Number Of Previous Cesarean Sections Research Articles

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 < 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.

Risk Factors and Pregnancy Outcome in Women with a History of Cesarean Section Complicated by Placenta Accreta

Abstract Objective: To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA). Methods: This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta. Results: For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21% vs. 231/869,26.58%) was significantly increased in the PA group (P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00–3520.00) g vs. 2920.00 (2530.00–3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly (P < 0.05). Weight (odds ratio (OR) = 1.03, 95% confidence interval (CI): 1.01–1.05)), parity (OR = 1.18, 95%CI: 1.03–1.34), number of miscarriages (OR = 1.31, 95%CI: 1.17–1.47), number of previous cesarean sections (OR = 2.57, 95%CI: 2.02–3.26), history of premature rupture of membrane (OR = 1.61, 95%CI: 1.32–1.96), previous cesarean-section transverse incisions (OR = 1.38, 95%CI: 1.12–1.69), history of placenta previa (OR = 2.44,95%CI: 1.50–3.96), and the combination of prenatal hemorrhage (OR = 9.95,95%CI: 8.42–11.75) and placenta previa (OR = 91.74, 95%CI: 74.11–113.56) were all independent risk factors for PA. Conclusion: There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

Repeatability and reproducibility of quantitative cervical strain elastography (E-Cervix) in pregnancy

Strain elastography of the uterine cervix may be useful in the diagnosis and prediction of obstetric complications. The inability to obtain quantitative results, with only the possibility of visual semiquantitative evaluation of the obtained elastograms, has been the limitation of the method thus far. E-Cervix is a software program that uses intrinsic compression to excite tissue and allows the evaluation of quantitative parameters on the basis of pixel distribution in an elastogram. The aim of this study was to assess the repeatability and reproducibility of quantitative cervical strain elastography (E-Cervix) of the uterine cervix and to assess the correlation of the obtained parameters with selected clinical features of patients in the third trimester of pregnancy. In total, 222 patients participated in the study. We assessed 5 ultrasound parameters: elasticity index (ECI), hardness ratio (HR), internal os strain (IOS), external os strain (EOS) and IOS/EOS ratio. Each study was performed according to a predetermined standardized protocol. For all assessed elastographic parameters, we obtained good intra- and interobserver reproducibility. The interclass correlation coefficient (ICC) ranged from 0.77 to 0.838 for intraobserver variability and from 0.771 to 0.826 for interobserver variability. We demonstrated a significant correlation of some obtained elastographic parameters with the basic clinical features of patients, such as age, the number of previous caesarean sections, pregnancy weight and BMI. In each case, the correlation was very low. Quantitative elastographic assessment with the use of E-Cervix is characterized by good repeatability. Some clinical features may affect the value of the parameters obtained. The clinical relevance of this interference requires further investigation.

Risk factors and clinical outcomes for placenta accreta spectrum with or without placenta previa.

To clarify risk factors and clinical outcomes for placenta accreta spectrum (PAS) stratified by placenta previa. We conducted registry-based multicenter cross-sectional study including 472,301 singleton deliveries between 2013 and 2015. PAS was considered as a primary outcome, as well as maternal age, parity, history of cesarean section, history of miscarriage, and assisted reproductive technology (ART) were considered as potential exposures. A multivariable Poisson regression analysis was conducted to assess the risk for PAS, stratified by placenta previa. In addition, the risk for subsequent blood transfusion and hysterectomy by each exposure using multivariable Poisson regression analysis was conducted. There were 426 and 1827 cases of PAS with and without placenta previa. Among cases with placenta previa, the number of previous cesarean sections was the most powerful predictor for PAS [adjusted risk ratio (aRR) for one previous cesarean section 5.34, 95% confidence interval (CI) 3.70-7.71; aRR for two or more previous cesarean section 16.5, 95% CI 11.5-23.6]. Among cases without placenta previa, previous cesarean section was not a significant predictor, whereas the strongest predictor was conception through ART (aRR 5.05, 95% CI 4.50-5.66). Although the risks of PAS for blood transfusion and hysterectomy were higher among cases with placenta previa, those without placenta previa also demonstrated non-negligible risks. The current study demonstrated that history of cesarean section was the strongest risk factor for PAS among women with placenta previa. Among those without placenta previa, ART was an important predictor, but not cesarean section.

Prenatal and Obstetric Parameters of Late Terminations: A Retrospective Analysis.

