Number Of Previous Cesarean Sections Research Articles

Influence of Cesarean Section Scar on the Mean Pulsatility Index of the Uterine Artery Doppler between 20 and 34 Weeks of Gestation

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

P-742 In-vitro fertilization outcomes after laparoscopic repair of cesarean scar defect

Abstract Study question Does laparoscopic repair of cesarean scar defect improve in-vitro fertilization (IVF) outcomes? Summary answer Laparoscopic (LSC) repair of cesarean scar defect (CSD) should selectively indicated to patients experiencing repetitive pregnancy failure or having an increased depth of niche What is known already Cesarean section (CS) rate has markedly from 7% in 1990 to an estimated 29% of all births by 2030. CSD, also known as isthmocele or uterine niche, has emerged as a cause of secondary infertility, frequently encountered with recurrent implantation failures and cycle cancellations because of the endometrial fluid collection both in endometrium and uterine lower segment of cesarean scar. Study design, size, duration This is a retrospective study encompassing total of 62 patients. With 50 patients undergoing expectant management, 12 undergoing LSC repair of CSD at a single IVF center from 2019 to 2023. Primary outcomes included the clinical pregnancy rate and time to pregnancy, while secondary outcomes were the depth of CSD and residual myometrial thickness. Of the 72 patients, 68 patients underwent frozen embryo transfer. Participants/materials, setting, methods Patients with secondary infertility who had experienced more than two instances of implantation failure or cycle cancellation due to endometrial fluid collection were included. Laparoscopic repair of CSD was performed by a single gynecologic oncologist in accordance with the physician’s preference and patient consent. For patients in expectant management, diagnostic hysteroscopy and endometrial fluid suction were conducted prior to embryo transfer. Main results and the role of chance The age, BMI, gravidity, parity, or the number of previous cesarean section showed no statistical differences between the expectant management and the LSC repair group. The uterine position, either anteflexion was similar across groups. (all p value >0.05). Both the clinical pregnancy rate and live birth rate did not significantly differ between the expectant management group and the LSC repair group (26.0% vs 50.0%, p = 0.149, and 32.0% vs 60.0%, p = 0.149, respectively). The mean time to pregnancy was 7.38 months in the expectant management group and 9.80 months in LSC repair group, showed no significant difference (p = 0.240). Correlation analysis revealed a significantly moderate correlation between the initial depth of CSD and the depth of CSD at embryo transfer with clinical pregnancy (r = -0.424, P = 0.001). Furthermore, our data indicated that the CSD depth at embryo transfer was significantly impacted on clinical pregnancy outcomes from the multivariate regression logistic analysis (OR = 0.522, 95% CI [0.332 – 0.823]). Limitations, reasons for caution This study is retrospectively designed and including small sample size, caution is required in interpreting the findings. Wider implications of the findings This study suggests that the depth of niche influences clinical pregnancy outcomes. Laparoscopic repair may offer a viable treatment option who have experienced multiple failed cycles and increased depth of niche. Future studies with larger population studies may further indicate the LSC repair based on the depth of CSD. Trial registration number not applicable

Prevalence and Risk Associated With Bladder Injuries During Caesarean Section in a Secondary Care Hospital.

Introduction Bladder injury during caesarean section (CS) is not uncommon. Various factors increase the risk of bladder injury during CS, including prolonged labor with bladder distension, pregnancy with a scarred uterus, suspected intra-abdominal adhesions, distorted local anatomy, cesarean hysterectomy, and an increasing number of previous CS. Vigilant preoperative assessment and surgical precision are essential to mitigate these risks and ensure optimal outcomes for mother and child. Objectives To find out the prevalence and risk factors associated with bladder injuries during caesarean section. Methodology Hospital-based retrospective record review of 3600 pregnant women who had undergone cesarean section during the period January 2015 to December 2023 were included in the study. Data was analyzed using SPSS software, version 22 (trial version) (IBM Corp., Armonk, NY). The Chi-square test and Fisher's exact test were used. Ethical clearance was obtained from the Institutional Ethics Committee at Tata Main Hospital Noamundi (approval number NI/CMO/26/24). Result Bladder injury prevalence was reported to be 1.1%. Bladder injuries were significantly (p<0.0001) more among the CS cases with underlined complications as compared to CS cases without any underlined complications. Repeat CSs were found to have a significantly (p<0.001) higher proportion of bladder injuries compared to primary CS. Conclusion Bladder injuries during cesarean section are a significant concern. The risk factors identified, such as the number of previous cesarean sections and complications during pregnancy, highlight the importance of careful preoperative assessment and surgical precision to prevent such injuries.

