Uterine Scar Dehiscence Research Articles

Postpartum Ultrasound: An Indispensable Tool in the Labor Ward.

Postpartum hemorrhage can occur because of different conditions. Apart from placental remnants and uterine atony, less common causes include uterine rupture, placental polyps, arteriovenous malformations, and pseudoaneurysms. Ultrasound plays a key role in the precise definition of the underlying pathology, which is necessary to initiate the appropriate therapy. It also helps to depict intraabdominal hematomas and uterine scar dehiscence, 2 conditions that do not necessarily lead to postpartum hemorrhage but are associated with increased maternal morbidity. This article presents 52 ultrasound images together with clinical and histopathologic images to give an overview of both frequent and rare pathologies in the postpartum period.

An unusual case of Uterine window revealing the placenta: A Diagnostic dilemma between Scar dehiscence and the Placenta Accreta Spectrum.

Uterine scar dehiscence, or the "uterine window," is a complication of a repeat cesarean section. Preterm delivery, caesarean sections performed more than twice in the past, or less than a 24-month interval between deliveries are all connected with an increased risk. The terms Placenta Accreta Spectrum (PAS) and uterine scar dehiscence are frequently used interchangeably. A 25-year-old unbooked pregnant woman, gravida 3 para 2 live 1, presented to OPD at 37 weeks gestation. During the intraoperative phase, we discovered a silent scar dehiscence with partially visible placental lobes under the intact serosa mimicking the Placenta Accreta Spectrum. A lower-segment caesarean section was performed, and the placenta was totally separated. After the cesarean incision was closed, the myometrial defect was corrected. It is crucial to distinguish it from disorders in the Placenta Accreta Spectrum, as prenatal imaging can be deceptive if not performed with the requisite expertise to distinguish between the two conditions. This distinction will inform the treatment strategies for uterine dehiscence and PAS disorders, which are distinct.

Importance of hemogram parameters for predicting uterine scar dehiscence

The pathophysiology of uterine scar dehiscence is not yet clear. The aim of this study was to investigate whether preoperative hemogram parameters can be used as predictive markers of uterine scar dehiscence, thus improving prediction and contributing to management of repeat Cesarean section. Between 2015 and 2020, 36670 (47.6%) cesarean sections were delivered in our hospital and 16943 of them had a previous Cesarean section. All cases of uterine scar rupture detected during Cesarean section were identified, and a total of 40 patients were included after excluding cases with impairment of the systemic inflammatory response (SIR). Controls consisted of 40 randomly selected, age-and body mass index (BMI)-matched patients, and the groups were compared. Age, BMI, and gravidity were similar (p>0.05). Although the gestational week and Apgar scores were similar between the groups (p>0.05), the birth weight amongst controls was significantly higher than the uterine dehiscence group (p=0.028). Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and other hemogram values were similar in both groups (p>0.05). Mean platelet volume (MPV) in the control group was significantly higher than in the uterine rupture group (p=0.049). Regression analysis found no significant result between hemogram parameters, birth weight, and dehiscence. In this study, which set out to identify predictors of the risk of uterine scar dehiscence with SIR parameters, only the MPV value was lower in the dehiscence group.

Terine rupture in the first trimester: A case report and literature review

Background: Uterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, mostly because of catastrophic bleeding. First-trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding, such as an ectopic pregnancy. We present a case of first-trimester scar dehiscence and conduct a literature review of this rare condition. Case presentation: A 39-year-old patient with 4 previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. The patient had two previous histories of third-trimester uterine rupture in previous pregnancies with subsequent hysterotomy and repair. The patient underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently performed. Conclusion: This case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The outline risk factors, clinical presentation, diagnostic imaging, and management may help in the early identification and management of this rare but life-threatening condition.