Background In Germany, the highly sensitive issue of late terminations of pregnancy and feticide is regulated in Sec. 218a para. 2 of the German Penal Code (medical indication). This study aimed to investigate the prenatal obstetric approach after feticide and the rate of maternal complications. Material and Methods All feticides of singleton pregnancies carried out at Leipzig University Hospital (n = 164) in the period between 01/2016 and 12/2019 were retrospectively analyzed. Selective feticides of multiple pregnancies were excluded from the study. Target indicators for the prenatal obstetric approach were sonographic accuracy of estimation, method used to induce feticide, time between feticide and delivery, and whether curettage was required. The rate of maternal complications was defined as blood loss of ≥ 500 ml. Results The number of feticides as a percentage of the total number of births during the investigation period was 1.6%. None of the terminations were performed primarily because of a serious risk to the motherʼs physical health; all of the indications to terminate the pregnancy were based on the psychosocial burden and the risk to the motherʼs mental health as outlined in Sec. 218a StGB (German Penal Code). The most common fetal diagnoses in the context of a maternal psychosocial emergency were central nervous system abnormalities (29.3%), numerical chromosomal aberrations (29.3%) and structural chromosomal aberrations/syndromes (21.3%). Sonographic measurements were used to estimate fetal weight and the weight of around half of the fetuses was underestimated (− 121.8 ± 155.8 g). The margin of estimation error increased with increasing gestational age (p < 0.001). Misoprostol was the most common drug administered to induce labor. No significant association was found between the method chosen for induction, parity, fetal birth position, fetal anomaly, fetal gender, birth mode or the number of previous cesarean sections and Δdelivery . However, a significantly higher loss of blood was observed with longer Δdelivery (p = 0.02). The likelihood of requiring curettage increased with increasing loss of blood. The number of maternal complications as a percentage of the total patient population was 10.4%. Only 11% of patients agreed to a postmortem examination. Conclusion Late terminations of pregnancy carried out in accordance with Sec. 218a para. 2 StGB are a reality and must be understood and accepted as a possible consequence of modern prenatal medicine. The complication rate after feticide and the subsequent obstetric procedure was 10% for the above-defined maternal complication. Late terminations and their obstetric management should be carried out in specialized perinatal centers which offer interprofessional expertise.

Prediction of placenta accreta spectrum in patients with placenta previa using clinical risk factors, ultrasound and magnetic resonance imaging findings.

To predict placental accreta spectrum (PAS) in patients with placenta previa (PP) evaluating clinical risk factors (CRF), ultrasound (US) and magnetic resonance imaging (MRI) findings. Seventy patients with PP were retrospectively selected. CRF were retrieved from medical records. US and MRI images were evaluated to detect imaging signs suggestive of PAS. Univariable analysis was performed to identify CRF, US and MRI signs associated with PAS considering histology as standard of reference. Receiver operating characteristic curve (ROC) analysis was performed, and the area under the curve (AUC) was calculated. Multivariable analysis was also performed. At univariable analysis, the number of previous cesarean section, smoking, loss of the retroplacental clear space, myometrial thinning < 1mm, placental lacunae, intraplacental dark bands (IDB), focal interruption of myometrial border (FIMB) and abnormal vascularity were statistically significant. The AUC in predicting PAS progressively increased using CRF, US and MRI signs (0.69, 0.79 and 0.94, respectively; p < 0.05); the accuracy of MRI alone was similar to that obtained combining CRF, US and MRI variables (AUC = 0.97) and was significantly higher (p < 0.05) than that combining CRF and US (AUC = 0.83). Multivariable analysis showed that only IDB (p = 0.012) and FIMB (p = 0.029) were independently associated with PAS. MRI is the best modality to predict PAS in patients with PP independently from CRF and/or US finding. It is reasonable to propose the combined assessment of CRF and US as the first diagnostic level to predict PAS, sparing MRI for selected cases in which US findings are uncertain for PAS.

A Comparison of Treatment Options for Type 1 and Type 2 Caesarean Scar Pregnancy: A Retrospective Case Series Study.

