History Of Previous Cesarean Section Research Articles

Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders

We aimed to assess the performance of ultrasound (US) and magnetic resonance imaging (MRI) signs for antenatal detection of placenta accreta spectrum (PAS) disorders in women with placenta previa (placental edge≤2cm from the internal uterine orifice,≥260/7 weeks' gestation) with and without a history of previous Caesarean section. Single center prospective observational study. US suspicion of PAS was raised in the presence of obliteration of the hypoechoic space between uterus and placenta, interruption of the hyperechoic uterine-bladder interface and/or turbulent placental lacunae on color Doppler. All MRI studies were blindly evaluated by a single operator. PAS was defined as clinically significant when histopathological diagnosis was associated with at least one of: intrauterine balloon placement, compressive uterine sutures, peripartum hysterectomy, uterine or hypogastric artery ligature, uterine artery embolization. A total of 39 women were included: 7/39 had clinically significant PAS. There were 6/18 cases of PAS with anterior placenta: hypoechoic space interruption and placental lacunae were the most sensitive sonographic signs (83%), while abnormal hyperechoic interface was the most specific (83%). On MRI, focal myometrial interruption and T2 intraplacental dark bands showed the best sensitivity (83%), bladder tenting had the best specificity (100%). 1/21 women with posterior placenta had PAS. There was substantial agreement between US and MRI in patients with anterior placenta (κ=0.78). US and MRI agreement in antenatal diagnosis of clinically significant PAS was maximal in high-risk women. Placental lacunae on ultrasound scan and T2 intraplacental hypointense bands on MRI should trigger the suspicion of PAS.

Induction of Labor with Vaginal Dinoprostone (PGE2) in Patients with a Previous Cesarean Section: Obstetric and Neonatal Outcomes.

Background: Vaginal dinoprostone (PGE2) is currently used as the prostaglandin of choice in many obstetric units. However, few studies have evaluated its safety, especially in women who previously had a cesarean section. Objective: To evaluate the efficacy and safety of PGE2 in pregnant women who are undergoing induction of labor (IOL), and who have had a previous cesarean section. Materials and Methods: A prospective observational study was conducted in La Mancha Centro Hospital in Alcázar de San Juan, Spain, from 1 February 2019 to 30 August 2020. Obstetric and neonatal outcomes, following IOL with PGE2, in 47 pregnant women who wanted a trial of labor after cesarean (TOLAC), and 377 pregnant women without a history of cesarean section, were analyzed. The outcomes were analyzed by bivariate and multivariate analyses using binary and multiple linear regression. Results: A total of 424 women were included in this study. The percentage of cesarean sections in the TOLAC group was 44.7% (21), compared with 31.6% (119) in the group without a history of cesarean section (adjusted odds ratio: 1.4; 95% CI: 0.68–2.86). In the multivariate analysis, no statistically significant differences were observed between both groups for obstetric and neonatal outcomes (p > 0.05). However, two uterine ruptures (4.3%) occurred in the group of patients with a history of cesarean section who underwent IOL with PGE2. Conclusions: The induction of labor with vaginal dinoprostone (PGE2), in patients with a previous history of cesarean section, was not associated with worse obstetric or neonatal outcomes compared with the group of patients without a history of cesarean section in our study sample. However, further research is needed regarding this IOL method, and it should be used with caution in this population group.

Tucked and treated- a case series on outcome of meshplasty with abdominoplasty for incisional hernia

Incisional hernia is the second most common type of hernia. Incisional hernia occurs in 10-20% of patients who were subjected to abdominal surgery in India. Here we are presenting a case series of 20 patients with incisional hernia and obesity. Body mass index (BMI) ranges from 28 to 35 in all cases. Females outnumbered the male in the ratio of 4:1 and 40% of cases had a previous history of caesarean section. All cases were operated by combining open polypropylene meshplasty and abdominoplasty techniques and follow up consultations were done for 1 year. 10% of cases had post-op wound infections, who were known to be diabetic. They were managed with appropriate antibiotics and maintained strict glycemic control. 90% of patients were satisfied from the procedure performed which improved their quality of life, significant cosmetic outcome and no recurrence. 10% of cases had recurrence after heavy weight lifting following surgery (BMI was 36). By incorporating the above mentioned techniques in hernia repair, recurrence rate and complications were reduced, quality of life and aesthetic outcome are enhanced.

