What are the risk factors for unsuccessful surgery in hysteroscopic isthmocele resection?

Outcome of multiple cesarean sections in a tertiary maternity hospital in the United Arab Emirates: A retrospective analysis

Cesarean-induced niche can cause symptoms such as abnormal postmenstrual bleeding, pain, and associated infertility. Although hysteroscopic niche resection is generally considered an effective treatment to control abnormal uterine bleeding, the impact of surgical resection on fertility outcomes is still uncertain. In the present study, we aimed to evaluate the fertility outcomes of symptomatic patients following hysteroscopic niche resection. The design in this retrospective cohort study is Canadian Task Force classification II-2 and it is carried out in a tertiary medical center (Tel-Hashomer) and a private medical center (Herzliya), both in Israel. We included all patients who underwent a niche resection between 2011 and 2015 following at least one year of infertility. From 2011 to 2015, 39 patients with a symptomatic niche and secondary infertility were treated by hysteroscopic niche resection. The patients’ mean age was 37.2 (34–41) years, mean number of gestations was 7.04 (1–16), and mean parity 5.1 (1–14). The mean number of previous cesarean sections was 3.4 (1–6). Before the surgery, 32 patients attempted and failed to conceive spontaneously and seven patients underwent in vitro fertilization (IVF) treatment and failed. One year after the hysteroscopic resection, 18 patients conceived (14 spontaneously and four following IVF), leading to a cumulative pregnancy rate of 46.15%. Among the patients who failed to conceive after at least two IVF cycles prior to the hysteroscopic resection, 42.8% conceived following surgery (three patients out of seven). Hysteroscopic niche resection should be considered an effective treatment in patients suffering from secondary infertility.PrécisHysteroscopic niche resection is a safe option for patients with symptomatic secondary infertility, resulting in acceptable fertility rates.

A higher incidence rate of nocturia in patients with obstructive sleep apnea (OSA) has been observed. We investigated the differences in clinical examinations between OSA patients with and without nocturia, and further compared those with successful and unsuccessful uvulopalatopharyngoplasty (UPPP). This retrospective study enrolled 103 patients with OSA undergoing UPPP. Patients were diagnosed with OSA by following the 2018 American Academy of Sleep Medicine (AASM) Scoring Manual Version 2.5. Patients were divided into two groups depending on if they urinated more than twice per night. The medical data of body mass index (BMI), nocturia frequency per night, apnea–hypopnea index (AHI), Epworth Sleepiness Scale (ESS), International Prostatic Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS) were analyzed before and after uvulopalatopharyngoplasty (UPPP) surgery. All of the measurements were compared between successful and unsuccessful surgery in the non-nocturia or nocturia groups, respectively. Fifty patients (41 males and nine females) without nocturia were assigned to group 1, and 53 patients (43 males and 10 females) with nocturia were assigned to group 2. Nocturia frequency and post-surgery AHI in group 2 were significantly higher than those in group 1 (p < 0.05). Significant decreases in IPSS and OABSS were observed in the successful surgery subgroup of group 2 (p < 0.05). A significant decrease in post-surgery AHI was observed between unsuccessful and successful surgery in patients with nocturia (p < 0.05), but not in the non-nocturia group (p > 0.05). Although AHI had a significant correlation to nocturia frequency in all OSA patients before UPPP, no significant correlation between AHI reduction and nocturia frequency was found. UPPP appeared to be an effective treatment for nocturia associated with OSA. OSA should be taken into consideration for patients who complain of nocturia syndrome. The relationship of AHI reduction and nocturia improvement after OSA treatment with UPPP is still unclear. In addition, it is necessary to establish the existence of nocturia in patients with OSA, as a result of its high prevalence in OSA patients. UPPP could reduce the symptoms of OSA and could also contribute to a reduction of nocturia even in the unsuccessful surgery group.

Background The present study aims to determine the influence of the number of previous cesarean section (CS) on the lower uterine segment (LUS). Patients and methods The study included 200 pregnant women divided equally into four groups: group I included 50 women with one previous CS, group II included 50 women with two previous CS, group III included 50 women with three previous CS, and group IV included 50 women with no previous uterine operation as a control group. The women studied were subjected to the following: a careful assessment of history, a thorough clinical and obstetrical examination, and ultrasonographic assessment of the LUS below, at, and above the CS scar to evaluate thickness. Results The results showed that women with previous CSs have significantly thinner LUS compared with the group of pregnant women without scars. With increasing numbers of previous CSs, the LUS thickness decreases, but the difference is not statistically significant. Conclusion Women with more CR had thinner LUS scars and more scar defects.