Uterine rupture in the first trimester: a case report and review of the literature

BackgroundUterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, which is mostly due to catastrophic bleeding. First trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding such as an ectopic pregnancy. We present a case of first trimester scar dehiscence and conduct a literature review of this rare condition.Case presentationA 39-year-old African patient with four previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. She had two previous histories of third trimester uterine rupture in previous pregnancies with subsequent hysterotomies and repair. She underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently done.ConclusionIn conclusion, the case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The risk factors, clinical presentation, diagnostic imaging, and management outlined may help in early identification and management of this rare but life threatening condition.

Placenta Accreta Spectrum: Evaluation of classic and non-classic presentations, pathologic grading, and uterine scar dehiscence features in a modern institutional series

IntroductionThe aim of this study is to document the distribution of classic versus non-classic presentation of Placenta Accreta Spectrum (PAS) disorders as well as grading categories by the Society for Pediatric Pathology (SPP) and FIGO systems in an institutional cohort of gravid hysterectomies. We also document the prevalence of uterine scar as a histologic correlate for uterine scar dehiscence, a phenomenon raised by some as central to PAS pathogenesis. MethodsPAS cases were assigned grade and designated as classic (anterior lower uterine segment implantation, prior C-section) or non-classic (implantation away from anterior lower uterine segment and/or no prior C-section). Features of dehiscence (uterine window, histologic evidence of scar) were recorded. ResultsSixty-two patients were included: 76 % had prior C-section; 55 % had other forms of uterine instrumentation. Classic PAS was recorded in 52 % patients; notably, 48 % had non-classic presentation; of these, all but one had prior instrumentation (curettage, myomectomy, laparoscopy). Uterine window was described in 53 % classic and 23 % non-classic PAS. Scar was demonstrated in 31 % classic and 23 % non-classic PAS; trichrome/reticulin stains were confirmatory. 32 % cases were SPP grade 1, 18 % grade 2, 18 % grade 3a and 32 % grade 3d. Grade 3 was significantly more common in classic (72 %) than non-classic (27 %) PAS. DiscussionWhile most PAS patients have classic presentation, a large subset does not; in addition, scar tissue is not identified histologically in most PAS hysterectomies; in these settings, PAS cannot be fully attributed to scar dehiscence. Uterine instrumentation often precedes non-classic PAS reinforcing the concept of decidual disruption as central to PAS pathogenesis. PAS grading as defined correlates with presentation (classic vs non-classic).

Outcome of subsequent pregnancies in women with prior uterine rupture

ObjectiveTo report maternal and neonatal outcomes of subsequent pregnancies in a series of women with a prior uterine rupture. MethodsThe records of all 103,542 deliveries (22,286 by cesarean section) performed in a single tertiary medical center from 2009 to 2021 were reviewed. Women with a prior uterine rupture, defined as a separation of the entire thickness of the uterine wall, with extrusion of fetal parts and intra-amniotic contents into the peritoneal cavity documented in the operative report of the previous cesarean delivery or laparotomy, were identified for inclusion in the study. ResultsThe cohort included 38 women with 50 pregnancies (50 neonates). Women had been scheduled for elective cesarean delivery at early term. Mean gestational age at delivery was 36 + 4 weeks (±5 days). In 7 pregnancies (14 %), spontaneous labor occurred before the scheduled cesarean delivery (at 36 + 6, 35 + 4, 35 + 3, 34 + 6, 34 + 3, 32 + 6 and 31 + 0 gestational weeks). A recurrent uterine scar rupture was found in 4 pregnancies (8 %), and uterine scar dehiscence, in 2 pregnancies (4 %), all identified during elective repeat cesarean delivery. In none of these cases was there a clinical suspicion beforehand; all had good maternal and neonatal outcomes. One parturient with placenta previa-accreta had a planned cesarean hysterectomy. ConclusionWomen with prior uterine rupture have good maternal and neonatal outcomes in subsequent pregnancies when managed at a tertiary medical center, with planned elective term cesarean delivery, or even earlier, at the onset of spontaneous preterm labor.

