Cesarean Section Scar Research Articles

Intrauterine Bigatti Shaver (IBS ® ) successful placental remnants removal, after caesarean section for a cervical pregnancy with placenta accreta.

Placenta accreta located in a caesarean section scar is difficult to remove. The Intrauterine Bigatti Shaver (IBS®) has already been proven to be effective in placental remnant removal. Our case report highlights that the IBS® is also a safe method to remove placental remnants attached to a previous caesarean section scar performed for a cervical pregnancy and associated with placenta accreta.

Local treatment with methotrexate of cesarean scar pregnancy: A case report

Cesarean scar pregnancy, is the implantation of a gestational sac within the myometrium at the side of previous cesarean section scar, is a rare type of ectopic pregnancy. Ultrasonography is the first and most important diagnostic method of this condition. Increased suspicion with widespread use of ultrasound lead to the recognition of most cases of Cesarean scar pregnancy in early pregnancy. This allows for rapid interventions and preservation of the uterus and fertility. The use of conservative treatments, including medical treatment, especially with methotrexate, saves from surgeries such as hysterectomy and preserves women's fertility. In this study, we presented a case of cesarean scar pregnancy which was successfully treated with transvaginal ultrasound-guided injection of methotrexate.

Endometriosis arising in a cesarean section scar: A case report.

Introduction and importanceScar endometriosis is an uncommon variant of extra pelvic endometriosis, which develops at the scar site of previous abdominopelvic surgery and is seen in women during their reproductive period.Case presentationWe report a 38-year-old female who presented with a nine-months history of a painful ulcerative mass that developed on a cesarean section scar. The mass was removed by a wide excision and confirmed by histology to be endometriosis.Clinical discussionWide surgical resection of ectopic endometriosis is the treatment of choice. It is usually curative and ensures the confirmation of the diagnosis.ConclusionCesarean section scar endometriosis can undergo malignant transformation. This case highlights the need for early detection and treatment.

Bacterial colonization at caesarean section defects in women of secondary infertility: an observational study

BackgroundDelayed childbearing has been noted in a high percentage of women with a previous Caesarean section (CS). Many women with CS scar defects (CSDs) present with clinical symptoms of irregular vaginal bleeding. The present study aimed to investigate bacterial colonies at CSDs in women suffering from secondary infertility.MethodsThis observational study included 363 women with secondary infertility who visited the Assisted Reproduction Unit between 2008 and 2013. Among them, 172 women with a previous CS and 191 women with no previous CS were approached. The women with a previous CS had their CS operations in the past 1 to 14 years, with a mean of 3.5 years. The presence of CSDs was detected by vaginal ultrasonography. Bacteriology cultures of specimens taken from the uterine niches in those with CSDs were collected during Day 7 to Day 10 of the follicular phase. Specimens were obtained from the endocervical canal for bacterial culture in those without CSDs. The main outcome measure was the detection of the growth of bacterial colonies.ResultsCSDs were found in 60.4% (96 of 159) of women with a previous CS. In women with a previous CS, bacterial colonies were identified in 89.6% (86 of 96) and 69.8% (44 of 63) of women with and without CSDs, respectively. In women with no previous CS, 49.7% (88 out of 177) of bacterial cultures of endocervical samples showed bacterial colony growth. Gram-positive cocci (P = 0.0017, odds ratio (OR) = 1.576, 95% confidence intervals (CI) -22.5 to − 5.4) and Gram-negative rods (P = 0.0016, OR = 1.74, CI − 20.8 to − 5.0) were the most commonly isolated bacteria and contributed to approximately 90% of all microorganisms found in those with a previous CS. In women with a previous CS, more Gram-negative rods were isolated (P = 0.01, OR = 1.765, CI − 27.2 to − 3.8), especially Pseudomonas species (P = 0.02, OR = 1.97, CI − 16.7 to − 1.0), in those with visible CSDs than in those without CSDs.ConclusionsBacterial colonization at CSDs was found in a high percentage of women with secondary infertility.