Characterising umbilical abdominal wall endometriosis as a distinct subgroup of abdominal wall endometriosis – retrospective cohort study

Abdominal wall endometriosis (AWE) is one of the rarest forms of endometriosis. Little is known about differences between umbilical AWE (U-AWE) and non-umbilical AWE (non-U-AWE) patients. This retrospective cohort study included patients treated for AWE at tertiary endometriosis centre between 2012 and 2020. Patients were divided into two groups – umbilical AWE and non-umbilical AWE. We identified 14 U-AWE and 45 non-U-AWE patients who mostly had lesions in caesarean section scar (38, 64.4%), rarely at other locations (7, 11.9%). Infertility rates for U-AWE patients and non-U-AWE patients were 57.1% and 17.8%, respectively. Concurrent or previous peritoneal endometriosis was noted in 85.7% of U-AWE and 24.4% of non-U- AWE patients. In addition, U-AWE patients and non-UAWE patients significantly differed in following: parity, number of previous caesarean sections, lesion size, prevalence of concurrent or previous deep infiltrating endometriosis, bleeding from abdominal wall, cyclic pain, continuous pain. Infertility and pelvic endometriosis were more prevalent in U-AWE patients. Our data suggests that U-AWE may be a specific marker for a patient highly prone to pelvic endometriosis and subsequent infertility. Findings suggests that clinician should consider comprehensive evaluation of U-AWE patients.

The effects of 3D/Full HD and 2D/Ultra HD imaging systems on suturing skills during total laparoscopic hysterectomy: a prospective cohort study.

2D/Ultra HD and 3D/Full HD imaging systems can provide surgeons with more accurate and detailed views of the surgical site. We aimed to compare the effects of 2D/Ultra HD and 3D/Full HD laparoscopy systems on laparoscopic suturing skills during total laparoscopic hysterectomy. In this prospective cohort study, patients were recruited from a tertiary hospital, and demographic data and surgical data were recorded. The primary outcome measures were the durations of the total operation and vaginal cuff closure. Secondary outcome measures were colpotomy duration, total number of sutures placed, duration of first, second, third and fourth sutures, mean suturing duration, total operation duration, the surgeon's perception of difficulty during the vaginal cuff suturing and complications. The 3D/Full HD (n = 39) and 2D/Ultra HD (n = 42) groups were compared in terms of age, BMI, number of previous abdominal surgeries, number of previous cesarean sections, and type of delivery were examined. Both groups were considered homogeneous. The 3D/Full HD group was found to be superior in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD group (p < 0.05 for all). In conclusion, the use of 3D/Full HD laparoscopy systems can lead to improved surgical outcomes in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD systems.

Nomogram model for predicting invasive placenta in patients with placenta previa: integrating MRI findings and clinical characteristics

This study aims to validate a nomogram model that predicts invasive placenta in patients with placenta previa, utilizing MRI findings and clinical characteristics. A retrospective analysis was conducted on a training cohort of 269 patients from the Second Affiliated Hospital of Fujian Medical University and a validation cohort of 41 patients from Quanzhou Children’s Hospital. Patients were classified into noninvasive and invasive placenta groups based on pathological reports and intraoperative findings. Three clinical characteristics and eight MRI signs were collected and analyzed to identify risk factors and develop the nomogram model. The mode’s performance was evaluated in terms of its discrimination, calibration, and clinical utility. Independent risk factors incorporated into the nomogram included the number of previous cesarean sections ≥ 2 (odds ratio [OR] 3.32; 95% confidence interval [CI] 1.28–8.59), type-II placental bulge (OR 17.54; 95% CI 3.53–87.17), placenta covering the scar (OR 2.92; CI 1.23–6.96), and placental protrusion sign (OR 4.01; CI 1.06–15.18). The area under the curve (AUC) was 0.908 for the training cohort and 0.803 for external validation. The study successfully developed a highly accurate nomogram model for predicting invasive placenta in placenta previa cases, based on MRI signs and clinical characteristics.

