scholarly journals PILOT STUDY OF LOWER UTERINE SEGMENT CESAREAN SCAR THICKNESS PREOPERATIVELY BY TRANSVAGINAL SONOGRAPHY AND ITS CORRELATION WITH INTRA-OPERATIVE FINDINGS

2021 ◽  
pp. 57-64
Author(s):  
NAVDEEP KAUR ◽  
MANJIT MOHI ◽  
SARABJIT KAUR ◽  
SARYU GUPTA
Keyword(s):  
Pilot Study ◽  
Cesarean Section ◽  
Lower Uterine Segment ◽  
Transvaginal Sonography ◽  
Characteristic Analysis ◽  
Research Committee ◽  
Cesarean Scar ◽  
Medical College ◽  
Trial Of Labor ◽  
Operative Findings

Objectives: Cesarean section rates are increasing with a decrease in the rate of trial of labor after first cesarean section. Proper assessment of uterus especially scar of the previous lower segment cesarean sections (LSCS) in pregnant females is the key stone for the successful vaginal birth after cesarean section. The objective of this pilot study was to evaluate LSCS scar thickness using transvaginal sonography (TVS) and to determine the correlation between TVS and intraoperatively measured lower uterine segment cesarean scar thickness. Methods: This prospective observational analytic pilot study was carried out jointly by the Departments of Obstetrics and Gynaecology and Radiodiagnosis, Government Medical College and Rajindra Hospital, Patiala after due ethical and research committee approval. 100 women at term with history of previous LSCS and who were scheduled for elective LSCS were recruited for the study after taking the informed consent. Pre-operative scar measurement as on TVS was compared with and analyzed with intraoperative (I/o) scar measurements taken by Calipers. Results: The cutoff value for TVS readings was found to be ≤2.5 mm using receiver operating characteristic analysis. It has significant correlation with I/o scar measurements. It also has a significant relationship with age, pre-pregnancy overweight, number of the previous LSCS, and gestational age. Conclusion: Assessment of the scar integrity and quality by TVS will be helpful in selecting candidates for trial of labor with an optimally informed decision but still a number of studies have to be done to develop a robust scoring system.

scholarly journals Status of Scar in Repeat Cesarean Section in a Tertiary Hospital

2016 ◽  
Vol 4 (1) ◽  
pp. 42
Author(s):  
Subha Shrestha ◽  
Raju Shakya ◽  
Buddhi Kumar Shrestha ◽  
Narinder Kaur ◽  
Babita Thapa
Keyword(s):  
Cesarean Section ◽  
Placenta Previa ◽  
College Teaching ◽  
Tertiary Hospital ◽  
Cesarean Scar ◽  
Medical College ◽  
Trial Of Labor ◽  
The Status ◽  
Repeat Cesarean Section ◽  
Scarred Uterus

Introduction: In modern Obstetrics, with rising trends of primary Cesarean section (CS) for fetal and maternal interests, pregnancy over the scarred uterus is a challenge to all treating obstetricians. How better the cesarean scar is sutured, its exact fate in next pregnancy is still not measurable. Objective of this study was to evaluate the status of previous cesarean scar during repeat cesarean section (RCS) and calculate the maternal morbidity in those cases in a tertiary hospital.   Methods: It was a descriptive, retrospective study conducted at department of Obstetrics of Lumbini Medical College Teaching Hospital. The study was conducted from 15th July 2014 to 14th July 2015. The data were retrieved from the department of Medical Records. Women undergoing RCS were enrolled. The status of scar was evaluated in terms of intact scar, scar rupture, scar dehiscence, thin lower uterine segment, scar placenta previa, and adhesions as indicator of scar integrity.   Results: There were 534 (25.4%) CS among 2,098 deliveries during the study period. Ninety one (17.04%) of them were RCS. Elective RCS were 73.6% (n=67), and emergency RCS were 26.4% (n=24). Eighty two (90.1%) women had RCS once and 9 (9.9%) had RCS for second time. Scar was intact in 22 (91.6%), scar dehiscence in 1 (8.3%), scar with adhesions in 1 (8.3%) among  emergency RCS and intact in 53 (91.3%) and scar with adhesions in 5 (8.7%) among elective RCS. Among nine women of two RCS, three (37.5%) had thin scar, five (62.5%) had well formed scar,  seven (87.5%) had intact scar, and one (12.5%) had scar with adhesion. There was no scar dehiscence and no scar rupture in two RCS women.  Adhesions were documented twice higher in women whose primary CS was undertaken outside our hospital. Placenta previa and placenta accreta each were found in two cases.   Conclusion: Most of the scars of repeat Cesarean section were healthy with no scar rupture. We can consider trial of labor for scarred uterus with strict vigilance and in need,  CS is always at option.

