A comparative study of fetal malpresentations in scarred and unscarred uteri

Abstract

Background: Malpresentations and malpositions as such are associated with increased incidence of adverse feto-maternal outcomes when compared to cephalic vertex presentations. Scarred uterus predisposes to malpresentations per se, adding accelerated morbidity and mortality to the fetus and the mother. When compared with general incidence of malpresentations, h/o caesarian section is observed to increased incidence of malpresentations leading to an added indication for caesarian section Objective: To evaluate incidence of the fetal mal presentations in Scarred and Unscarred Uteri and scarred uterus as an etiological factor for malpresentation leading to adverse feto-maternal out come Methods:- 300 cases taken up for Cesarean section with history of previous one/two Caesarean sections and 300 cases of primary caesarian sections with singleton pregnancy with 37 completed weeks of gestation are selected at random during the same period the criteria noted-Age, Parity, Scarred/Unscarred uteri, type of presentation, mode of delivery ,Intra and post operative events and fetal outcome. Results: High incidence of malpresentations, more elective surgeries, and more intra operative complications including hemorrhage and placenta previa are noted in scarred uteri. Conclusion: In this present study, previous scarred uterus is seen as an etiological factor for malpresentations worsening the prognosis of malpresentation further with added difficulty in delivery, scar extensions, intra operative hemorrhage and bladder trauma. Scarred uterus is an etiological factor for malpresentations and increased morbidity and mortality for both mother baby fetal outcomes is almost the same in both groups.