A transvaginal ultrasound-based diagnostic calculator for uterus post-cesarean scar defect

BackgroundA cesarean scar defect (CSD) is incomplete healing of the myometrium at the site of a prior cesarean section (CS), complicating more than half of all cesarean sections. While transvaginal ultrasound (TVU) is the most common modality for diagnosing this defect, hysteroscopy remains the gold standard. We aimed to develop an efficient diagnostic tool for CSD among women with abnormal uterine bleeding (AUB) by integrating TVU findings and participants’ demographic features.MethodsA single-center cross-sectional study was conducted on 100 premenopausal and non-pregnant women with a history of CS complaining of AUB without a known systemic or structural etiology. Each participant underwent a hysteroscopy followed by a TVU the next day. The defect dimensions in TVU, patients’ age, and the number of previous CSs were integrated into a binary logistic regression model to evaluate their predictive ability for a hysteroscopy-confirmed CSD.ResultsHysteroscopy identified 74 (74%) participants with CSD. The variables age, the number of CSs, defect length, and defect width significantly contributed to the logistic regression model to diagnose CSD with odds ratios of 9.7, 0.7, 2.6, and 1.7, respectively. The developed model exhibited accuracy, sensitivity, and specificity of 88.00%, 91.89%, and 76.92%, respectively. The area under the receiver operating curve was 0.955 (P-value < 0.001).ConclusionAmong non-pregnant women suspected of CSD due to AUB, looking at age, the number of previous CSs, and TVU-based defect width and length can efficiently rule CSD out.

Plasenta akreta spektrumunu öngörmeye yönelik bir skorlama sistemi: prospektif bir çalışma

Purpose: The aim of this study was to assess the utility of a scoring system using selected ultrasonographic features to predict placenta accreta spectrum (PAS) and its severity in suspicion of PAS.&#x0D; Materials and Methods: This prospective study was conducted with a total of 27 pregnant women with placenta previa totalis with suspicion of PAS between 24 and 37 weeks gestation between July 2019 and January 2020. PAS score was calculated with the following parameters: loss of clear zone, number, size, and regularity of placental lacunae, turbulent flow in lacunae, uterovesical or subplacental hypervascularity, bridging vessels, and the number of previous cesarean section. Patients were divided into groups due to PAS scores and the severity of PAS. Receiver operating characteristics curves were performed to assess the performance of the PAS scoring system.&#x0D; Results: In a total of 27 patients, 7 (25.9%) patients did not have PAS, 5 (18.5%) patients had accreta, 7 (25.9%) patients had increta, and 8 patients (29.6) had percreta. In groups with PAS scores higher than 8, 86% of patients had placenta percreta. PAS score was 2.8±1.4 in the no PAS group, 3.6±1.9 in the accreta group, 5.1±2.4 in the increta group, 9.8±1.6 in the percreta group and statistically higher in the percreta group. The optimal cut-off values of the PAS score to predict abnormal placental invasion was 4.5 (60% sensitivity, 86% specificity), 7.5 for differentiation percreta from increta (87.5% sensitivity, 75% specificity)&#x0D; Conclusion: A PAS scoring system that combines several ultrasound and clinical characteristics may greatly improve prenatal risk assessment and prediction of PAS.

Evaluation of management of Cesarean Scar Pregnancy (CSP).

