EVALUATION OF CESAREAN SECTION SCAR USING MATERNAL SERUM LEVEL OF CREATINE KINASE ISOENZYME (CK-MB) PRIOR TO DELIVERY

Abstract

Aim: This study aimed to evaluate cesarean scar by using maternal serum creatine kinase isoenzyme (CK-MB) prior to delivery as a soft marker to detect CS complications (uterine rapture, dehiscence).Material and Methods: It was a prospective study carried out at Alzahraa University Hospital where 90 pregnant women divided into two groups : group A included 60 women with previous cesarean section. They were subdivided into 2 subgroups : group (A1) 19 patients who included cases with emergency cesarean delivery and group (A2) 41 patients which included cases with elective cesarean delivery. Group B includced the control group which included 30 patients with planned normal vaginal deliveries. Before delivery blood sample were collected from both groups before cesarean delivery and during normal vaginal delivery. The plasma (heparinized/EDTA) was collected from our 90 subject. Total CK, CK-MB level analyses were done by immuno-inhibition method using auto- analyzer. The normal values of CK total (24-170 U/L) and CKMB (0-25U/L).Results: Twenty patients had scar abnormality (defect=4,thin=16) and remaining forty cases had intact scar these patients had elevated levels of CKMB with sensitivity, specificity, PPV and NPV for thin scar 100%, 84.09%, 69.6% and 100%, respectively, and sensitivity, specificity, PPV and NPV for rapture scar 100%,78%,38.9% and 100%, respectively.Conclusion: CKMB can be used as a soft marker beside other methods for detection of cesarean scar abnormality (uterine rapture , dehiscence ) prior to delivery with high sensitivity and specificity.