Prevalence and determinants of ectopic pregnancy in Ethiopia: Systematic review and meta-analysis

Background: Ectopic pregnancy is a life-threatening obstetric emergency, and is a major health problem for women of fertile age. Therefore, the aim of this systematic review and meta-analysis was to estimate the prevalence, determinant factors, and outcomes of ectopic pregnancy among fertile age women in Ethiopia. Method: International databases (MEDLINE/Pub Med, Hinari, Scopus, Google scholar, African journals, and literatures were searched and nine eligible cross sectional and two case control studies were included in this systematic review and meta-analysis. Eggers test and funnel plot were computed to check publication bias across the studies. Publication bias was computed using a funnel plot and eggers test. Heterogeneity of the studies was checked using Cochrane Q-test and I2 statistic. Results: The pooled prevalence of ectopic pregnancy in Ethiopia was 3.61% (95%CI: 2.24–4.98, I2 = 89.2.0%, p < 0.001). Having cesarean section scar (AOR = 7.44, 95%CI: 5.48–10.09), single marital status (AOR = 5.71, 95%CI: 4.76–6.85), history of sexually transmitted infection (AOR = 4.68, 95%CI: 3.04–7.19), history of abortion (AOR = 3.89, 95%CI: 3.35–4.52), history of ectopic pregnancy (AOR = 5.74, 95%CI: 3.81–8.65), and emergency contraceptive use (AOR = 8.72, 95%CI: 2.90–26.20) were the determinant factors for the occurrence of ectopic pregnancy. Conclusion: This systematic review and meta-analysis showed that the prevalence of ectopic pregnancy was high in Ethiopia. Thus, educating women to limit the number of sexual partners, smoking cessation, using a condom during sex helps prevent sexually transmitted infections and the risk of pelvic inflammatory disease is crucial.

Bullous Pyoderma Gangrenosum Occurring on a Cesarean Section Scar.

Bullous Pyoderma Gangrenosum Occurring on a Cesarean Section Scar.

Two Dimensional and Color Doppler Ultrasound Scoring in Evaluation of Anterior Low Lying Placenta and its Adherence to Previous One Cesarean Section Scar inthe Third Trimester

Two Dimensional and Color Doppler Ultrasound Scoring in Evaluation of Anterior Low Lying Placenta and its Adherence to Previous One Cesarean Section Scar inthe Third Trimester

Complete Uterine Rupture a Stigma for Modern Obstetrics: An Observational Study

Aims:: To know the maternal and perinatal outcome in women with complete uterine rupture. Background: Uterine rupture is a catastrophic obstetric event associated with high maternal, perinatal morbidity, and mortality. Objective: The present study was conducted to know prevalence, risk factors, presentation, the maternal, perinatal outcome in women with complete uterine rupture. Methods:: Present retrospective observational study was conducted on 31 women admitted to the Obstetrics ward of the rural tertiary center of Northern India with complete uterine rupture between January 2016 and December 2018 after Institutional ethical committee approval and informed written consent from participants. Data included socio-demographic parameters, gestation, predisposing factors, clinical features, site of rupture, associated bladder injury, need for hysterectomy, perinatal, and maternal outcome. Statistical analysis was conducted using Statistical Package for the Social Sciences software version 22.0. Results:: Of the total of 9,156 deliveries during the study period, 31 women had a uterine rupture, indicating the prevalence of 0.34%. Of all 21(67.7%) women had an unscarred uterine rupture, and 10(32.3%) scarred uterine rupture. The majority cases were un-booked (77.4%), multiparous (90.3%), and term at gestation (66.7%), with an average age of all cases as 26.97±3.73 years. The most common risk factor was injudicious use of oxytocic (29.0%) and previous cesarean section scar (22.6%). The most common site of unscarred uterine rupture was the lower uterine segment (26.7%) and in the scarred uterus, the site of previous cesarean section (26.7%). Eight (25.8%) women had bladder injury. Total 24 (77.4%) fetuses were stillborn. Seventeen (54.8%) women needed hysterectomy as a lifesaving procedure, and three (9.7%) succumbed to death despite all resuscitative measures. Conclusion:: Hence, complete uterine rupture is common in rural areas and is serious obstetric emergency with high perinatal, maternal morbidity and mortality. Other: As most of the cases of complete uterine rupture occur in unbooked women, hence, motivating all antenatal women for regular antenatal visits can prevent the dreadful condition to a large extent, thereby saving many maternal and fetal lives.