Objective: To evaluate our experience in treatment of Caesarean Scar Pregnancy (CSP). Study Design: Cross Sectional Descriptive study. Setting: Department of Gynecology and Obstetrics, Independent Medical College Faisalabad. Period: Jan 2016 to Jan 2021. Material &amp; Methods: The data for this study retrospectively obtained from outpatient department, emergency ward and labor ward registers. Data was analyzed by simple descriptive statics. Diagnosis of CSP was made by using transvaginal ultrasound and color flow Doppler ultrasound. Treatment offered was either medical management as systemic methotrexate or surgical as D&amp;C or laparotomy. The aim was to do conservative treatment for fertility sparing. Patient age, gestational age at time of presentation, number of previous Cesarean Section and success of overall management strategy was analyzed. Results: In this study we had 12 patients diagnosed to have CSP with at least one scar on uterus of previous caesarean section. The mean age of patients was 32.5± 2 years and the gestational age range was from 5 weeks and 3 days to 10 weeks and 1 day. The diagnosis was done by using transvaginal ultrasound and color flow Doppler ultrasound. Which showed high velocity and low impedance flow in sub trophoblastic area. Out of 12 patient’s 58.33 percent were treated with systemic methotrexate and had successful outcome. These were followed by B-hCG levels till non pregnant serum level of B-hCG of &lt;5.1IU was achieved. 16.66 percent patients underwent D&amp;C, but due to hemorrhage they were treated with laparotomy as supplementary procedure. 41.55 percent Patients were treated by laparotomy as their primary management with aim of fertility sparing surgery. The laparotomy was found to be successful treatment in all the patients who underwent surgical management as their primary treatment. Conclusion: Prompt diagnosis has pivotal role in reducing morbidity and mortality associated with CSP. Medical management is found to be successful at early gestational age. Fertility sparing surgery is better option as gestation advances more than 8 weeks to avoid undesirable outcome like hemorrhage and hysterectomy.

Intraoperative complications of multiple caesarean sections (literature review)

Multiple caesarean sections increase the risk of intraoperative complications: adhesions, damage to the pelvic organs (bladder, ureters, intestines), bleeding with the need for blood transfusion, abnormal placentation, hysterectomy for cae- sarean section, failure of the uterine scar, uterine rupture. The frequency of these complications increases in proportion to the number of previous caesarean sections. Although a causal relationship is often difficult to establish, some of these complications are likely related to surgically induced adhesions. Repeated cesarean section operations are associated with more complex surgical interventions: difficulties in opening the abdominal cavity, difficult separation of the uterus, bladder and ureters from adhesions, the need for blood transfusion and surgical correction of damage to neighboring organs (bladder, ureters, intestines), the need for additional surgical intervention such as hysterectomy . Reducing unnecessary primary caesarean sections and repeat caesarean sections, post-caesarean vaginal delivery, and careful surgical technique can significantly reduce intraoperative surgical complications.

Associated Factors with Vaginal Delivery on a Uni- or Bi-Scar Uterus in a Low-Resource Setting

Introduction: Delivery in a scar uterus is one of the most debated topics in obstetrics. The objective was to determine the uterine test and the maternal-fetal outcome in patients with uni- and bi-scared uterus who received the uterine test at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of patients who delivered on a uni- or bi-scareduterus at Panzi Hospital, between January 1, 2021 and August 1, 2022. Results: The average age of the patients was 27.09 years, with an age range of 25 - 34 years, they were mostly married (88.3%), with secondary educational level (60.4%). Pauciparous women, with a history of previous caesarean delivery once, represented respectively 52.2%; 7.2% of parturients with an intergenital space equal to 18 months. 63.9% were overweight, 58.6% had undergone more than three ANC sessions. We noted statistically significant associations between modes of admission, water sac, type of membranes rupture, uterine height and success of uterine test (p 0.05). We did not find significant associations between parturient age, gestational age, intergestational interval, pregnancy term, surgical history, number of ANC performed, number of previous caesarean sections, number of newborns. We did not record any cases of maternal death but one case of perinatal death with 0.9% in this study. Conclusion: A good selection of patients with uni- or bi-scared uterus would allow the reduction of the fetomaternal morbidity during the uterine test.