Placenta Accreta Spectrum After Surgical Management of Retained Products of Conception, with no History of Previous Caesarean Section – Case Report and Literature Review

Placenta Accreta Spectrum After Surgical Management of Retained Products of Conception, with no History of Previous Caesarean Section – Case Report and Literature Review

Magnitude and associated factors of caesarean section deliveries among women who gave birth in Southwest Ethiopia: institutional-based cross-sectional study

BackgroundCaesarean section is a life-saving comprehensive obstetric procedure of women and newborn performed during childbirth-related complications and should be universally accessible for all pregnant mothers globally. Appropriate use of caesarean section can reduce maternal and perinatal mortality. However, inappropriate use of caesarean section can negatively affect infant health, women health, and future pregnancies. The magnitude and factors associated with caesarean section delivery were not consistent and will vary between different hospitals of Ethiopia. Hence, this study aimed at assessing the magnitude and factors associated with caesarean section deliveries in Southwest Ethiopia.Methods and MaterialsAn institutional-based cross-sectional study was conducted from January 1 to February 29, 2020. A systematic random sampling technique was used to select 551 study participants. A pretested, structured, and face-to-face interview was used to collect data. Data were entered into Epi-data version 4.2.0 and exported to SPSS version 23 for analysis. Bivariate and multivariate analyses were used to identify factors associated with caesarean section deliveries. P values < 0.05 result were considered as a statistically significant association.ResultsThe magnitude of caesarean section deliveries was found to be 32.5 % (95 % CI; 28.6%-36.7 %). Mothers resided in an urban area [AOR = 2.58, (95% CI; 1.66–4.01)], multiple pregnancies [AOR = 3.15, (95% CI; 1.89–5.23), malpresentation [AOR = 3.05, (95% CI; 1.77–5.24)], and previous history of caesarean section [AOR = 3.55, (95% CI; 2.23–5.64) were factors associated with caesarean section deliveries.ConclusionsCaesarean section deliveries were found high in the study area. Mothers resided in an urban area, multiple pregnancies, malpresentation, and previous history of caesarean section were factors associated with caesarean section deliveries. Therefore, counselling of mothers on the risk of giving birth through elective caesarean section without absolute and relative medical indications and giving enough time for the trial of vaginal birth after caesarean section are recommended.

ANAESTHETIC MANAGEMENT IN CAESAREAN SECTION IN A PARTURIENT WITH KYPHOSCOLIOSIS : A CASE REPORT

Alterations in maternal physiology and pathological changes in kyphoscoliosis results in anaesthetic complications for caesarean section with potential risk for both mother and fetus. Safe and skilled anaesthetic management to minimize risk to mother and fetus is required. We report a case of 25-year-old female, with G2P1L1, with 28 weeks of period of gestation, with history of previous caesarean section, with pre-eclampsia, with kyphoscoliosis in labour with contracted pelvis, managed by general anaesthesia for caesarean section.

Bladder Injury during Caesarean Section, Surgical and Anaesthetic Management: A Case Report and Review of the Literature

Urinary bladder injury is a rare complication during caesarean section but its incidence is increasing due to growing trend in caesarean deliveries. In this case report, we reported a 32 year old pregnant female with previous history of caesarean section who presented during labour. Emergency caesarean was done and the case was complicated with bladder injury intraoperatively. The injury was immediately identified and was repaired in two layers. This case highlights the anaesthetic and surgical management of inadvertent bladder injury during caesarean section. Keywords: Bladder injury, caesarean section, Emergency caesarean.