Background: There is currently no agreement on the optimal management of caesarean scar pregnancy. Caesarean scar pregnancy is currently categorised into two subtypes according to the site of implantation. This may consequently result in the difference in treatment options. However, the comparison of the success rate of each treatment option according to the subtypes has not been fully investigated.Methods: 71 patients who were treated by uterine curettage (D and C), or uterine artery embolization with curettage (UAE) or hysteroscopy in conjunction with laparoscopy between January 2016 and March 2020 were included. Data on maternal age, gestational sac age, the sac diameter, the interval between two pregnancies, the number of previous caesarean sections, amount of bleeding and β-hCG levels were collected and analysed dependent on the subtypes.Results: There was no difference in the clinical parameters of the cases who received different options of treatment, as well as no difference in the clinical parameters between type 1 and type 2 caesarean scar pregnancy. The primary success rate for type 1 caesarean scar pregnancy by D and C, or UAE, or hysteroscopy in conjunction with laparoscopy was 95, or 100 or 100%, respectively. The primary success rate for type 2 caesarean scar pregnancy by D and C, or UAE, or hysteroscopy in conjunction with laparoscopy was 27, or 67, or 95% respectively.Conclusion: Our data demonstrates that hysteroscopy in conjunction with laparoscopy for type 2 caesarean scar pregnancy was the most successful compared to other options, but for type 1 caesarean scar pregnancy, D and C could be the cost-effective option.

A New Modified Hysteroscopic-Laparoscopic Surgery for Cesarean Scar Pregnancy of Stable Type III.

ObjectiveTo introduce a modified hysteroscopic-laparoscopic operation for cesarean scar pregnancy (CSP) of stable type III.Patients and MethodsWe retrospectively studied the case notes of 31 patients with stable type III cesarean scar pregnancy who underwent hysteroscopic-laparoscopic surgery in our hospital. Thirteen patients received the modified hysteroscopic-laparoscopic surgery (modified surgery group), and eighteen patients received traditional hysteroscopic-laparoscopic surgery (traditional surgery group).ResultsThere was no significant difference in patients’ age, gestational age, number of previous cesarean sections, the serum human chorionic gonadotropin (hCG) level before surgery, gestational sac diameter, myometrium thickness between the two groups. In the modified hysteroscopic-laparoscopic surgery, the mean surgical time was 50.45±24.45 mins, the mean length of stay in hospital was 4.50±0.50 days, which was significantly shorter than the traditional surgery group (84.75±33.28 mins and 5.50±0.75 days, respectively). And the intraoperative hemorrhage in the modified group was also less than that in the traditional group (40.50±12.25 mL vs 75.33±25.45mL). Whereas the time for hCG normalization, postoperative vaginal bleeding and menstrual recovery had no significant difference between the modified surgery group and the traditional surgery group. There was no recurrence of CSP in both groups.ConclusionThe modified hysteroscopic-laparoscopic surgery had shorter operation time, less blood loss, and sooner recovery time after surgery compared to traditional hysteroscopic-laparoscopic surgery, which could be more beneficial to our patients and should be applied in clinics generally.

The neonatal respiratory morbidity associated with early term caesarean section – an emerging pandemic

To examine the impact of early term caesarean section (CS) on respiratory morbidity and early neonatal outcomes when elective caesarean section was carried out before 39 completed weeks gestation in our population. A one-year population-based retrospective cohort analysis using routinely collected hospital data. Livebirths from women who had elective lower segment cesarean section (ELSCS) for uncomplicated singleton pregnancies at early term (ET) 37+0 to 38+6 weeks were compared to full term (FT)≥39+0 weeks gestation. Exclusion criteria included diabetes, antenatal corticosteroid use, stillbirths, immediate neonatal deaths, normal vaginal deliveries and emergency caesareans sections. The outcomes were combined respiratory morbidity (tachypnea [TTN] and respiratory distress syndrome [RDS]), Apgar <7 at 5min of age, respiratory support, duration of respiratory support and NICU admission. Out of a total of 1,466 elective CS with term livebirths, the timing of CS was early term (ET) n=758 (52%) and full term (FT) n=708 (48%). There was a higher incidence of respiratory morbidities and neonatal outcomes in the ET in comparison to FT newborns. In the univariable analysis, significant risks for outcomes were: the need for oxygen support OR 2.42 (95% C.I. 1.38-4.22), respiratory distress syndrome and/or transient tachypnea of newborn (RDSF/TTN) OR 2.44 (95% C.I. 1.33-4.47) and neonatal intensive care unit (NICU) admission OR 1.91 (95% C.I. 1.22-2.98). Only the need for oxygen support remained (OR 1.81, 95% C.I. 1.0-3.26) in the multivariable analysis. These results were observed within the context of a significantly higher proportion of older, multiparous, and higher number of previous caesarean sections in the early term CS group. There is a significant risk of respiratory morbidities in infants born by elective cesarean section prior to full term gestation. Obstetricians should aim towards reducing the high rate of women with previous multiple cesarean sections including balancing the obstetric indication of early delivery among such women with the evident risk of neonatal respiratory morbidity.