THE RELATIONSHIP OF PLACENTA ACCRETA SPECTRUM WITH PREVIOUS CESAREAN SECTION IN PATIENTS WITH PLACENTA PREVIA- A CASE-CONTROL STUDY IN TERTIARY CARE HOSPITAL OF PESHAWAR

Objective: To determine the relation of placenta Acreta Spectrum with previous Cesarean section in patients with placenta previa. Material and Methods: This case-control study was conducted in a tertiary care hospital in Peshawar from 1st July 2019 to 30th June 2021. All the cases with placenta Previa were included. Women with placenta Acreta Spectrum diagnosed on obstetric ultrasound served as cases. Patients with placenta previa without accrete served as controls. Their records were studied in detail and all the data was recorded in a Proforma specially designed for this study. Odds ratios at the end of the study were calculated using SPSS-23. Results: During our study period, a total of 102 patients with placenta previa were enrolled. The ages ranged between 20-45 years. The majority of the patients were &gt; 40 years old (31.3%). On the basis of gravidity, different groups were found i.e. 45 patients (44.1 %) were between G5-G6. A total of 14 women were found with placenta accrete spectrum making an incidence of 13.72%. Of all the patients’ i.e.100% (odd ratio 1.1) were having a history of previous Cesarean birth. 6 out of 14 patients (42.8%) had a history of previous 1 Cesarean section while two patients (10%) had a history of 4 c\s in the past. Nearly all patients had major placenta previa except one patient who had minor placenta previa (7%). Conclusion: Our study highlighted the striking relationship of placenta Accreta spectrum with previous Cesarean delivery in patients with placenta previa however it was not found that increasing the number of previous Cesarean sections resulted in an increased number of placentae Accreta spectrum. Keywords: Placenta Accreta spectrum, Cesarean section.

Perinatal outcomes of multiple cesarean sections

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

Small Bowel Injury During Peritoneal Entry at Cesarean Section: A Five-Year Case Series.

Introduction Small bowel injury during peritoneal entry may occur unexpectedly at cesarean section (CS) and may present unexpected management problems and prolonged postoperative hospital stay. Methods This was an observational study of patients who sustained inadvertent injuries compared to those who did not. Both study and control patients had the same number of previous cesarean sections. Findings In this study population, the frequency of small bowel injury during peritoneal entry was 0.0003/10,000 cesarean sections. The majority comprised serosal trauma (7/10) and tended to occur in females who had had two or more CS. Compared to patients with a similar number of previous cesarean sections, patients who sustained small bowel injuries in the index cesarean section were twice as likely to have had adhesiolysis of flimsy or dense lesions in the immediate preceding procedure. Conclusion Bowel injury during peritoneal entry at cesarean section is rare but may be frequently encountered in maternity units with high-volume CS rates.

Timing of cesarean delivery for women with four or more previous cesarean sections

Background/Aim: The number of recurrent cesareans is increasing worldwide, but the optimal timing for delivery in women who have had previous cesareans is controversial. The aim of this study is to determine the optimal timing of elective cesarean delivery in women with a history of four or more cesarean sections (CSs). Methods: This retrospective cohort study was conducted in a tertiary hospital; 195 patients with a history of four or more CSs were grouped according to their gestation weeks on operation day and analyzed in terms of demographic features and clinical data as well as maternal and neonatal outcomes. Gestation weeks were grouped as 37-38 weeks and 39 weeks. Logistic regression analysis was used to determine the effect of independent variables on maternal and fetal outcomes. Results: Of the 195 patients, 118 had CS between 37-38 weeks and 77 at 39 weeks. Clinical and demographic characteristics were similar among groups. The overall maternal complication did not differ between the groups (16.1% vs 16.9%, P = 0.885). The 1st and 5th minute APGAR scores were significantly lower in the 37-386 weeks group (P = 0.013 and P = 0.04, respectively). Logistic regression analysis found that neonatal 5th minute APGAR score was associated with a model including maternal age, number of previous CS, anesthesia type, gestational week at delivery, and neonatal birth weight. Conclusion: Timing CS at 39 weeks in patients with a history of four or more CSs was found not to worsen maternal outcomes. Additionally, planning at 39 weeks could improve newborn outcomes.

