Previous Cesarean Research Articles

Perinatal Morbidity Among Women With a Previous Cesarean Delivery (PRISMA Trial): A Cluster-Randomized Trial

(Lancet. 2024; 403:44–54. doi: 10.1016/ S0140-6736(23)01855-X) Pregnant women with a previous cesarean delivery (CD) face a difficult decision between attempting a trial of labor after a cesarean (TOLAC), hoping for a successful vaginal delivery (VD), or opting for a planned repeat CD. Recent studies suggest women need support in decision-making as both delivery modes have unique risks. TOLAC is associated with a risk of uterine rupture and perinatal complications, while repeat CD is associated with an increased risk of maternal complications.

May the indication for a previous cesarean section affect the outcome at trial of labor in women with induction of labor? Aretrospective cohort study.

Cesarean sections are increasing worldwide and are associated with altered risks of complications for both mother and child. Vaginal birth after cesarean section is associated with lower maternal and neonatal morbidity than in repeat cesarean section. Only a few studies have considered the indication for the previous cesarean section to be of importance for the outcome of subsequent labor. The aim of this study was to evaluate whether the indication for a previous cesarean section affects the outcomes at a subsequent delivery in women with induction of labor. This retrospective cohort study of the four largest delivery units in Stockholm during 2012-2015 included 1150 women with one previous cesarean section with induction of labor. women with induced labor and a previous cesarean section, singleton pregnancy, cephalic presentation, gestational age of ≥34 weeks. The women were grouped by indication for the previous cesarean section. mode of delivery (vaginal birth after previous cesarean section or repeat cesarean section). induction to delivery time, postpartum hemorrhage, uterine rupture. Neonatal outcomes: birth weight, Apgar score <7, arterial umbilical cord blood gas pH <7.0. Our study found that the indication of labor dystocia at the previous cesarean section, increased the risk of repeat cesarean section (aOR 5.35; 95% CI: 1.64-17.50) in women with induction of labor. Other risk factors for repeat cesarean section were birth weight >4000 g, maternal BMI ≥30 or if vaginal prostaglandin was used as the method for induction of labor. A previous vaginal delivery and use of oxytocin increased the chance of a vaginal delivery in this group of women. Our study showed that the indication for the previous cesarean section affects the outcome in the subsequent delivery in women with induction of labor. If the indication for the previous cesarean section was labor dystocia, the risk of repeat cesarean section was increased.

Comparison Of Postpartum Hemoglobin Decrease Levels In Patients Who Had Normal Vaginal Delivery Versus Cesarean Section

Introduction: Cesarean section is an operation that carries a higher risk compared to normal vaginal delivery in terms of bleeding. In this study, we aimed to compare hemoglobin decreases in pregnant women who had normal vaginal delivery and cesarean section. Material and methods: In this study, pregnant women who had normal vaginal delivery and cesarean section between 01.01.2021 and 30.06.2022 in a university hospital were analyzed retrospectively. The pregnant women included in the study were standardized as those between the ages of 18-45, who did not have any systemic disease, and who gave birth to a baby between 2000-4000 gr at 37-41 weeks of gestation. The patients included in the study were divided into two groups as those who had normal vaginal delivery and cesarean section, and those who delivered by cesarean section were divided into two groups as primary cesarean section and previous cesarean section, and the decreases in hemoglobin levels taken before and at the 6th hour after delivery were statistically evaluated. Results: It was determined that 199 of the 473 pregnant women included in the study had normal delivery and 274 had a cesarean section (119 had a previous cesarean section and 155 had a primary cesarean section). Among the pregnant women included in the study, the mean postpartum Hb decrease was 0.73 ± 0.90 g/dl in the pregnant women who had normal delivery, and 1.41 ± 0.93 g/dl in those who delivered by cesarean section, the difference was found to be statistically significant (p=0.000). The mean postpartum Hb decrease in those who underwent cesarean section with a previous cesarean indication was 1.30 ± 0.73 g/dl, and 1.49 ±0.9 g/dl in primary cesarean sections, the difference was statistically significant (p=0.045). Conclusion: With these results determined in accordance with the literature, it would be appropriate to take the necessary precautions by taking these findings into account when making a cesarean section decision.