The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complication development. The research was conducted at the Clinic of Gynecology and Obstetrics in Nis covering 10-year-period (from 1995 to 2005) with 32358 deliveries, 1280 deliveries after a previous cesarean section, 131 cases of placenta previa and 118 cases of placental abruption. The experimental groups was presented by the cases of placenta previa or placental abruption with prior cesarean section in obstetrics history, opposite to the control group having the same conditions but without a cesarean section in medical history. The incidence of placenta previa in the control group was 0.33%, opposite to the 1.86% incidence after one cesarean section (p<0.001), 5.49% after two cesarean sections and as high as 14.28% after three cesarean sections in obstetric history. Placental abruption was recorded as placental complication in 0.33% pregnancies in the control group, while its incidence was 1.02% after one cesarean section (p<0.001) and 2.02% in the group with two previous cesarean sections. The difference in the incidence of intrapartal hysterectomy between the group with prior cesarean section (0.86%) and without it (0.006%) shows a high statistical significance (p<0.001). The previous cesarean section is an important risk factor for the development of placental complications.

Introduction. The literature suggests that the mode and timing of delivery have a greater impact on adverse neonatal outcomes than the number of previous cesarean sections. Materials and methods. A retrospective observational case-control study was carried out. The study included 352 pregnant women with a singleton pregnancy and at least one previous cesarean section: 177 pregnant women with two or more previous cesarean sections (experimental group) and 175 with a primary cesarean section (control group). Excel tables were used to organize the data. For comparing categorical variables in groups, the χ² test was used. A p &lt; 0.05 was considered statistically significant. Results. Termination of the pregnancy by cesarean section at 39 + 0 – 39 + 6 weeks of gestation (56.5% and 27.4%, respectively; p &lt; 0.001) was statistically significantly more frequent in the experimental group. Analysis of deliveries revealed that emergency cesarean sections in pregnancy (18.9% and 9.0%, respectively; p &lt; 0.01) and emergency cesarean sections during labor (60.6% and 30.5%, respectively; p &lt; 0.001) were performed statistically significantly more frequently in the control group. Planned cesarean sections during pregnancy (60.5% and 20.6%, respectively; p &lt; 0.001) were performed statistically significantly more frequently in the experimental group. The rate of full-term neonates was statistically significantly higher in women from the experimental group (96.6% and 83.4%, respectively; p &lt; 0.001), and the rate of post-term neonates was statistically significantly higher in women from the control group (12.0%; p &lt; 0.001). The Apgar score values 1 minute after birth equal to 8–10 points (130 – 84.4% and 10 – 47.6%, respectively; p &lt; 0.001) were statistically significantly more frequent in pregnant women without acute fetal distress during labor, and the Apgar score values 1 minute after birth equal to 1–7 points (11 – 52.4% and 24 – 15.6%, respectively; p &lt; 0.001) were statistically significantly more frequent in pregnant women with acute fetal distress during labor. Similar results were found in the Apgar score at 5 minutes after birth. Conclusions. In our research, it was demonstrated that the mode and timing of delivery have a greater impact on adverse neonatal outcomes than the number of previous cesarean sections.

Multiple repeat caesarean section: is it safe?

Total Laparoscopic Hysterectomy in Women with Previous Cesarean Sections

Objective: Our purpose was to determine the relationship between previous caesarean section and subsequent development of placenta praevia and placenta praevia with accreta. Method: A retrospective review of the case records of all women delivered with the diagnosis of placenta praevia during the 2-year period from January 1, 1995, to December 31, 1996, at the tertiary referral centre, Princess Badeea Teaching Hospital, in north Jordan. Results: There were 18,651 deliveries in the study period. 65 (0.35%) had placenta praevia, 21 (32.3%) of whom had a history of previous caesarean section. The incidence of placenta praevia was significantly increased in those with a previous caesarean section (1.87%) compared with those with an unscarred uterus (0.25%); p < 0.0001). This risk increased as the number of previous caesarean sections increased: 1.78% for one previous section; 2.4% for two, and 2.8% for three or more. The incidence of anterior placenta praevia and placenta accreta was significantly increased in those with previous caesarean scars. In the group without antecedent of caesarean section, accretism risk was 9%, with one section or more 40.8% (p < 0.005). Conclusion: There is a high association between anterior placenta praevia, placenta accreta and previous caesarean section. This was enhanced with the increasing number of previous caesarean sections. Patients with an antepartum diagnosis of placenta praevia who have had a previous caesarean section should be considered at high risk of developing placenta praevia and accreta.