The safety of misoprostol alone use for second-trimester termination of pregnancy in women with previous caesarean deliveries

Purpose To investigate the safety of misoprostol use in second-trimester pregnancy termination among women with previous caesarean sections. Materials and methods This is a retrospective cohort study conducted in a tertiary centre, examining 359 patients whose pregnancy was terminated with misoprostol alone between 14 and 24 weeks with the indication of foetal anomalies. Two dose regimens were administered vaginally or sublingually: (1)400 mcg misoprostol every 3–6 h; (2) 200 mcg misoprostol every 3–6 h following a loading dose of 400 mcg. The patients were divided into three groups according to the number of previous caesarean sections (CSs) and compared in terms of demographic and clinical characteristics and complications. Termination-related complications were the primary outcomes considered. Results Of the 217 patients, 80 (36.8%) had no previous uterine scar, 79 (36.4%) had one previous CS, and 58 (26.7%) had at least two prior CSs. The overall complication rate was 0.9%. There were no differences among groups in terms of complications (p > 0.05). There was no difference in complications in women with prior CS when they were compared according to the misoprostol regimens used (p > 0.05). The total dose of misoprostol used ranged from200 to 3,600 mcg. The treatment success of misoprostol during the second trimester was 92.1%. According to regression analysis, an increase in the week of gestation increased the failure rate of misoprostol for inducing second-trimester abortion by 2.7 times (95%CI (1.38–5.39)). Conclusion Misoprostol alone is a safe and effective option for terminating second-trimester pregnancies with one or more previous CSs in settings where mifepristone is unavailable.

Contributing Factors for Placenta Accreta in Patients Presenting in a Tertiary Care Hospital

Objective: determine the frequency of contributing factors for placenta accreta in patients presenting in a tertiary care hospital Methodology: The study was conducted on all the pregnant patients diagnosed with placenta preavia on ultrasound that were admitted through emergency and outpatient department of Lady Willingdon Hospital Lahore. A total of 180 patients fulfilling the inclusion/exclusion criteria coming to the Emergency Department were recruited in study. Contributing risk factors i.e. placenta previa, number of previous caesarean sections, and Dilatation &amp; Curettage were recorded by the researcher herself on a pre-designed proforma attached. Data was collected and analyzed by single researcher to overcome the bias. Results: In our study, out of 180 cases, 73.33%(n=132) were between 20-30 years of age while 26.67%(n=48) had &gt;30 years of age, mean+sd was calcualted as 27.89+4.14 years, 73.33%(n=132) were between 20-30 years of age while 26.67%(n=48) had &gt;30 years of age, mean+sd was calcualted as 27.89+4.14 years, contributing factors of placenta accreta shows that 87.22%(n=157) had placenta previa, 51.67%(n=93) had &lt;2preivous cesarean section, 48.33%(n=87) had 3 previous cesarean section and 27.22%(n=49) had D&amp;C. Conclusion: We concluded that Placenta previa is a leading contributing factor followed by 2 and 3 cesarean sections and D&amp;C for placenta accreta. Keywords: Placenta accreta, contributing factors, placenta previa, previous cesarean section, dialatation &amp; curettage

P-407 Pregnancy outcomes of different endometrial preparation in patients with a history of cesarean section