Comparative characteristics of the vaginal and endometrial microbiome in patients with secondary infertility associated with a uterine scar niche after cesarean section

Aim. To compare the vaginal and endometrial microbiome in patients with cesarean scar niche (both in the presence of specific complaints of secondary infertility in combination with a niche with stagnant contents, and in the absence of such).
 Materials and methods. The prospective study included 67 female patients of reproductive age who had a uterine scar after caesarean section that met the inclusion criteria. Depending on the presence or absence of clinical complaints of secondary infertility, ultrasound and/or magnetic resonance imaging of the pelvic organs to visualize stagnant content in the projection of the niche, the patients were divided into two groups: group 1 (n=40) patients with secondary infertility in combination with stagnant contents in the projection of a niche (main group), group 2 (n=27) patients without clinical complaints, with a formed scar on the uterus, without signs of a niche (control group). All patients underwent a comparative study of the vaginal samples and the endometrial samples. The species and quantitative composition of the microbiome was analyzed using real-time polymerase chain reaction. Statistical research was carried out using the IBM SPSS Statistica v22 software (IBM Corp., USA).
 Results. Various microbiological communities were found in the analysis of samples of the vagina and endometrium in patients with stagnant content in the projection of the niche (group 1, main) and without it (group 2, control). Lactobacillus spp. was found most often in vaginal discharge samples (more than 50% of cases) both in group 1 and in group 2, however, their level was statistically significantly higher in group 2 (57.5 and 88.9%, respectively), p=0.005. When comparing endometrial samples from patients of groups 1 and 2, it was revealed that in group 1, in the presence of liquid content in the projection of a niche, opportunistic microorganisms were most often detected (more than 50% of cases): Enterobacteriaceae (65%) p0.0001, Streptococcus spp. (60%) p0.0001, Staphylococcus spp. (52.5%) p0.0001, and Gardnerella spp. (22.5%) p=0.0342 and there was a deficiency of Lactobacillus spp. (25%), on the contrary, in group 2, Lactobacillus spp. prevailed (66.7%) p=0.008. Comparative analysis of vaginal samples and endometrial samples of the niche projection in group 1 revealed the predominance (more than 50% of cases) of Lactobacillus spp. in the vagina (57.5%) p=0.003, on the contrary, in the uterine cavity there is a predominance of opportunistic microbiota, p0.001. Comparative analysis of vaginal samples and endometrial samples of the uterine cavity in group 2 revealed a statistically significant predominance of Lactobacillus spp. both in the vagina (88.9%) and in the uterine cavity (66.7%), p=0.0497. In patients with secondary infertility associated with the presence of stagnant content in the projection of the niche, compared with the control group, there was a higher alpha-diversity both in the samples of vaginal discharge (Shannon's index 2.0170.093 vs 1.0600.044; p=0.0120), and in endometrial samples (Shannon's index 3.4480.267 vs 1.0200.040, р=0.00008; Simpson's index 1.109 vs 0.003; p=0.00006). When analyzing beta-diversity, there were no statistically significant differences between groups.
 Conclusion. In the structure of the microbiome of the vagina and uterine cavity in women without scar defect on the uterus Lactobacillus spp. predominate. The presence of stagnant content in the projection of a niche is associated with an increase in the frequency and quantitative content of opportunistic microbiota of the uterine cavity, especially Enterobacteriaceae, Streptococcus spp., Staphylococcus spp., Gardnerella spp. Also, in patients with stagnant contents in the projection of the niche, a higher biodiversity was revealed both in the vaginal discharge samples and in the endometrial samples. These results highlight the importance of assessing the endometrial microbiome in women with cesarean section scar, especially those faced with the problem of secondary infertility.