Transvaginal Ultrasound Evaluation Of Cesarean Section Niche Scar During Pregnancy: A Prospective Longitudinal Study

Background and Objectives: To determine the prevalence of a CS scar niche during pregnancy using transvaginal ultrasound imaging, and to determine the relationship between the evolution of the CS scar niche and the ultimate pregnancy result. Materials and Methods: Transvaginal sonography was used in this prospective observational research to look at the uterine scars of 100 women at 11+0-13+6, 18+0-20+6 and 32+0-35+6 weeks of pregnancy. When the region of hypoechogenic myometrial discontinuity of the lower uterine section was discovered, a scar was discernible while pregnant. An indentation at the location of the CS scar with a depth of at least 2 mm in the sagittal axis was designated as the CS scar niche (or "defect"). Myometrial thickness next to the niche and the remaining myometrial thickness were used to quantify the hypoechogenic portion of the CS niche in two dimensions. (RMT). The entire lower uterine segment (LUS) thickness and the myometrial layer thickness were measured during the second and third trimesters of pregnancy at the thinnest portion of the scar area. In a non-selected subset of patients (n=20), CS scars were measured by two separate examiners. Scar visibility was evaluated using descriptive analysis, and the intraclass correlation coefficient (ICC) was computed to demonstrate the degree of absolute agreement between two observers for measuring scars. Maternal age, BMI, smoking status, prior vaginal deliveries, obstetric complications, and a history of uterine curettage were among the factors looked into as potential contributors to the CS scar niche. The hospital's computerized medical database provided clinical statistics on pregnancy outcomes and complications. Results: 80.9% of the ladies could see the scar. A CS scar niche was prevalent in 53.6% of people with a noticeable CS scar. Excellent intra- and interobserver agreement was observed for CS scar niche readings. There was no statistically significant correlation between maternal age, BMI, gestational diabetes, smoking status, previous vaginal delivery after CS, and niche development when subgroups of women were compared in terms of CS scar niche and non-niche. In contrast to 34.4 % of the women who did not have uterine curettage, 56.3% of the women who had done uterine curettage had uterine scar niches. Conclusions: The CS scar niche could be reproducibly measured by a transvaginal scan in half of the cases with a visible CS scar at the first trimester of pregnancy, according to an ultrasonography evaluation. An increased chance of uterine niche formation in a subsequent pregnancy was linked to prior uterine curettage. The CS scar area may be connected to uterine scar dehiscence.

EP16.03: Pandora's Box: a challenging case of chronic uterine scar dehiscence masked by placenta accreta

EP16.03: Pandora's Box: a challenging case of chronic uterine scar dehiscence masked by placenta accreta

FREQUENCY OF SCAR DEHISCENCE IN PATIENTS WITH PREVIOUS ONE CAESAREAN SECTION HAVING SCAR TENDERNESS

Objectives: To determine the frequency of uterine scar dehiscence in patients with previous one cesarean section having scar tenderness. Materials and Methods: This Descriptive Cross Sectional Study was conducted in the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar from 28th Jan 2021 to 28th July 2021. Total 222 pregnant women with singleton pregnancy more than 28 weeks of gestation and history of previous one lower segment Caesarean Section presenting with scar tenderness were included in the study while patients having previous classical caesarean section, multiple pregnancies, not fi t for VBAC and without scar tenderness were excluded .Study was started after taking approval from IREB. Sampling was done in consecutive manner and followed to determine the occurrence of scar dehiscence. Results: The mean age of the participants was 27.1 + 5.3 years and mean BMI was 25.2 + 2.5kg/ m2 . The mean gestational age was 38.7 +1.9 weeks. Among the participants 43.7% had parity of 1-4 and 56.3% had more than > 5. Maternal tachycardia was present in 32% and on follow up, scar dehiscence was recorded in 14.9%. Conclusion: Scar dehiscence after previous CS is relatively common in women presenting at term pregnancy with scar tenderness. Further studies are recommended on relationship between CS, common factors which can lead to scar dehiscence and its outcome mother and new born.