P–634 The effect of bariatric surgery on PCOS patients’ obstetrical and neonatal outcomes: A population based study

Abstract Study question Does bariatric surgery (BS) decrease the occurrence of adverse obstetrical and neonatal outcomes in morbidly obese women with polycystic ovarian syndrome (PCOS)? Summary answer Patients with PCOS who underwent BS were at lower risk for gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), than other women with PCOS. What is known already Studies have shown that PCOS in pregnancy is associated with the occurrence of GDM, preeclampsia, PIH, preterm birth (PTB), cesarean section, miscarriage, hypoglycemia, and neonatal death. Patients with PCOS may have an increased risk of obesity compared to the general population, which magnifies the inherent insulin resistance many fold. PCOS patients who underwent bariatric surgery have a marked improvement in menstrual irregularities, hirsutism, T2DM, hypertension, and dyslipidemia. The benefit of bariatric surgery for PCOS patients and the improvement of pregnancy related complications has not been adequately studied, with most studies being small. Study design, size, duration This is a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database from 2004 to 2014. Using multivariate logistic regression analysis, we compared women with PCOS who underwent BS with a control group consisting of pregnant patients with PCOS of all BMIs who had not had weight reduction operations regarding pregnancy, delivery, and neonatal outcomes. Participants/materials, setting, methods The study group included pregnant PCOS patients who underwent BS and the control group consisted of pregnant patients with PCOS; who delivered between 2004 and 2014. Demographic and clinical characteristics, pregnancy, delivery, and neonatal outcomes were compared. Multivariate logistic regression analysis was performed to control for all statistically different (P &amp;lt; 0.05) confounding effects. Each subject was included once per delivery. Main results and the role of chance We identified 9,096,788 pregnancies during the study period. 141 patients had a history of PCOS and underwent BS. The control group was composed of 14,741 patients with PCOS who didn’t undergo BS. Prevalence of PCOS patients who underwent BS increased from 0/1,000 in 2004 to 14.6/1,000 in 2014(p = 0.001). Those who underwent BS were more likely to be older than 35-years(42.6% vs. 18.7%, p &amp;lt; 0.0001), obese at delivery(44.7% vs. 22%, p &amp;lt; 0.0001) and have a history of previous cesarean sections (24.8% vs. 18.2%, p = 0.045). Differences in pre-gestational diabetes (7.1% vs. 4.1%, p = 0.086) and hypertension (12% vs. 8.4%, p = 0.125) .The BS group was less likely to develop PIH (aOR–0.39, 95%CI–0.21–0.72) and GDM( aOR–0.40, 95%CI–0.23–0.70) when compared to the control group. When comparing the PCOS with and without BS; differences in gestational hypertension(95%CI–0.22–1.30), preeclampsia(95%CI–0.19–1.15), spontaneous vaginal delivery (95%CI 0.58–1.3), operative vaginal delivery (95%CI 0.34–1.8), Cesarean section (95%CI 0.79–1.79), post partum hemorrhage (95%CI–0.12–1.94), transfusion (95%CI–0.1–5.22), preterm delivery (95%CI–0.56–1.75) and maternal infection (95%CI–0.27–2.07) were similar. Regarding neonatal outcomes of PCOS with and without BS: small for gestational age babies (95%CI–0.26–2.68), and congenital anomalies (95%CI–0.09–4.52) were similar. Limitations, reasons for caution Limitations of our study include its retrospective design. Information regarding the time interval between the surgical intervention and pregnancy wasn’t available. Nor was information on the type of gastric bypass performed. Wider implications of the findings: Our study demonstrated an association between bariatric surgery in the setting of PCOS patients and a reduced risk of GDM and PIH. Although no differences were noted in other delivery and neonatal outcomes, data was not compared to a group of strictly obese PCOS controls. Trial registration number Not applicable

The Accuracy of Shear Wave Elastography in the Assessment of Placental Invasion in Women with Placenta Previa