Fertility-Preserving Surgical Management of a Cesarean Section Scar Ectopic Pregnancy

To demonstrate techniques used for fertility-preserving surgical management of a cesarean scar ectopic pregnancy. A narrated video case report demonstrating techniques and surgical approach. With the increasing number of cesarean deliveries being performed, cesarean scar ectopic pregnancies (CSEP) have an increasing incidence affecting approximately 1 in 2000 pregnancies. CSEP can be associated with serious complications, which include maternal hemorrhage, uterine rupture, and even maternal death. This video highlights a case presentation of a 28-year-old G6P4014 with a history of 4 previous cesarean deliveries who presented with a persistent cesarean scar ectopic pregnancy that had failed previous medical management. This video highlights the techniques that allow for fertility-preservation with restoration of normal anatomy as well as minimizing blood loss with a potentially morbid procedure. Techniques used to allow for fertility preservation with restoration of normal anatomy: 1. Utilization of avascular spaces and identification of critical structures to restore anatomy that is often distorted by the CSEP. 2. Limited use of electrosurgery to allow for adequate postoperative healing. 3. Identification of the endometrial cavity to allow for complete removal of the CSEP and isthmocele repair. Techniques used to minimize blood loss: 1. Intracervical injection of dilute vasopressin. 2. Intrauterine injection of dilute vasopressin (20U in 60 cc of injectable saline). 3. Temporary occlusion of bilateral gonadal vessels using surgical clips. The surgical techniques highlighted in this video allow for the surgical removal of a cesarean scar ectopic pregnancy with concurrent repair of the uterine defect, allowing for restoration of normal anatomy. This is a safe and feasible fertility-preserving option that can be performed using a minimally-invasive approach.

Serum β-HCG Level in Women Diagnosed as Having Retained Products Of Conception: A Prospective Cohort Study

Retained products of conception (RPOC) may occur after delivery or abortion, often necessitating operative hysteroscopy for their removal. A preoperative diagnosis of RPOC by ultrasonography is not always accurate and may lead to unnecessary surgical procedures. We sought to evaluate whether serum level of β-human chorionic gonadotropin (β-HCG) may aid in the preoperative diagnosis of RPOC. A prospective cohort study. Gynecology department in a university affiliated medical center. Women undergoing operative hysteroscopy for removal of RPOC between December 2019 and January 2021. Operative hysteroscopy for RPOC removal. Serum β-HCG levels were obtained on the day of surgery, and level ≥5.0 mIU/mL was considered positive. All operative specimens were evaluated by pathology for the presence of trophoblastic tissue. Of the 105 women recruited to the study, the operative pathology showed trophoblastic tissue in 81 cases (77.1%), and they were included in the data analysis. The β-HCG level was positive in 16 of those 81 cases (19.8%). Positive β-HCG level was significantly associated with RPOC after an abortion (surgical or medical) compared with RPOC after delivery. In addition, the mean RPOC mass was larger in the β-HCG-positive group than the β-HCG-negative group (29.1 ± 9.5 mm vs 23.8 ± 8.9 mm, respectively, p=.004), and the interval from termination of pregnancy to surgery was shorter (4.8 ± 1.7 weeks vs 7.5 ± 2.1 weeks, respectively, p <.001). Relatively high β-HCG level (352 mIU/mL and 3561 mIU/mL) were found in 2 cases in which the RPOC mass was implanted on a previous cesarean section scar. β-HCG level is noncontributory to the preoperative diagnosis of RPOC.