Abstract Study question To investigate the efficacies of three cycle regimens in women receiving frozen embryo transfer with a history of cesarean section(CS). Summary answer In women undergoing frozen embryo transfer with a history of CS, hormone replacement therapy for endometrial preparation was associated with a higher early miscarriage rate. What is known already Rates of CS are rising worldwide. Many women with a history of a CS delivery conceived through assisted reproductive technology (ART) are in need of frozen embryo transfer (FET) for their second progeny. Various protocols for endometrium preparation have been used to provide an optimal uterine environment for the transfer of thawed embryos, but the evidence supporting the superiority of one protocol over another is insufficient. Study design, size, duration A retrospective cohort study of patients (N = 6,159) with a history of CS who fulfilled the inclusion criteria were enrolled in the study from January 2014 to December 2019 at the CITIC-Xiangya Hospital of Reproduction and Genetics. Participants/materials, setting, methods Reproductive outcomes of patients in the natural cycle （NC） (n = 4,306) versus hormone replacement therapy（HRT） (n = 1,007) versus gonadotropin-releasing hormone agonist （GnRH-a） + HRT groups (n = 846) were compared. Multiple logistic regression analyses were performed to investigate the potential confounding factors. Main results and the role of chance The unadjusted odds of the miscarriage rate of singleton pregnancies were also significantly higher in the hormone replacement therapy compared with the natural cycle (25.5% versus 20.4%, respectively). After adjusting for possible confounding factors, the early miscarriage rate and the miscarriage rate of singleton pregnancies remained significantly higher in the hormone replacement therapy than the natural cycle. The clinical pregnancy rates in the hormone replacement therapy, hormone replacement therapy and treatment with gonadotropin-releasing hormone agonist of women with a history of cesarean section was 48.8%, 48% and 47.1%, respectively, and the live birth rates were 37%, 34.1% and 35.7%, respectively. Limitations, reasons for caution This study is limited by its retrospective design. Furthermore, the detailed ultrasound information on uterine myometrial defects, complications related to CS and the number of previous CSs were unavailable in our study. Another limitation is that pregnancy-related complications and neonatal outcomes were not analyzed. Wider implications of the findings Our study could help physicians improve their understanding of the impact of different protocols on pregnancy outcomes in patients with a history of CS. Prospective randomized trials should be conducted to assess the efficacy of endometrial preparation protocols for FET in women with a history of CS. Trial registration number not applicable

The fetal and maternal outcomes related to previous number of cesarean sections and uterus sparing surgery in women with abnormal placentation

Objectives. We aimed to study the number of previous cesarean sections in cases diagnosed with placenta previa (PP) and placenta accreta spectrum (PAS), and maternal and fetal results in cases where we performed uterus-sparing surgery. Materials and Methods. PAS patients diagnosed with PP (PPAS) were included in this retrospective study. Postoperative hemogram values, blood transfusion amounts, hospitalization days, intraoperative and postoperative complication rates of all patients, APGAR scores (5-minute), mortality rates and birth weights were registered for all newborns on admission to the intensive care unit. Results. A total of 122 pregnant women were included in the study. In the comparison of hospitalization rates, there was a significant difference between CS ≤1 and CS =2 (p=0.01). When postoperative hemoglobin values were compared, there was significant difference between CS ≤1 and CS ≥3 (p&lt;0.01). Neonatal intensive care admission rates increase as the number of CS increases. Conclusions. Uterus-sparing surgery in experienced clinics seems to be applicable, even if maternal and fetal morbidity increases. We suggest to consider CS numbers in PPAS group for fetal and maternal wellness while doing surgical planning.

The comparison of maternal and neonatal outcomes between emergency and planned cesarean deliveries in women with placenta previa

Objectives: To compare maternal and neonatal outcomes concerning emergency or planned cesarean deliveries in pregnancies complicated by placenta previa (PP), and to evaluate factors related to blood transfusion requirement. Methods: Three hundred sixty-three women with PP with (n = 80) and without (n = 283) placenta accreta spectrum (PAS) who delivered between May 2016 and May 2021 were retrospectively reviewed. The patients were allocated to two main groups as PAS and non-PAS and into two subgroups as emergency cesarean delivery (ECD) and planned cesarean delivery (PCD). Results: One hundred twenty-eight deliveries were emergency and 155 were planned in non-PAS group. In PAS group 38 patients were delivered urgently and 42 were delivered as planned. General anesthesia was preferred more frequently in emergency cases. Gestational age, birth weight, and the 1st and 5th minute APGAR scores of the infants were significantly lower and neonatal intensive care unit (ICU) admission was significantly higher in the ECD cases (p &amp;lt; 0.001) in both PAS and non-PAS groups. The total amount of blood and blood product transfused (p = 0.005), length of hospital stay (p = 0.022) were higher in the ECD cases and adult ICU admission was significantly higher in the ECD cases in non-PAS group (p = 0.016). In multilinear regression analysis, the need for blood transfusion was found to increase with the number of previous cesarean sections, ECD, PP with PAS, general anesthesia, and uterine artery ligation. Conclusions: In placenta previa, which is an obstetric condition associated with serious maternal and neonatal morbidity and mortality, adverse maternal and neonatal outcomes increase in cases of emergency cesarean delivery.