Background: Placenta accreta spectrum is a term which describes abnormal invasion of the placenta into the uterine myometrium. The first line in diagnosis is ultrasonography and magnetic resonance imaging may complement the diagnosis. Aim: The aim of the work is to assess the accuracy of shear wave elastography in predication of placental invasion in women with placental previa.Materials and Methods: This is a prospective cohort study which was conducted in Ain Shams University on 50 women with a diagnosis of anterior placenta previa and history of previous cesarean section who were pregnant at 32 weeks or more and were planned for delivery by elective cesarean section. They were subjected to ultrasonography and elastography study and the diagnosis of placenta accreta spectrum was confirmed/ excluded intraoperatively.Results: Placental separation was normal in 36% of cases, delayed in 46 % of cases, partial in 6% of cases only whereas non separation occurred in 12% of cases. elastrgraphy had a sensitivity of 73.7%, specificity of 90.3%, positive predicting value of 82.4% and negative predictive value of 84.8% in diagnosing cases with abnormal placental invasion while sensitivity, specificity positive and negative predictive value of ultrasonography in diagnosing abnormal placental invasion was 89.5%, 96.8%, 94.4% and 93.8% respectively.Conclusion: Elastography is sensitive and specific but inferior to ultrasonography in evaluating women with suspected placenta accreta spectrum but it may be useful in diagnosis of focal invasion.

Frequency of Placenta Previa on Ultrasonography in Females with History of Caesarean Section

Background: Placenta previa (P.P) is a condition where the lower edge of the placenta lies close to the internal os. It may partially or completely cover the internal os. Objectives: To determine the frequency of placenta previa on ultrasonography in females with history of Caesarean section. Methodology: This descriptive study was held in Ghurki Trust Teaching Hospital Lahore and Tehsil Headquarter Hospital, Pattoki. Convex Probe Esotae 2.5 5-7MHz and Logiqv3 (5-7MHz) was used in the study. 140 pregnant women with history of previous Caesarean section were included in the study and were examined through convenient sampling. Data was collected after signing the consent form. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: According to the data analysis, minimum age patient was of 18 years and maximum age was 41 years. 37(26.4%) women had 1 previous Caesarean section. 57(40.7%) women had 2, 31(22.1%) women had 3, 15(10.7%) had 4 of previous Caesarean sections. 86(61.4%) women had a history of bleeding. 54(38.6%) women had no history of bleeding. According to analysis of placenta previa, 126(90.0%) women did not have a placenta previa and 14(10.0%) women had placenta previa. Cross tabulation analysis between frequency of patients with placenta previa and previous Caesarean cases evaluated that 126 patients with previous Caesarean rate did not placenta previa confirmed on ultrasound whereas 14 patients with previous Caesarean section had placenta previa on ultrasound. Conclusion: Placenta previa is seen in ten percent of subsequent pregnancies in females who have a history of previous Caesarean section.

The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases.

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient’s medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16–5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87–22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14–0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5–9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

Prevalence and factors associated with caesarean section in a comprehensive specialized hospital of Ethiopia: A cross-sectional study; 2020

IntroductionCaesarean section is one of the lifesaving procedures of medical interventions attributed to the decrease of maternal and newborn mortality and morbidity rates. The World Health Organization (WHO) shows a cesarean rate between 5% and 15%. However, the prevalence of cesarean section is increasing globally as well as in Ethiopia. Different scholars argue that the prevalence and factors of the caesarian section vary in different countries and health institutions. The aim of this study was to assess the prevalence and factors associated with cesarean section in Debre Tabor Comprehensive Specialized Hospital. MethodAn institutional-based cross-sectional study was conducted on a total of 320 mothers who gave birth at Debre Tabor Comprehensive Specialized Hospital from July 01, 2020, to October 30, 2020. The samples were selected using the convenience sampling technique. The Data were collected using a structured checklist. Bivariable and multivariable logistic regressions were used to check the association. P-values less than 0.05 were considered statistically significant. ResultsThe overall prevalence of cesarean section was 39.1% in the current study. Mothers age 35–39 years, educational level college and above, employed, mothers with a monthly income of >6000, and mothers with a previous history of cesarean section were significantly associated with an increased risk of cesarean section. ConclusionThe prevalence of cesarean section was high in Debre Tabor Comprehensive Specialized Hospital. Age of the mothers, educational status, occupation, monthly income, and previous history of cesarean section were significantly associated with an increased occurrence of cesarean section.

Late registration for antenatal care by pregnant women with previous history of caesarean section.

