set at p-value <0.05. Results: The age range of the patients was 20- 36 years with a mean of 27.91 ±3.690 years. Gestational age at the time of cesarean section was between 27-40 weeks of gestation with a mean of 37 ±2.126 weeks. The interval from previous cesarean was 10 months at the minimum, and 6 years at the maximum with a mean of 2.29 ±1.0 months. Mean scar thickness was 2.5 mm. Association between scar thickness (<1-3 mm) and intaoperative findings of dehiscence and rupture showed a p-value of <0.001. Conclusion: Sonographic assessment of a uterine scar has a practical application to determine the thickness of previous scar, and assess its integrity.

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The Effect of Single-Layer or Double-Layer Closure of the Uterine Incision at Cesarean Section on Uterine Scar Formation

İstanbul Kanuni Sultan Süleyman Tıp Dergisi ◽

10.5222/iksst.2018.029 ◽

2017 ◽

Author(s):

Firdevs Şekerci Baran ◽

Muhittin Eftal Avcı ◽

Ahmet Yiğit Çakıroğlu ◽

Aydın Çorakçı

Keyword(s):

Cesarean Section ◽

Double Layer ◽

Single Layer ◽

Scar Formation ◽

Uterine Incision ◽

Uterine Scar

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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

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Caesarean section at Koudougou regional hospital centre: indications and prognosis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205211 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4792

Author(s):

Djiguemde Nebnomyidboumbou Norbert Wenceslas ◽

Lankaonde Martin ◽

Savadogo-Komboigo B. Eveline ◽

S. I. B. Sansan Rodrigue ◽

Ouedraogo Wendlassida Estelle ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Caesarean Section Rate ◽

Cross Sectional Study ◽

Cross Sectional ◽

Important Place ◽

History Of ◽

Group 3 ◽

Group 5 ◽

Uterine Scar

Background: Objective was to study the indications and the prognosis of cesarean section in the obstetrics and gynecology department of CHR Koudougou from August 1st to October 16th 2018.Methods: This was a cross-sectional study for descriptive purposes with prospective collection of data over the month and monitoring of parturients up to the 42nd day post caesarean section. The study covered the period from August 1 to October 16, 2018. Gestures received in the work room and those hospitalized for a scheduled cesarean were involved in this study.Results: This study involved 316 deliveries. The caesarean section rate was 34.8% (n=110). The average age was 26.75 years with extremes of 12 and 42 years. Term pregnancies represented 90.9%. History of cesarean section was observed in 47, 3%. The main groups contributing to the caesarean section rate represent: Groups 5 (9.5%), Group 1 (9.2%), Group 3 (5.1%), the scar uterus (17.3%) and suffering fetal (14.6%). The reported complications were 15.5% including 3.6% parietal suppuration and 0.8% stillbirth.Conclusions: The caesarean section occupies an important place in the maternity service of the RHC of Koudougou. Robson's group 5 was the largest contributor to the overall cesarean rate in our study. Measures should be taken in this group so that the uterine scar does not become an absolute indication for cesarean.

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

10.21516/2413-1458-2020-19-4-336-342 ◽

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.

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