Prediction of success of uterus-preserving management in women with placenta accreta spectrum (CON-PAS score): A multicenter international study.

To create a model for prediction of success of uterine-preserving procedures in women with placenta accreta spectrum (PAS). PAS-ID is a multicenter study that included 11 centers from 9 countries. Women with PAS, who were managed between January 1, 2010 and December 31, 2019, were retrospectively included. Data were split into model development and validation cohorts, and a prediction model was created using logistic regression. Main outcome was success of uterine preservation. Out of 797 women with PAS, 587 were eligible. Uterus-preserving procedures were successful in 469 patients (79.9%). Number of previous cesarean sections (CS) was inversely associated with management success (adjusted odds ratio [aOR] 0.02, 95% confidence interval [CI] 0.001-3.63 with five previous CS). Other variables were complete placental invasion (aOR 0.14, 95% CI 0.05-0.43), type of CS incision (aOR 0.04, 95% CI 0.01-0.25 for classical incision), compression sutures (aOR 2.48, 95% CI 1.00-6.16), accreta type (aOR 3.76, 95% CI 1.13-12.53), incising away from placenta (aOR 5.09, 95% CI 1.52-16.97), and uterine resection (aOR 102.57, 95% CI 3.97-2652.74). The present study provides a prediction model for success of uterine preservation, which may assist preoperative and intraoperative decisions, and promote incorporation of uterine preservation procedures in comprehensive PAS protocols.

Gynecological outcomes of uterine niche after cesarean section: A descriptive study

Objectives: Our aim was to study the prevalence of isthmocele in cases with previous cesarean section scar presented to El Shatby maternity university hospital and its association with gynecological complications. Material and Methods: After approval of the ethics committee of Alexandria faculty of medicine, a sample of 300 patients delivered by cesarean section since 6 months or more presented by one or more of the following symptoms: Abnormal uterine bleeding (AUB) dysmenorrhea, secondary infertility, and lower abdominal pain were selected from the gynecology clinic of El Shatby maternity university hospital. All patients were subjected to history taking, clinical, and gynecological examination. Post-menstrual 2D transvaginal ultrasonography was done. Where the niche or isthmocele was seen as triangular or dome- shaped echo-free space. Data were collected and entered to the computer using Statistical Package for the Social Science program for statistical analysis. Results: Niche was found in 44 cases. Most of them were symptomatic. Duration from the last (CS) was statistically significant. Symptoms were related to number of previous cesarean sections. Conclusion: The incidence of post-cesarean section niche in El Shatby Maternity hospital was 14.67%. Most common symptoms were AUB and dyspareunia.

Surgical management for type II cesarean scar pregnancy

Background: Cesarean scar pregnancy (CSP), a rare type of ectopic pregnancy, can lead to adverse pregnancy outcomes. However, there is no uniform international treatment guideline for CSP. In this study, we retrospectively analyzed the advantages and disadvantages of three different surgical methods for type II CSP, trying to find the best treatment plan. Methods: From January 2013 to December 2018, a retrospective analysis was performed in 58 patients with type II CSP admitted to the Department of Gynecology, Second Affiliated Hospital of Anhui Medical University. 20 patients underwent hysteroscopic resection (Group A), 18 patients underwent laparoscopic resection and repair (Group B), and 20 patients underwent vaginal resection and repair (Group C). All patients were treated with preventive uterine artery embolization (UAE) preoperatively. The clinical data were collected, and the treatment effects of the different surgical methods were compared. Results: Age, gravidity, parity, number of previous cesarean sections, time period since the last cesarean section, menolipsis days, and preoperative level of the beta-subunit of human chorionic gonadotropin (β-hCG) were not significant different among the three groups (P &gt; 0.05). The differences in operation time (46.85 ± 20.91 min vs. 105.78 ± 32.95 min vs. 67.85 ± 32.88 min), intraoperative blood loss (45.00 ± 17.32 mL vs. 262.22 ± 235.74 mL vs. 166.50 ± 150.66 mL), postoperative hemoglobin level decreased (11.60 ± 5.60 g/L vs. 20.11 ± 7.72 g/L vs. 14.95 ± 5.40 g/L), and menstrual cycle recovery time (35.40 ± 6.31 day vs. 30.11 ± 5.04 day vs. 30.80 ± 4.62 day) were significant different. Conclusions: Hysteroscopic, laparoscopic, and transvaginal surgery can effectively treat type II CSP. Treatment should be individualized according to the diameter of the gestational sac, the patient’s fertility requirements as well as the doctor’s surgical experience and the surgical equipment of the local hospital.