BackgroundDespite good access to antenatal care (ANC) services for most women, and regular training of healthcare workers in obstetrics and gynaecology, many pregnant women with a previous history of caesarean section (C/S) still presented late for ANC services at Letsholathebe II Memorial Hospital (LIIMH) in Maun, Botswana. This may increase morbidity and mortality in women with previous C/S delivery and neonates. Knowing why women with previous C/S present late for ANC may help in the formulation of interventions that decrease morbidity and mortality amongst these women and neonates.AimThe aim of this study was to explore the reasons why pregnant women with a previous history of C/S registered late for ANC, at LIIMH.SettingThis study was performed at LIIMH, a district hospital situated in Maun, Botswana.MethodsThis was a descriptive qualitative study. Consenting pregnant women with previous C/S who presented at LIIMH after the 20 weeks of pregnancy were interviewed until data saturation. The data was analysed for themes.ResultsThe reasons for late registration at LIIMH include lack of information, misconception on the appropriate booking time and venue, dissatisfaction with the quality of ANC clinic services, use of alternative ANC providers, delayed referral, and pregnancy experience.ConclusionLack of knowledge of ANC delivery venue, using alternative ANC providers, and dissatisfaction with ANC clinic services, contributed to late registration. Pregnant women with previous history of C/S should be informed about ANC, delivery plans, and the assistance of alternative ANC providers should be explored.

Placenta percreta with bladder invasion: managed successfully

Placenta percreta (PP) is a potentially life-threatening condition. When PP is complicated by bladder invasion, mortality rates have been estimated as high as 9.5% and 24% for mother and child, respectively. Early diagnosis allows for appropriate antenatal care and accordingly surgical planning and management. Herein, we are going to present a case report, in which a woman G3P2L2 with previous 2 caesarean section with pre-term gestation was diagnosed with placenta accreta, but intra-operatively it was placenta percreta with bladder invasion. Patient was managed successfully by doing subtotal hysterectomy. Any pregnant patient with previous history of caesarean section we should be suspicious of placenta accrete spectrum, hence should be managed in a tertiary care center with a multidisciplinary approach, and with earliest possible involvement of the urologist in decision-making.

Placenta accreta spectrum: Management and outcomes in a tertiary centre in India: An observational cross-sectional study.

Our observational cross-sectional study looked at the risk factors, diagnosis, management and outcomes of placenta accrete spectrum at the Christian Medical College and Hospital, Vellore, India, between January 2013 and December 2018. A total of 21 cases of placenta accrete spectrum are described among whom a preop diagnosis was available in 14 cases. A previous history of Caesarean section and placenta previa was present in 90%. Caesarean hysterectomy was carried out in 80%, but none of those managed conservatively required interval hysterectomy. Urinary tract injury was the most common surgical complication, seen in over 50%. The mean blood loss was 3.5 l and 14 patients required intensive care unit admission, but no maternal mortality ensued. Thus, we conclude that the conservative management in carefully selected cases is feasible.

The impact of previous cesarean section on the outcome of patients with non-adherent placenta previa

ObjectiveTo evaluate the impact of previous lower segment cesarean section on maternal and fetal outcomes of patients with non-adherent placenta previaMethodsThis is a retrospective study of all patients who delivered at a tertiary referral university hospital by lower uterine cesarean section with non-adherent placenta previa, over a 10-year period. Data were obtained through hospital registry and medical records. The differences in demographic, obstetric characteristics, peripartum complications, and fetal outcome between patients with no previous cesarean and those with previous cesarean section were analyzed.ResultsNinety patients with non-adherent placenta previa were included, 54 patients with no previous cesarean and 36 patients with previous cesarean section. Patients with previous cesarean section were significantly more likely to incur inadvertent organ injury, transfusion of 4 or more units of packed red blood cells, transfusion of fresh frozen plasma, uterine brace compressive sutures, uterine artery ligation, and peripartum hysterectomy.ConclusionThere is a significant increase in the incidence of inadvertent neighboring viscus injury, transfusion of 4 units or more of packed red blood cells, transfusion of fresh frozen plasma, uterine brace compressive sutures, uterine artery ligation, and peripartum hysterectomy in patients with non-adherent placenta previa and previous cesarean section, compared to those with non-adherent placenta previa and no previous history of cesarean section, with no difference in perinatal outcome.