Impact of selected risk factors on uterine healing after cesarean section in women with single-layer uterine closure: A prospective study using two- and three-dimensional transvaginal ultrasonography.

Modern obstetrics must meet many challenges, including long-term complications resulting from the presence of a uterine niche after cesarean section. To assess the impact of selected risk factors on the uterine healing process after cesarean section. The uterus was closed with a single-layer continuous suture covering the entire thickness of the myometrium, excluding the decidua. A prospective, case-controlled study was carried out at 2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Poland. Women who delivered by cesarean section at our Department were invited to undergo an ultrasonographic assessment of the cesarean section scar from 6 to 9 weeks after the procedure. In all cases, the uterus was closed with a single-layer continuous suture. The ultrasound examination of the niche was performed according to the modified Delphi protocol. The volume of the niche was calculated and a 3D model was created. The obtained data were analyzed with clinical information from the maternal medical history and the course of the pregnancy. A total of 204 patients participated in the study. Five patients had a residual myometrial thickness (RMT) <2.2 mm and 35 had a residual myometrial thickness to adjacent myometrial thickness ratio (RMT/AMT) ≤0.5. In 45% of women, pregnancy course was complicated by gestational diabetes mellitus (GDM), gestational hypertension and hypothyroidism. The cervical canal was colonized with pathogenic flora in 22% of women. No correlation between maternal and gestational age at delivery, presence of medical complications during pregnancy, colonization of the cervical canal, and presence of niche and its parameters were found. Our study revealed that the selected risk factors, such as systemic diseases during pregnancy and in the maternal medical history, as well as the colonization of the cervical canal, have no impact on uterine scar healing in women undergoing single-layer uterine closure spanning the entire thickness of the myometrium, excluding the decidua.

Relation of Implantation Site to Placental site in Presence or Absence of Cesarean Section Scar with Doppler Assessment of Retro Chorionic Blood Flow

Background: Implantation is a complicated communication mechanism between the embryo and the endometrium that includes adhesion, nidation, and trophoblast invasion of the inside of the endometrial tissue. It is through this attachment that the fetus gets nutrients and oxygen from the mother to thrive. Aim of the Work: To determine the effect of cesarean section scar on gestational sac implantation site and its relation to future placental location (An ultrasound and retro-chorionic Doppler velocimetric study). Patients and Methods: A Prospective case-control study that include 100 pregnant women with singleton pregnancy, half of them with a history of previous CS and the other half with no history of CS was conducted from October 2020- September 2021 at El-Hussein Hospital Department of Obstetrics and Gynecology Outpatient Clinic and Inpatient. Results: Inverse correlation between GS distance from IO and implantation site, indicating low implantation site for short distance between GS to IO. Also weak inverse relation between GS distance from IO and placental location, indicating low placental location for short distance between GS to IO. Conclusion: Doppler indices but retro-chorionic Doppler was valuable in color mapping and confirmation of chorio-decidual reaction site for easy detection of early implantation site. Relation of gestational sac midpoint to uterine midpoint is a better and easy method of locating the gestational sac site than measuring distance from lower edge of gestational sac to internal OS due to different gestational sacs size. Keywords: Cesarean Section; Doppler; Retro Chorionic Blood Flow

Successful Treatment of a Cesarean Scar Ectopic Pregnancy Using a Novel Approach with Oral Mifepristone followed by Trans Cervical Suction Evacuation with Prophylactic Tranexamic Acid: A Case Report

Cesarean scar pregnancy is a rare form of ectopic pregnancy where the conceptus is implanted at the site of a previous cesarean section scar which pauses life-threatening complications if not diagnosed and managed timely. Though numerous types of treatment approaches have been described there is no consensus on the optimal treatment modality which is a challenge to clinicians. Current treatment approaches are a combination of medical and surgical interventions with varying success rates and complications.

Evaluating efficacy and safety of the topical silicone gel containing onion extract in the treatment of post-cesarean surgical scars.