Clinicopathological features of gestation course associated with uterine scar dehiscence in women with a past medical history of a single caesarean section

Aim. To compare the clinicopathological features, the course of pregnancy and its outcomes with the results of histological examination of the uterine scar in women with a past medical history of a single caesarean section.Materials and Methods. We analysed the associations between histological features of scarred myometrium and clinicopathological parameters of 48 pregnant women aged 19 to 40 years with a past medical history of a single caesarean section. All women were divided into two groups depending on the uterine scar condition. Tissue sampling for histological examination was performed during lower segment caesarean section from the scar area after fetal extraction.Results. 26 women had non-defective uterine scar and 22 women had uterine scar dehiscence (an overstretched inferior uterine segment with little or no muscle fiber and disorganised connective tissue at histological examination). Clinicopathological parameters associated with a uterine scar dehiscence were are ≤ 2-year interval between deliveries (OR = 6.85, 95% CI = 1.27-36.90, p = 0.025) and obesity (OR = 3.5, 95% CI = 0.97-12.70, p = 0.056). Typical pregnancy complication in patients with uterine scar dehiscence was placental insufficiency (OR = 4.75, 95% CI = 1.39-16.2, p = 0.013).Conclusion. Identification of the risk factors for uterine scar dehiscence may assist in selecting a method of delivery for women with a past medical history of caesarean section.

Maternal and Neonatal Outcomes After Ex-Utero Intrapartum Treatment for Congenital Diaphragmatic Hernia: A Case Series.

Despite advances in neonatal intensive care, fetuses with congenital diaphragmatic hernia (CDH) remain to have a poor prognosis. Exclusive postnatal treatment is inadequate in patients with moderate CDH (observed than expected lung-to-head ratio [O/E LHR] 26-45%) and can lead to respiratory failure at birth, requiring extracorporeal membrane oxygenation in 75% of cases. An ex-utero intrapartum treatment (EXIT) procedure may be beneficial in these cases, improving the fetal-neonatal transition. We review all pregnancies with fetal isolated left CDH with moderate O/E LHR delivered by EXIT in our center from January 2007 to December 2022. Maternal and neonatal variables were analyzed. As primary outcomes, we included neonatal survival and mortality rates, surgical and infectious complications, uterine scar dehiscence, and blood loss during EXIT. As secondary outcomes, we studied recurrences of the diaphragmatic defect, long-term evolution, subsequent pregnancies, and mode of delivery. A total of 14 patients were delivered by the EXIT procedure, with a neonatal survival rate of 85.7%. All these children had optimal physical and neurocognitive development and no pulmonary morbidity. We found no major complications and 7.1% of minor maternal complications. There were no cases of surgical wound infection or endometritis. The median decrease in hemoglobin during the EXIT procedure was 1.9 mg/dL, and only one case required postoperative transfusion. Two out of the 14 women became pregnant again, and both pregnancies were uneventful. In our series, the EXIT procedure allows for adequate airway management associated with a high neonatal survival rate in patients with moderate O/E LHR CDH, with a low rate of neonatal and maternal complications.

O-142 Surgical evacuation with adjuvant uterine artery embolization: a fertility preserving treatment for advanced live caesarean scar ectopic pregnancies