Determinants of post cesarean section surgical site infection at public hospitals in Dire Dawa administration, Eastern Ethiopia: Case control study.

IntroductionPost cesarean section surgical site infection increases both the duration of a patient’s hospital stay and unplanned hospital costs. It can delays recovery, prolongs hospitalization, necessitates readmission, and adds to hospital bills and other morbidities as well as mortalities.MethodFacility-based case-control study was conducted from 1st March to 20th April, 2019 among all the mother records enrolled from 1st January to 31st December, 2018 at Public hospitals in Dire Dawa administration. The records of the mothers’ who had post-cesarean section surgical site infection (119) was extracted by a census and every three consecutive controls (357) for each case were collected by trained data collectors using a structured data extraction tool. Variables which had p-value <0.25 in bivariate analysis were considered as candidates for multivariable analysis. Statistical significance was declared at P-value ≤0.05 with adjusted odd ratio and 95% confidence interval in the multivariable logistic regression model.ResultAge 20–34 years (AOR:5.4; 95%CI:2.35,12.7), age >35 years (AOR:8.9; 95%CI:1.8,43.9), ≥4 per vaginal examinations (AOR: 4.2; 95%CI:2.16,8.22), current history of Chorioamnionitis (AOR:5; 95%CI:1.05,23.9), previous history of cesarean section (AOR:6.2; 95%CI: 2.72,14.36), provision of antibiotics prophylaxis (AOR:3.2; 95%CI:1.81,5.62), perioperative HCT level <30% (AOR:6.9; 95%CI:3.45,14.1) and duration of rupture of membrane >12 hours (AOR:5.4; 95%CI:1.84,15.87) were the independent determinants of post-cesarean section surgical site infection.ConclusionIncreased in age of the mother, higher number of per vaginal examination, having a history of chorioamnionitis, having previous history of cesarean section, not receiving antibiotics prophylaxis, lower perioperative hematocrit level and longer duration of rupture of membrane were statistically significant in multivariable analysis. Therefore; emphasis should be given for mothers who have higher age category, previous cesarean scar and history of choriamnionitis. In addition; provision of antibiotics should be comprehensive for all mothers undergoing cesarean section.

Indications of Preterm Caesarean Section: Experience of 100 Cases at a Tertiary Care Hospital in Bangladesh

Background: Preterm caesarean section is performed for different indication among the pregnant women.&#x0D; Objective: The purpose of the present study was to find out the indications of preterm caesarean section among pregnant women.&#x0D; Methodology: This cross sectional study was conducted in the Department of Obstetric &amp; Gynaecology at Shaheed Ziaur Rahman Medical College Hospital, Bogra, Bangladesh from January 2007 to December 2007 for a period of one year. Women with the gestational age between 32 to 36 completed weeks who were selected for delivery by Caesarean section were selected as study population. All the women of study were assessed on the basis of detailed history, clinical examination, gestational period, history of premature rupture of membranes, any vaginal bleeding and fetal condition.&#x0D; Result: A total number of 100 pregnant women were recruited for this study. In this study most of the pregnant women were in the age group of15 to 20 years which was 40(40.0%) cases followed by the age group of 21 to 25 years which were 20(20.0%) cases. About 43(43.0%) cases were complicated with pregnancy induced hypertension. Almost all of them had indication for immediate caesarean section. Among the group incidence of eclampsia was high which was in 23(23.0%) cases; however, preeclampsia was found in 20(20.0%) cases. Ante partum haemorrhage was reported in 10(10.0%) cases. Pregnant women with premature rupture of membrane (PROM) was found in 14(14.0%) cases; furthermore, PROM with Chorioamnionitis was detected in 5(5.0%) cases. Preterm labour with history of previous caesarean section was given by 5(5.0%) women.&#x0D; Conclusion: In conclusion eclampsia and preeclampsia are the most common indication for preterm caesarean section followed by premature rupture of membrane.&#x0D; Journal of Current and Advance Medical Research, January 2021;8(1):44-48