In patients with primary hyperparathyroidism, complete surgical resection of all hyperfunctioning parathyroid tissue is essential. The aim of this study was to evaluate the success rates of minimally invasive parathyroidectomies for primary hyperparathyroidism performed after localization studies with 99mTc-sestamibi (MIBI) scintigraphy and neck ultrasonography (USG). And also, we aimed to determine the factors affecting the success rate in surgery. Retrospective analysis of 58 consecutive patients with a diagnosis of primary hyperparathyroidism who underwent parathyroidectomy between January 2018 and December 2021 in our institution. The patients were evaluated according to Miami criteria and divided into two groups as successful or unsuccessful surgery. Demographic and clinical characteristics of the patients were obtained from hospital records. Surgical success was achieved in 50 (86.2%) of the 58 patients included in the study. In both groups, neck USG and MIBI scintigraphy showed the same localization for the lesion in a correlated manner. The clinical complaints of the patients, preoperative PTH, Ca and 24-hour urinary Ca levels were similar in both groups. In 10 (17.2%) patients, inconsistency in localization was found between USG and MIBI scintigraphy, and surgical failure was found in 4 (40%) of these patients. Surgical failure was statistically significant in patients with inconsistency in localization between USG and MIBI scintigraphy. The sono-scintigraphic scan concordance increases surgical success rates in cases where minimally invasive parathyroid surgery is planned. If there is an inconsistency between USG and MIBI, preoperative four dimentional computed tomography, intraoperative rapid PTH, gamma probe or frozen method can be used. It should be kept in mind that multiple gland pathologies may be more common in addition to solitary adenoma in lesions smaller than 1 cm in USG. In addition, in these cases, as the diagnostic value of scintigraphy is low, surgical success will also decrease.

The aim of this study was to assess the influence of the cesarean section scars on the mean pulsatility index (PI) of the uterine artery Doppler between 20 and 34 weeks of gestation. A secondary objective was to assess the association between previous cesarean section and adverse maternal/perinatal outcomes. A retrospective cohort study was conducted with pregnant women who had their deliveries between March 2014 and February 2023. PI of the uterine arteries Doppler was performed transvaginally between 20-24 weeks and transabdominally between 28-34 weeks. The following variables were considered adverse perinatal outcomes: birth weight <10th percentile for gestational age, preeclampsia, premature birth, placental abruption, perinatal death, postpartum hemorrhage, neonatal intensive care unit (NICU) admission. A total of 479 pregnant women were included in the final statistical analysis, being that 70.6% (338/479) had no (Group I) and 29.4% (141/479) had at least one previous cesarean section (Group II). Pregnant women with a previous cesarean had higher median of mean PI (1.06 vs. 0.97, p=0.044) and median MoM of mean PI uterine arteries Doppler (1.06 vs. 0.98, p=0.037) than pregnant women without previous cesarean section at ultrasound 20-24 weeks. Pregnant women with a previous cesarean section had higher median of mean PI (0.77 vs. 0.70, p<0.001) and mean MoM PI uterine arteries Doppler (1.08 vs. 0.99, p<0.001) than pregnant women without previous cesarean section at ultrasound 28-34 weeks. Pregnant women with ≥2 previous cesarean sections had a higher median of mean PI uterine arteries Doppler than those with no previous cesarean sections (1.19 vs. 0.97, p=0.036). Group II had a lower risk of postpartum hemorrhage (aPR 0.31, 95% CI 0.13-0.75, p=0.009) and composite neonatal outcome (aPR 0.66, 95% CI 0.49-0.88, p=0.006). Group II had a higher risk of APGAR score at the 5th minute <7 (aPR 0.75, 95% CI 1.49-51.29, p=0.016). The number of previous cesarean sections had a significant influence on the mean PI uterine arteries Doppler between 20-24 and 28-34 weeks of gestation. Previous cesarean section was an independent predictor of postpartum hemorrhage and APGAR score at the 5th minute <7. Pregnancy-associated arterial hypertension and number of previous deliveries influenced the risk of composite neonatal outcome, but not the presence of previous cesarean section alone.

One or multiple previous cesarean sections are associated with similar increased frequency of placenta previa

To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS). In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I-IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I-IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I-IV). Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value=0.000 each). However, the number of previous CS (p=0.440) and inter-delivery interval (p=0.062) had no statistically significant correlation with thickness of LUS. Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.

Introduction: Most of the patients with previous caesarean section undergo repeat caesarean section therefore previous cesarean section tends to make potential obstetric procedures at high risk and hence such women represent a high risk group in obstetrics. Aim: To analyse peroperative findings in pregnant women who are undergoing repeat cesarean section, to study the surgical difficulties being encountered in such women with previous cesarean section. Material and methods: This study was an observational study, conducted in the Department of obstetrics and gynaecology. We included a total of 100 cases of repeat cesarean section. We requested the operating surgeons to record all the difficulties they faced while operating a case of previous cesarean section. All the information that was recorded included maternal age, parity, number of previous cesarean section, type of cesarean section, type of abdominal and uterine incision and post-operative complications. Approximate blood loss was appreciated by soaked sponges and amount in suction jar. Results: The most frequent indication for performing a repeat cesarean section was fetal distress 28%, highest number 62% of patients were gravida 2, Estimated blood loss of < 500 ml in 69% cases and Blood transfusion was required in 12% of our cases, Pfannensteil skin incision was the most frequent skin incision given in 86% cases and most common type of adhesion was loose adhesion bladder to uterus in 32% cases. Conclusion: Thus in conclusion we can say that previous cesarean section should be considered important and the women and her family members should be educated about the need of routine antenatal care, and should decide wisely the mode of delivery for the well being of both mother and child and to prevent complications.

Factors Associated With Lower Uterine Segment Thickness Near Term in Women With Previous Caesarean Section