Abstract Study question Can advanced caesarean scar ectopic pregnancies be managed safely surgically whilst preserving future fertility? Summary answer With the available support of uterine artery embolization, suction and curettage can be an effective treatment for live advanced caesarean scar ectopic pregnancies, avoiding hysterectomy. What is known already Caesarean scar ectopic pregnancies (CSEPs) are associated with significant maternal morbidity and termination of pregnancy is often offered to patients to protect their health and fertility. Treatment of early first trimester CSEPs is usually effective and safe, but the management of more advanced cases is more challenging, and hysterectomy has been considered the treatment of choice for second trimester CSEPs. Study design, size, duration This was a retrospective cohort study in a tertiary referral centre between 2008-2023. Of 371 women diagnosed with CSEP, 22 (6%) had live advanced CSEPs. 17/22 (77%) patients opted for surgery, whilst the remaining five opted to continue with their pregnancies. CSEP was defined by implantation of the pregnancy into a myometrial defect caused by dehiscence of a lower uterine segment caesarean scar. Advanced CSEP was defined as crown rump length (CRL) of ≥ 40mm. Participants/materials, setting, methods A preoperative ultrasound was performed in each patient. All women underwent surgical evacuation under ultrasound guidance and insertion of modified Shirodkar cervical suture as a primary haemostatic measure. Additional haemostatic measures included uterine artery embolization (UAE). Our primary outcome was the rate of blood transfusion. Secondary outcomes were estimated intraoperative blood loss (BL), UAE, and admission to intensive care unit (ICU) and fertility preservation. Descriptive statistics were used to describe these variables. Main results and the role of chance For the 17 cases included, median CRL was 54.1 mm (range 40.0 - 85.7) and median gestational sac diameter was 52.7mm (range 41.0 – 82.7). Median gestational age based on CRL was 12 + 2 weeks (range 10 + 6 weeks and 15 + 2 weeks). Two (12%) women had a recurrent CSEP and 1 woman had a heterotropic pregnancy. On pre-operative ultrasound placental lacunae were recorded in 13 (76%) cases and colour Doppler score was ≥3 in 10 (59%) cases. A Shirodkar cervical suture was used in all cases, as per our protocol. It was successful in achieving haemostasis by tamponade in 13/17 (76%) cases. In the remaining 4 (24%) tamponade failed to achieve a complete haemostasis and UAE was required to control persistent arterial bleeding into the uterine cavity. Median BL at the time of surgery was 800 ml (range 250-2500) and 7/17 (41%) patients had a BL of > 1000 ml with 6/17 (35%) requiring blood transfusion. All four women who had UAE required admission to ICU. Three cases had a two-stage procedure with interval UAE to control the bleeding. All patients made a good postoperative recovery and no emergency hysterectomy was required. Three patients fell pregnant again and all pregnancies were normally sited. Limitations, reasons for caution Although this is the largest series of advanced CSEPs one limitation is its retrospective design and the relatively small number of cases. A second limitation is no women ≥ 16 weeks were included. Lastly, this study was conducted in a tertiary referral centre and results may not be widely replicable. Wider implications of the findings Surgical evacuation with a Shirodkar cervical suture and selective UAE is an effective treatment for advanced CSEPs and should be available to women who want to retain their fertility and avoid a hysterectomy. Pre-surgical planning and collaboration between gynaecologists and interventional radiologists is key in managing these high-risk women. Trial registration number not applicable

Measurement of Lower Uterine Segment Thickness to Detect Uterine Scar Defect: Comparison of Transabdominal and Transvaginal Ultrasound.

Lower uterine segment (LUS) thickness measurement using transabdominal ultrasound (TA-US), transvaginal ultrasound (TV-US), or the combination of both methods can detect scar defect in women with prior cesarean. We aimed to compare the sensitivity of three approaches. Women with prior cesarean underwent LUS thickness measurement at 34-38 weeks' gestation. Among those who underwent repeat cesarean before labor, we compared the accuracy of TA-US, TV-US, and the thinner of the two measurements (the "combined measurement") for uterine scar dehiscence using the area under the curve (AUC) of receiver operating curves with their 95% confidence intervals (CI). We calculated the sensitivity and specificity of the three approaches using a cut-off of 2.3 mm based on prior literature. We included 747 participants. The mean LUS thickness was greater with TA-US (3.8 ± 1.6 mm) compared with TV-US (3.5 ± 1.9 mm) or the combined measurement (3.2 ± 1.5 mm; P < .001). The AUC was 78% (95% CI: 69%-87%), 85% (95% CI: 79%-91%), and 88% (95% CI: 82%-93%), respectively (all with P < .001). The AUC difference between TA-US and the combined measurement was not significant (P=.057). A LUS below 2.3 mm would have predicted 9 (45%) of the 20 cases of uterine scar dehiscence using TA-US, 17 (85%) using TV-US, and 18 (90%) using the combined measurement (P < .01). The choice of ultrasound approach influences the measurement of the LUS thickness. The combination of the TA-US and TV-US seems to be superior for the detection of uterine dehiscence.