12216 The 3-Step: Comprehensive Canopy Concept Versus Lateral Approach of Bladder Dissection in TLH With Previous Cesarean Sections

12216 The 3-Step: Comprehensive Canopy Concept Versus Lateral Approach of Bladder Dissection in TLH With Previous Cesarean Sections

Lower uterine segment thickness to predict uterine rupture: a secondary analysis of PRISMA cluster randomized trial

BackgroundThird-trimester lower uterine segment thickness (LUST) is associated with uterine rupture during trial of labor after cesarean (TOLAC) but threshold values vary according to the approach used (lower values with vaginal ultrasound, higher values with abdominal ultrasound). ObjectiveTo estimate the optimal LUST cut-off value combining vaginal and abdominal ultrasound to predict uterine rupture during TOLAC. Study DesignWe performed a secondary analysis of PRISMA cluster randomized trial including women with a single previous cesarean who underwent ultrasound LUST measurement at 34-38 weeks using the thinnest measurement obtained by combining transvaginal and transabdominal measurements. Participants in the intervention group were informed about the risk of uterine rupture according to LUST reported in 3 categories [≥2.5 mm: low risk - TOLAC is safe; 2.0-2.4 mm: intermediate-risk - TOLAC is safe under specific conditions (e.g. Grobman estimate of vaginal delivery of at or above 70 percent and/or having a history of vaginal delivery; estimated fetal weight below 4000 grams; inter-delivery interval ≥18 months); <2.0 mm: high-risk for uterine rupture]. Delivery outcomes including uterine rupture were compared using non-parametric analyses and receiver operating characteristics (ROC) curves. ResultsAmong 3460 participants, 2809 (81%); 385 (11%); and 266 (8%) were identified at low-; intermediate-; and high-risk for uterine rupture, respectively. As expected, low-risk participants were more likely to undergo TOLAC (49% vs 46% vs 13%; p<0.001) and more likely to undergo labor induction (16% vs 12% vs 3%, respectively; p<0.001) than intermediate-risk and high-risk participants. Four (0.3%) cases of uterine rupture during TOLAC occurred among 1382 low-risk participants but none among the intermediate-risk (0/178) and high-risk (0/35) participants (p=0.73). Among low-risk participants, uterine rupture was associated with LUST combining vaginal and abdominal ultrasound (area under the ROC curve : 0.93; 95% confidence interval: 0.86 – 0.99; p<0.001) with all cases occuring among women with LUST between 2.5 and 3.0 mm (4/371 or 1.1%) compared to none (0/1011) among those with LUST ≥3.0 mm (p<0.01). ConclusionsThird-trimester LUST measurement influences the rates of TOLAC and uterine rupture. TOLAC appears to be associated with a low risk of uterine rupture with a LUST between 2.0 and 2.4 mm under specific conditions. However, these conditions should perhaps be extended to patients with a LUST of less than 3.0 mm, as we found an increase in uterine ruptures in this sub-group (between 2.5 and 3.0 mm) who had no special conditions to comply with. LUST ≥3.0 mm combining vaginal and abdominal ultrasound was associated with a very low risk for uterine rupture. A large-scale study using these new parameters would have the potential to demonstrate a reduction in uterine ruptures during TOLAC.