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

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

scholarly journals Uterine Isthmocele (Niche after Cesarean Section)

2019 ◽  
Vol I (1) ◽  
pp. 13-16
Author(s):  
: Mohamed Nabih EL-Gharib
Keyword(s):  
Cesarean Section ◽  
Gold Standard ◽  
Standard Treatment ◽  
Magnetic Resonance Tomography ◽  
Transvaginal Sonography ◽  
Vaginal Repair ◽  
Cesarean Scar ◽  
Irregular Menses ◽  
No Gold Standard ◽  
Prior Cesarean Section

An isthmocele, also called a niche, cesarean scar defect, or cesarean scar dehiscence is a pouchlike defect of the anterior uterine isthmus at the site of a prior cesarean section. Its occurrence has been increased in the last years secondary to the increased incidence of cesarean section. Many patients with isthmocele are asymptomatic. The most frequent complaint relates to intermittent postmenstrual bleeding as the isthmocele functions as a reservoir collecting blood during menstruation, with irregular menses that can run for 2 to 12-days. Various sources have described isthmocele as a case of infertility, pain and dysmenorrhea. An isthmocele is typically diagnosed on transvaginal sonography, hysterosalpingography and hysteroscopy. Magnetic resonance tomography is useful to measure the thickness of the lower uterine segment, the profundity of the isthmocele. The treatment of isthmocele includes laparotomy, laparoscopy, hysteroscopy, vaginal repair, and several combined techniques with no statistically superior outcome noted in the literature. In that respect is no gold standard treatment for isthmocele.

Re: Predicting successful vaginal birth after Cesarean section using a model based on Cesarean scar features examined using transvaginal sonography

2013 ◽  
Vol 42 (1) ◽  
pp. 122-123
Author(s):  
E. N. C. Schoorel ◽  
S. M. J. van Kuijk ◽  
J. G. Nijhuis ◽  
L. J. M. Smits ◽  
H. C. J. Scheepers ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Birth ◽  
Transvaginal Sonography ◽  
Vaginal Birth After Cesarean ◽  
Cesarean Scar ◽  
Model Based

scholarly journals Classical Cesarean Section

2020 ◽  
Vol 06 (S 02) ◽  
pp. S98-S103
Author(s):  
Amano Kan
Keyword(s):  
Cesarean Section ◽  
Uterine Rupture ◽  
Preterm Labor ◽  
Placenta Previa ◽  
Subsequent Pregnancy ◽  
Lower Uterine Segment ◽  
Transverse Incision ◽  
Dense Adhesion ◽  
Trial Of Labor ◽  
Vertical Incision

AbstractCesarean section is the most common surgery in obstetrics. Several techniques are proposed according to the indication and the degree of urgency. Usually laparotomy followed by hysterotomy with a low transverse incision is preferable. However, in cases in which it is difficult to access the lower uterine segment, such as that in preterm labor, dense adhesion, placenta previa/accrete a vertical hysterotomy (classical cesarean section) may be needed. Although a smooth and gentle delivery of the fetus is possible through the vertical incision, uterine closure is technically difficult. To decrease the risks of hemorrhage and adhesion, a speedy and skillful technique is mandatory. The most serious risk of vertical incision in the contractile corpus is uterine rupture in the subsequent pregnancy. Therefore, cases of prior classical cesarean section are contraindicated for trial of labor after cesarean section.

scholarly journals Niche After Cesarean Section

2019 ◽  
pp. 19-25
Author(s):  
Mohamed Nabih EL-Gharib
Keyword(s):  
Cesarean Section ◽  
Gold Standard ◽  
Standard Treatment ◽  
Magnetic Resonance Tomography ◽  
Transvaginal Sonography ◽  
Vaginal Repair ◽  
Cesarean Scar ◽  
Irregular Menses ◽  
No Gold Standard ◽  
Prior Cesarean Section

A uterine niche, also calld cesarean scar defect, or cesarean scar dehiscence, uterine diverticulum, uterine sacculation or isthmocele. It is a man made pouchlike defect of the anterior uterine isthmus occurs at the site of a prior cesarean section. Its occurrence has been increased in the last years secondary to the increased incidence of cesarean section. Many patients with isthmocele are asymptomatic. The most frequent complaint relates to intermittent postmenstrual bleeding as the isthmocele functions as a reservoir collecting blood during menstruation, with irregular menses that can run for 2 to 12 days. Various sources have described isthmocele as a case of infertility, pain and dysmenorrhea. An isthmocele is typically diagnosed on transvaginal sonography, hysterosalpinography and hysteroscopy. Magnetic resonance tomography is useful to measure the thickness of the lower uterine segment, the profundity of the isthmocele. The treatment of isthmocele includes laparotomy, laparoscopy, hysteroscopy, vaginal repair, and several combined techniques with no statistically superior outcome noted in the literature. In that respect is no gold standard treatment for isthmocele.

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