Multifactorial Intraoperative Uterine Scar Dehiscence: A Case Report

Now-a-days, the number of Caesarean section (c-section) has increased, also the complications of c-section has increased. Obstetricians often encounter uterine scar dehiscence during delivery by c-section. However, it is rare to find a uterine scar dehiscence which is extending over one-third of the anterior uterine wall and it is yet to build the best surgical approach for repairing this rare complication of c-section or a torn anterior wall during delivery. Herein, a 23-year-old female who is Rhesus factor (Rh) negative G2P1L1 with seven months of amenorrhea came with chief complaints of pain in the abdomen since morning. On ultrasonography, severe oligohydramnios was diagnosed as Amniotic Fluid Index (AFI) was &gt;5 cm. Hence, the patient was taken for emergency Lower Segment Caesarean Section (LSCS), Lower Uterine Section (LUS) was papery thin, uterovaginal fold of peritoneum was opened and the bladder was pushed down. One-third of the anterior uterine wall was involved. LUS was sutured using vicryl No. 1 and complete haemostasis was achieved. As uterine scar dehiscence is not preventable, efforts should be made to manage it efficiently and repair the myometrium safely.

Hemostatic agents use during cesarean delivery and the risk for uterine rupture during subsequent TOLAC

Hemostatic agents were found to be associated with post-cesarean infections in general and endometritis specifically. We aim to evaluate the association between a hemostatic agent used at the time of cesarean delivery to uterine scar rupture or dehiscence at the subsequent trial of labor. A multicenter retrospective cohort study of women who underwent their first trial of labor after cesarean delivery between 2005 and 2021. Women with a singleton pregnancy in whom a hemostatic agent was placed at the time of the index cesarean were compared to women in whom no such agent was placed. The primary outcome of this study was the rate of uterine rupture or dehiscence. Secondary outcomes were adverse maternal and neonatal outcomes. Univariate analyses were followed by multivariate analysis (adjusted Odds Ratio (aORs); [95% Confidence Interval]). During the study period, 7204 women underwent a trial of labor and met inclusion and exclusion criteria, of whom 431 (6.0%) had prior use of a hemostatic agent and 6773 (94.0%) didn't. History of the use of hemostatic agent wasn't found to be significantly associated with uterine scar rupture (0.9% vs. 0.4%, p=0.15) or dehiscence (0.9% vs. 0.5%, p=0.21). Moreover, we found no differences between the study groups in any maternal or neonatal parameter examined (Table 1). This was confirmed on multivariate analysis as well [aOR 1.95 (0.67–5.69), p = 0.22] for uterine rupture (Table 2). Amongst women undergoing a trial of labor, a history of hemostatic agent use confers no additional risk than no use. Further prospective studies in other settings to strengthen these findings are needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Resolving placenta accreta spectrum biology with spatial transcriptomics

Placental accreta spectrum (PAS) is associated with severe obstetric morbidity. The pathophysiology involves myometrial invasion as a function of signaling between an abnormal decidual environment and uterine scar dehiscence. The cellular heterogeneity at the site of invasion and the function of cell types at the maternal-fetal interface have not been well characterized. Single-cell spatial transcriptomics allows cellular architecture to be maintained while understanding the cellular heterogeneity, serving as a tool for biomarker discover and more so, understanding PAS disease mechanism. We performed spatial transcriptomics and single-cell RNAseq assays to determine local gene expression profiles at the site of accreta invasion (AI) and a non-invasive site from the same placenta (AO), as well as in controls (C). We utilized the GeoMX Digital Spatial Profiler for RNA library preparation and sequencing for next-generational sequencing. We selected 12 regions of interest (ROI) per condition for spatial transcriptomic analysis. ROIs were compared following segmentation and probe QC. Spatial transcriptomics annotation identified distinct gene signature by condition – AI, AO, and C. Clustering analysis identified 99 genes differently regulated between AI versus AO. AI showed a unique gene signature most prominent in the endothelial and stromal cell populations. The highest expression in AI compared to AO and C was seen in the following genes: HGF, LAMA2, DCN, SPARC, COL3A1, EGFL6 and decreased in ANK1, PTX1 and MGARP. Gene set enrichment analysis identified the following key pathways: blood vessel development, regulation of cell adhesion and migration, and the integrin pathway. We present an in-depth transcriptomic characterization of PAS across the site of invasion and sites of non-adherence with relative morphological context. This high-resolution transcriptomic profiles with locality information of PAS helps to understanding disease mechanism and inform diagnostic and therapeutic discoveries, that currently imply loss of boundary limits on a cellular level.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