A practical FIST maneuver to minimize the bleeding during cesarean hysterectomy for placenta percreta: a retrospective comparative study

Background Placenta percreta (PP) is a life-threatening condition and its surgery poses a very high potential for bleeding. The recommended treatment is a cesarean hysterectomy. There are several techniques reported in the literature to reduce the bleeding during percreta operations. Objective To show and describe a practical and novel intraoperative maneuver to minimize the hemorrhage during cesarean hysterectomy for PP. Methods The patients who were diagnosed with PP and underwent cesarean hysterectomy (CH) in our unit between 2016 and 2020 were retrospectively evaluated. These patients were divided into two groups. Group A included patients who underwent hysterectomy with intraoperative FIST maneuver. Group B included patients with ordinary cesarean hysterectomy. The groups were compared with regards to the intraoperative bleeding, surgical complications, and perioperative outcomes. Results Seventy-two patients who had a cesarean hysterectomy and diagnosed with PP during the study period were included in this retrospective cohort. 22 patients underwent intraoperative FIST maneuver with CH as Group A and 50 patients underwent ordinary CH as Group B. The demographic variables including maternal age, gravida, number of previous cesarean sections, and body-mass index were not statistically different between the two groups. Intraoperative FIST maneuver was significantly associated with reduced operative hemorrhage, the need for transfusion of erythrocyte suspension, admission to intensive care unit, and hospitalization days (p < .005). The operative time was statistically significantly shorter in Group A than Group B, respectively (90 ± 18.6 vs 120 ± 20.5 min) (p < .05). Conclusion FIST maneuver is a very practical, easy to apply, and effective method that reduces the obstetrical bleeding during cesarean hysterectomy in placenta percreta cases.

Dehiscence of cesarean section scar during pregnancy and delivery — risk factors

We wanted to identify risk factors for dehiscence of cesarean section (CS) scars in patients undergoing repeated cesarean section. This was a retrospective case-control study over a 3-year period in our medical center (2011-2014), comparing women who had repeated CS without complications and women diagnosed with dehiscence. Data were collected from medical records and the groups were compared for demographic and obstetrical data. Dehiscence was identified in 27 women, while 54 women without dehiscence were the control group. Statistically significant differences were found in the need for augmentation, the number of previous cesarean sections, cesarean section in the active phase of labor and length of hospitalization. The need for augmentation of labor, CS in the nonactive stage and more than one cesarean section, all increased the risk of dehiscence. There was no association between dehiscence and scar pain, time elapsed since the previous cesarean section, the method of wound closure or fever.

Retrospective Evaluation of Placenta Previa Cases: A Secondary-center Experince

Abstract Aim: The aim of this study was to retrospectively evaluate the maternal and neonatal outcomes of placenta previa cases managed in our hospital. Material and methods: The records of 107 placenta previa cases delivered between 2010 and 2015 were retrospectively reviewed. Age, gravida, parity, red blood cell (RBC)-fresh frozen plasma (FFP) transfusion necessity, gestational week at birth, birth weight, 1st and 5th minute Apgar score, number of previous cesarean sections, requiring additional surgical intervention (Hypogastric artery ligation [HAL], peripartum hysterectomy) and maternal complications were examined. Results: RBC-FFP transfusion and HAL rates were significantly higher incomplete placenta previa cases than the partial placenta previa cases. RBC-TDP transfusion, HAL and peripartum hysterectomy rates were significantly higher in placenta accreata spectrum (PAS) cases compared to those cases with normal placental invasion. Prematurity risk increased in all placenta previa subgroups. Conclusion: Pregnancy complicated by placenta previa increases the risk of adverse maternal and neonatal outcomes, especially if there is a concomitant placental invasion anomaly. Keywords: Placenta previa, Placenta accreata spectrum, Hypogastric artery ligation, Peripartum hysterectomy.

Etiopathogenesis and risk factors for placental accreta spectrum disorders.

Placenta accreta spectrum (PAS) disorders, comprising placenta accreta, increta, and percreta, are associated with serious maternal morbidity and mortality in both the developed and the developing world. The incidence of PAS has increased in the recent years, and the rising rates of cesarean section rate, placenta accreta in previous pregnancies, and other uterine surgeries including myomectomies and repeated endometrial curettage are implicated in its etiopathogenesis. The absolute risk of PAS increases with the number of previous cesarean sections. The PAS remains undiagnosed in one-half to two-thirds of cases, thus increasing maternal morbidity and mortality. Understanding etiopathogenesis and risk factors of this condition allows early diagnosis and planning of delivery, and thereby would help improve maternal and fetal outcomes.