RECURRENT INFECTION CAUSED BY NON-ABSORBABLE POST-CESAREAN SUTURES LEADING TO BLADDER CALCULUS: CASE REPORT AND REVIEW OF THE LITERATURE

Background: Bladder stones are a rare pathological condition in women, often secondary to any etiology. Further investigations are required to identify the various factors involved in their formation and the complications they cause. For a woman, the appearance of a bladder stone following a predisposing factor, in particular an intra-vesical foreign body is a source of recurrent urinary tract infections and calculus, manifested by dysuria and hypogastric heaviness. This study aimed to describe the case of the formation of a bladder calculus from the presence of a non-absorbable suture. Case presentation: The case of a 30-year-old woman with a bladder stone causing several recurrent urogenital infections despite years of medical treatment is reported. After several additional para-clinical investigations, an ultrasound diagnosis of a bladder stone with pre-renal failure was established. The patient underwent a median exploratory laparotomy below the umbilicus for surgical management, followed by an open cystolithotomy with the extraction of a large bladder stone on which an old suture was implanted, probably as a result of the previous cesarean section. Conclusion: Bladder stones are rare, but relatively rare in our environment, with limited diagnostic resources. In this case, it appears that the non-absorbable suture was inadvertently placed in the bladder during the cesarean section, which has unfortunately contributed to recurrent urogenital infections and the formation of bladder calculus.

PERINATAL OUTCOME IN SUCCESSFUL VAGINAL BIRTH AFTER CESAREAN SECTION

Successful vaginal birth has been reported in 60%–80% of cases reported in published studies of women attempting vaginal birth after a previous Cesarean section. The recommended criteria for selecting candidates suitable for VBAC are potentially applicable in tertiary centers in developing countries, but there are many inadequacies in meeting them in our environment. VBAC avoids major abdominal surgery, lowers the women’s risk of postpartum morbidities like fever, blood transfusion, infections, and shorter hospital stay, and encourages earlier breastfeeding and better bonding between mother and neonate. Objectives: To determine the frequency of perinatal outcomes in successful vaginal birth after cesarean section (VBAC). Methods: Descriptive, case series study in the Department of Obstetrics &amp; Gynecology, Lady Reading Hospital, Peshawar from August 2020 to February 2021. A total of 207 pregnant women with singleton pregnancy of cephalic presentation with successful vaginal birth after cesarean of gestational age 37-41 weeks were included. Patients with multiple pregnancies, ruptured uterus, placenta previa, and fetal malpresentation were excluded. After taking informed consent, all women were followed till delivery and perinatal outcome i.e. low birth weight, Apgar score&lt;7 at 1 minute, and NICU admission was noted. Results: The age range in this study was from 18 to 40 years with a mean age of 29.32 ± 4.57 years. The majority of the patients 104 (50.24%) were between 31 to 40 years of age. The mean gestational age was 38.33 ± 1.17 weeks. The mean parity was 2.11 ± 0.82. In my study, the frequency of perinatal outcome in successful vaginal birth after the cesarean section was as follows; low birth weight in 15.94%, APGAR score&lt;7 at 1 minute in 9.67%, and NICU admission in 14.01% neonates. Conclusion: This study concluded that the frequency of perinatal outcome in successful vaginal birth after cesarean section was as follows; low birth weight in 15.94%, APGAR score&lt;7 at 1 minute is 9.67%, and NICU admission in 14.01% neonates.

Potential Risk Factors for Developing Cesarean Scar Pregnancy in Women With a History of Cesarean Section.

Cesarean scar pregnancy (CSP) occurs in 0.2%-0.5% of women with a previous cesarean section globally. Multiple factors influence the development of CSP; however, to date, the critical factors contributing to the development of CSP have not been fully explored due to its relatively low incidence. Moreover, CSP can be clinically categorized into type 1 and type 2 CSP. In this retrospective study with a large sample size, we investigated potential risk factors that could contribute to CSP development. Two hundred-one women diagnosed with CSP, either type 1 or type 2 CSP, and 1700 pregnant women with a history of cesarean section but without CSP diagnosis in subsequent pregnancy were included. Gravidity, previous live birth(s), consecutive cesarean section(s), surgical abortion(s), the interval between the pregnancies, and maternal age were compared between the 2 groups. Gravidity, the number of previous live births, the number of previous consecutive cesarean sections, and the number of surgical abortions were significantly associated with CSP development in women with a past cesarean section. This association was regardless of the subtypes of CSP. Notably, the interval between 2 pregnancies was also significantly associated with CSP development, but this association was only seen in type 2 CSP. However, maternal age was not an independent risk factor for CSP development. Additionally, a higher incidence of CSP was observed in China compared to that reported in the literature. In addition to a previous cesarean section, our study highlights at the number of surgical abortions also contributes to the development of CSP.