New ultrasonographic risk assessment of uterine scar dehiscence in pregnancy after cesarean section

PurposeWe performed a new ultrasonographic risk assessment of uterine scar dehiscence, which is a potential risk factor for uterine rupture, in pregnancy after cesarean section. We attempted to shed light on the natural course of the change in the lower uterine segment by means of a longitudinal investigation through quantitative and qualitative evaluations.MethodsThis retrospective single-center study involved 31 women with a normal singleton pregnancy delivered by elective cesarean section between 2020 and 2021, with all women showing a “niche” in the lower uterine segments. The lower uterine segments were assessed qualitatively and quantitatively using transvaginal ultrasonography at 16–21, 22–27, and 28–33 weeks of gestation, and subjects were divided into two groups: those with uterine dehiscence (12 women) and those without uterine dehiscence (19 women), depending on the gross findings of the lower uterine segments at cesarean section. Analyses were performed using Wilcoxon’s rank-sum and Mann–Whitney U test with a significance level of P < 0.05.ResultsThe lower uterine segments changed from V-shaped to U-shaped to thin as gestation progressed and was more prominent in the uterine dehiscence group, occurring mostly at 22–27 weeks. At 22–27 weeks, the median myometrial thickness in the uterine dehiscence group was lower than in the group without uterine dehiscence (P = 0.0030). Thinning of the lower uterine segments had moved the cephalad at 22–27 and 28–33 weeks in cases with and without uterine dehiscence.ConclusionA model of morphological changes in the niche was constructed based on qualitative and quantitative assessments. The morphological changes and actual thinning of the lower uterine segments were prominent in the second trimester in women considered to have uterine scar dehiscence.

EP40.02: New ultrasonographic risk assessment of uterine scar dehiscence in pregnancy after Caesarean section

EP40.02: New ultrasonographic risk assessment of uterine scar dehiscence in pregnancy after Caesarean section

Impact of Short Pregnancy Interval on Feto-Maternal Outcome in Women with Previous caesarean section

Background: Short inter-pregnancy interval has been associated with an increase risk of adverse pregnancy outcomes after caesarean section. Method: A descriptive study, carried out in tertiary care hospital on total 63 numbers of women for a duration of six months with short inter-pregnancy interval and history of previous caesarean section. Results: Among women with history of previous LSCS (n=63), mean age 26.5±4.6 years, gestational age 37.8±2.2 weeks, recommended IPI (&gt;18 months) was observed only in 15.9% women. Most common indications for current C-section were irregular pain (20.6%), term women (12.7%), and fetal distress (11.1%). Occurrence rate of uterine scar dehiscence was 33.3%, preterm birth 19.0%, low birth weight 15.9%, and uterine rupture 3.2%. Frequency of uterine scar dehiscence was significantly higher in IPI ≤6 months than in &gt;6 months (66.7% vs. 33.3%; p 0.040); and in IPI ≤12 months than in &gt;12 months (81% vs. 19%; p 0.036). All two cases of uterine rupture were observed in IPI ≤6 months but the difference was not statistically significant. Frequency of preterm birth was insignificantly higher in IPI ≤18 months than in &gt;18 months (66.7% vs. 33.3%; p 0.086). Conclusion: We found elevated risk of uterine scar dehiscence, uterine rupture, low birth weight babies along with preterm births. Keywords: IPI (Inter-pregnancy interval), LSCS (Lower Segment Cesarean Section), Scar dehiscence, Low Birth Weight.