Effect of previous cesarean sections on second-trimester uterine artery Doppler.

In this study, we investigated the effects of previous cesarean sections on uterine artery Doppler indices. This prospective cohort study included 153 healthy pregnant women between 18 and 24 weeks of gestation. Seventy-three pregnant women without previous cesarean sections (control group) and 80 pregnant women with previous cesarean sections (study group) were compared in terms of uterine artery Doppler indices. The mean uterine artery pulsatility index (PI) MoM value was 1.18 ± 0.40 in the study group and 1.07 ± 0.35 in the control group (P = 0.046). The number of patients with uterine artery PI values above 95 percentile was 18 (22.5%) in the study group and 5(6.8%) in the control group (P = 0.007). The mean gestational age at birth was significantly lower in the study group (38.2 ± 1.3 vs. 39 ± 1.0, P < 0.001). There was no significant difference between the mean PI, resistance index (RI) and systolic/diastolic (S/D) ratio values of the uterine artery (P = 0.16, 0.11, 0.08, respectively). When the comparison was made with the number of previous cesarean sections, all three index values of the patients who had had more than two cesarean sections were found to be significantly higher. The Doppler flow indices of the uterine artery significantly increased in patients with more than two previous cesarean sections. When evaluating uterine artery Doppler indices in pregnant women with a history of previous cesarean sections, these factors should be considered.

Lower-Segment Transverse Cesarean Section.

Cesarean section is the ultimate method of successful delivery of infants under various circumstances and is an indispensable operation in obstetrics. However, the degree of difficulty varies greatly depending on the gestational weeks, number of fetuses, number of previous cesarean sections, degree of placental adhesion, presence of uterine myomas, maternal obesity, and other factors. In addition, emergency cesarean section is a battle against time, and prompt surgery is required.During training in cesarean section, surgeons must master the basic techniques in cases of term head presentation first. They must then master the techniques in cases involving complications such as malpresentation, preterm birth, placenta previa, abruptio placentae, uterine myomas, and other conditions.Cesarean section itself is a simple operation. However, there are many difficult cases, and many complications such as placenta accreta and defects of the incision scar may occur after cesarean section.The present report describes the basic procedures and cautionary points to perform the cesarean section without complications.

TO ANALYSE PER OPERATIVE FINDINGS IN PATIENTS WITH REPEAT CESAREAN SECTION: A HOSPITAL BASED STUDY

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

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

TitleOutcome of multiple cesarean sections in a tertiary maternity hospital in the United Arab Emirates. ObjectiveTo describe the operative outcomes, clinical findings, maternal morbidity and neonatal outcome associated with increasing numbers of cesarean deliveries. DesignRetrospective study. SettingCorniche Hospital, Abu Dhabi, United Arab Emirates. PopulationThe study cohort was 1008 women giving birth by cesarean section who had previously undergone one or more cesarean sections, who had a singleton pregnancy, and who were not in labor. MethodsA retrospective study was undertaken over the one-year period from January 2016 to December 2016. Women were divided into five groups according to number of previous cesarean sections. The first group comprised of women who had one previous cesarean section, the second group women who had two previous cesarean sections, the third group consequently three previous cesarean sections and the fourth group four previous cesarean sections, whereas in the fifth group women had previously five or more previous cesarean sections. The maternal and neonatal outcomes of the groups were retrospectively evaluated. ResultsThe risks of placenta previa, placenta accreta, uterine dehiscence or rupture, postpartum hemorrhage, blood transfusion, bladder injury, lengths of operative time and hospital stay, and number of admissions to the high dependency unit increased with increasing numbers of previous cesarean sections. Women with five or more previous cesarean sections had a 10-fold increased risk of placenta previa (odds ratio [OR], 9.8; 95 % confidence interval [CI], 3.3–28.6), a 27 - fold increased risk of placenta accreta (OR, 26.5; 95 % CI, 4.2–166.3), and an 11-fold increased risk of uterine dehiscence or rupture (OR, 11.3; 95 % CI, 1.8–70.8). DiscussionThe results of our study indicate that serious maternal morbidity increases with increasing numbers of previous cesarean sections. Women planning large families should consider the risks of repeat cesarean sections when contemplating elective primary cesarean delivery or attempted vaginal birth after one previous cesarean section.