Cesarean section scars are post-surgical problems in women. Many active ingredients have been found to diminish scar formation. Clinical investigations on the onion extract have gained more attention due to its properties, such as improvement of scar appearance and texture. However, published studies evaluating the usefulness of the onion extract in the treatment of scars are controversial. The three-month study period followed a prospective, randomized, and double-blinded design. Each enrolled subject's post-cesarean completely sealed wounds were divided into two halves along the closure axis. Each half was randomly assigned to the treatment with either silicone gel containing 5% onion extract or the silicone gel containing vitamin C. All subjects were respectively evaluated at the one, two, and three months of the treatment. After the three-month follow-up, there was a statistically significant difference in scar improvement between before and after treatment. None of statistically significant difference in the Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS) scores and melanin value was found between silicone gel containing 5% onion extract and the control silicone gel. However, the improvement of scar erythema by treatment with the silicone gel containing 5% onion extract was significantly greater than in the control group. No adverse effects were reported in either group.

Robotic Assisted Laparoscopic Resection of a Cesarean Section Scar Ectopic Pregnancy

Study Objective Demonstrate the removal of a cesarean section scar ectopic pregnancy performed robotically. Design Video Demonstration. Setting Operating Room. Patients or Participants One. Interventions Uterine artery embolization was performed prior to surgery. Measurements and Main Results Cesarean section scar ectopic pregnancy was resected with minimal blood loss in a minimally invasive surgery. Conclusion Resection of a cesarean section scar ectopic pregnancy was safely performed after uterine artery embolization using robotic assisted laparoscopy. Demonstrate the removal of a cesarean section scar ectopic pregnancy performed robotically. Video Demonstration. Operating Room. One. Uterine artery embolization was performed prior to surgery. Cesarean section scar ectopic pregnancy was resected with minimal blood loss in a minimally invasive surgery. Resection of a cesarean section scar ectopic pregnancy was safely performed after uterine artery embolization using robotic assisted laparoscopy.

Transvaginal Sonographic Evaluation of Cesarean Section Scar Niche in Pregnancy: A Prospective Longitudinal Study

Background and Objectives: To investigate the prevalence of a Cesarean section (CS) scar niche during pregnancy, assessed by transvaginal ultrasound imaging, and to relate scar measurements, demographic and obstetric variables to the niche evolution and final pregnancy outcome. Materials and Methods: In this prospective observational study, we used transvaginal sonography to examine the uterine scars of 122 women at 11+0–13+6, 18+0–20+6 and 32+0–35+6 weeks of gestation. A scar was defined as visible on pregnant status when the area of hypoechogenic myometrial discontinuity of the lower uterine segment was identified. The CS scar niche (“defect”) was defined as an indentation at the site of the CS scar with a depth of at least 2 mm in the sagittal plane. We measured the hypoechogenic part of the CS niche in two dimensions, as myometrial thickness adjacent to the niche and the residual myometrial thickness (RMT). In the second and third trimesters of pregnancy, the full lower uterine segment (LUS) thickness and the myometrial layer thickness were measured at the thinnest part of the scar area. Two independent examiners measured CS scars in a non-selected subset of patients (n = 24). Descriptive analysis was used to assess scar visibility, and the intraclass correlation coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners for scar measurements. Factors associated with the CS scar niche, including maternal age, BMI, smoking status, previous vaginal delivery, obstetrics complications and a history of previous uterine curettage, were investigated. Clinical information about pregnancy outcomes and complications was obtained from the hospital’s electronic medical database. Results: The scar was visible in 77.9% of the women. Among those with a visible CS scar, the incidence of a CS scar niche was 51.6%. The intra- and interobserver agreement for CS scar niche measurements was excellent (ICC 0.98 and 0.89, respectively). Comparing subgroups of women in terms of CS scar niche (n = 49) and non-niche (n = 73), there was no statistically significant correlation between maternal age (p = 0.486), BMI (p = 0.529), gestational diabetes (p = 1.000), smoking status (p = 0.662), previous vaginal delivery after CS (p = 1.000) and niche development. Uterine scar niches were seen in 56.3% (18/48) of the women who had undergone uterine curettage, compared with 34.4% (31/74) without uterine curettage (p = 0.045). We observed an absence of correlation between the uterine scar niche at the first trimester of pregnancy and mode of delivery (p = 0.337). Two cases (4.7%) of uterine scar dehiscence were confirmed following a trial of vaginal delivery. Conclusions: Based on ultrasonography examination, the CS scar niche remained visible in half of the cases with a visible CS scar at the first trimester of pregnancy and could be reproducibly measured by a transvaginal scan. Previous uterine curettage was associated with an increased risk for uterine niche formation in a subsequent pregnancy. Uterine scar dehiscence might be potentially related to the CS scar niche.