Assessment of risk factors associated with pre-term labour in Tertiary care Hospitals, Lahore

Background: Pakistan has one of the highest rates of preterm births, nearly 16 for every 100 babies born. Around 4% of these premature babies, are at highest likelihood of death. The objective of this study was to assess association of multiple risk factors with preterm birth in Pakistani women.&#x0D; Patients and methods: An analytical cross-sectional study was carried out in Obstetrics and Gynecology Department of Akhtar Saeed Trust Hospital and Farooq Hospital, West Wood Branch, Lahore from October 2018 to December 2019. Total 116 pregnant females who gave birth to preterm babies with gestational age between 20-37 weeks were included. Data about patients’ socio-demographic profile, previous obstetric history and current gestational profile was collected using closed ended structured questionnaire. Variables were presented in the form of frequency tables. Chi-square and Fisher exact test were applied to establish association of various risk factors and preterm presentation of patients’ in hospital. A p-value ≤ 0.05 was taken as significant.&#x0D; Results: Out of 116 participants, 49 (42.2%) were aged between 20-25 years, 47 (40.5%) were illiterate. Of the total sample 60 (51.7 %) participants were obese (BMI &gt;30). Eighty-two (70.7%) patients were multigravida and 65 (56.1%) gave the history of previous cesarean section. Significant association was found between preterm birth and multi-parity (p=0.001), previous history of abortion (p=0.000), intrauterine death (p=0.001), infertility (p=0.04), cesarean-section (p=0.000), and inter-pregnancy interval of less than 24 months (p=0.007). Other significant factors associated with preterm labour were urinary tract infections (p=0.001), documented fever more than 101oF (p=0.000), anemia (p=0.000), singleton pregnancy (p=0.000) and cephalic fetal presentation (p=0.002), during current pregnancy.&#x0D; Conclusion: Multi-gravidity, history of abortion, intrauterine death, previous infertility, cesarean-section, inter-pregnancy interval of less than 24 months, UTI, genital tract infection, anemia, singleton pregnancy and cephalic fetal presentation during current pregnancy were observed to be significantly associated with preterm births.

ACCURACY OF MULTI-SLICE 3D-DOPPLER IN DIAGNOSIS OF MORBIDLY ADHERENT PLACENTA IN COMPARISON WITH 2D-DOPPLER

Background: Morbidly adherent placenta can be diagnosed prenatally by different modalities. 2D, 3D multi-slice Doppler ultrasound and MRI have emerging roles in prenatal diagnosis of morbidly adherent placenta, but histopathological diagnosis is the gold standard.Aim of the work: To detect the accuracy of multi-slice 3D Doppler ultrasound over 2D-Doppler in diagnosis of placenta accreta in relation to postpartum histopathology and intrapartum findings.Patients and Methods: This study was conducted at Ain shams university maternity hospital during the period between March 2020 and September 2020. A total of 50 pregnant women having placenta Previa were included in the study. Patients were included in the study according to the following criteria: Pregnant women with history of previous cesarean section or hysterotomy, placenta previa with its lower edge covering the scar of previous cesarean section, From 28 wks – Full term.Each patient was scanned in a systematic fashion by 2D ultrasonography, 2D-Doppler, Multislice 3D-Doppler preoperatively and results were compared with histopathological examination postoperatively.Results: Crowded vessels over peripheral sub-placental zone had the highest diagnostic characteristics among multislice 3D Doppler signs in diagnosis of placental invasion compared with postoperative histopathology with (sensitivity 95.2%, specificity 93.1%, PPV 90.9%, NPV96.4%, LR 270.00).Hyper vascularity of serosa–bladder interface had the highest diagnostic characteristics among 2D Doppler ultrasonography signs in the diagnosis of placental invasion compared with postoperative histopathology with (sensitivity 90.5%, specificity 89.7%, PPV 86.4%, NPV 92.9%, LR 82.33).Conclusion: Multi-slice 3D Doppler ultrasound is more accurate than 2D ultrasound in diagnosis of placenta accrete and degree of adherence in relation to postpartum histopathology and intrapartum findings.