VP02.05: Pregnancy implanted on Caesarean section scar: role of ultrasound in diagnosis and management

VP02.05: Pregnancy implanted on Caesarean section scar: role of ultrasound in diagnosis and management

Alpha Feto-Protien as a Biochemical Marker in Prediction of Morbidly Adherent Placenta

Abstract Background Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Aim of the Work To compare between alpha-fetoproteine as biological marker &amp; ultrasound &amp; Doppler findings for prenatal predication of morbid adherent placentation in anterior placenta on scar of previous cesarean section. Patients and Methods The current study is a prospective cohort study, conducted at a tertiary center: Ain Shams University Maternity Hospital during the period between February 2018 and April 2019,where 150 pregnant women having placenta previa covering scar of previous uterine surgery had been recruited from the outpatient obstetrics clinic or emergency room and admitted to antepartum inpatient high risk service, but 50 patients were dropped out due to loss in follow up because of emergency antepartum haemorrhage &amp; C.S., others escaped follow up. Results The results of the current study showed a significant association between all criteria of the 3DPD with multislice view and presence of placental adherence, need for added surgical steps, CS hysterectomy and bladder injury with sensitivity 83% &amp; specificity 57%, PPV 76%, NPV 66%. Conclusion The current study suggests that AFP assay, it isn't good test alone as regards its sensitivity &amp;specificity &amp;its level of accuracy 55% as compared to 2D &amp;3D power doppler with multislice view, so it is unreliable test alone for antenatal diagnosis of morbidly adherent placenta.

Rarest of All – A Case of Cesarean Scar Ectopic Pregnancy in an Elderly Woman

One of the most common causes of mortality of females in the first trimester is ectopic pregnancy. Ectopic pregnancy can occur at different anatomic locations of which the fallopian tube is most common. Very rarely implantation of blastocyst can occur in the lower uterine segment at the site of the previous transverse cesarean section; this very rare type of ectopic pregnancy is known as cesarean scar pregnancy. Cesarean scar pregnancy is usually associated with the risk of uterine rupture leading to hemorrhage and hence diagnosis at an early stage and a proper management is necessary to avoid any serious complications. We present an interesting case of a 39-year-old elderly woman of G3P2 L2 who complained of amenorrhea for the past 7 weeks. Her urine tested positive for β-human chorionic gonadotropin, and she was further sent for antenatal ultrasound scan to confirm the pregnancy. On transvaginal ultrasound examination, there was a single gestational sac with yolk sac, fetal pole, and cardiac activity seen at the anterior end of the lower uterine segment near the old healed scar of the previous cesarean section corresponding to the gestational age of 6 weeks and 6 days. A diagnosis of cesarean scar ectopic pregnancy was made. The woman underwent a laparotomy with excision and termination of the pregnancy. Ectopic pregnancy of any location should be promptly diagnosed and adequately treated. In cases where transvaginal ultrasonography is inconclusive, magnetic resonance imaging is performed. Diagnosis is important to avoid any further complications and in young females to preserve fertility.