Risk of postpartum hemorrhage according to the planned mode of delivery among twin pregnancies with previous cesarean delivery

IntroductionBoth twin pregnancies and previous cesarean delivery are situations with increased risk of failed vaginal delivery. Cesarean delivery after a trial of labor is associated with an increased risk of postpartum hemorrhage Therefore, in twin pregnancies with a previous cesarean delivery, planned vaginal delivery could lead to an increased risk of postpartum hemorrhage due to an important rate of cesarean delivery after a trial of labor. Our objective was to evaluate the association between the planned mode of delivery and postpartum hemorrhage in women with twin pregnancies and a previous cesarean delivery. MethodsWe conducted a secondary analysis of the JUMODA French population-based prospective cohort study of twin pregnancies (n = 8823). We included women with one previous cesarean and without contraindication to vaginal birth. The primary outcome was postpartum hemorrhage. ResultsAmong the 735 women included, 187 women (25.4%) had planned vaginal delivery and 548 (74.6%) had planned cesarean delivery. Among women with planned vaginal delivery, 125 (66.8%) had a successful vaginal delivery. The incidence of PPH was 8.2% in the planned cesarean group and 9.1% in the planned vaginal delivery group(p = 0.709). After adjustment for confounders, the planned mode of delivery was not associated with the risk of postpartum hemorrhage (adjusted relative risk 0.94, 95% CI 0.56–1.60). There were only 2 uterine ruptures, both in the planned cesarean delivery group. ConclusionIn women with a twin pregnancy and a previous cesarean delivery, there is no overall association between the planned mode of delivery and the risk of postpartum hemorrhage.

Cesarean delivery in a tertiary institution of the Republic of Moldova: analysis using the Robson classification

BackgroundThe worldwide rise in cesarean section rate is a major public health concern and cause of significant debate. Despite multiple studies showing that higher cesarean rates may be associated with adverse maternal and perinatal outcomes, the number of cesarean births increases continuously. In the Republic of Moldova, the cesarean section has increased from 15.75% in 2012 to 27.42% in 2022, however, the perinatal mortality remains unchanged - constituting 11.6‰. In order to understand the factors that determine the increasing trend of cesarean section and to approach new strategies to reduce unnecessary surgical delivery, a standardized tool is needed to assess and compare cesarean section rates. ObjectiveTo assess changes in cesarean section rates and trends and to evaluate the contribution of different obstetrical populations to overall cesarean rates in Municipal Clinical Hospital using the Robson Classification. Study DesignA cohort study conducted at the Municipal Clinical Hospital in Chisinau. The study includes 13882 women who gave birth in 2017, 2019, and 2022 in this hospital. All births were classified into 10 Robson groups, using six basic variables (parity, cesarean section delivery in medical history, labor onset, number of fetuses, gestational age, and fetal presentation). Statistical data were collected and analyzed using the Epi INFO program. ResultsThe overall cesarean section rate was 20.02% (2779/13882) with a significant increase from 18.59% (809/4351) to 21.59% (1134/5252), P=0.0003. Approximately one-third 39.55% (1099/2279) of all cesarean deliveries were performed before the labor onset. The main contributor in all study years is Group 5 - 34.44% (957/2779). The next valuable group as a contributor to the overall cesarean rate are the women from Group 2 representing 14.14% (393/2779), followed by women of Group 1 with 11.98% (333/2779). ConclusionsThe use of the Robson Ten-groups classification offers a clear and detailed record of the cesarean section trends, and due to its simplicity and exclusivity, it can be implemented in the Republic of Moldova as well. The main contributors to the overall cesarean rate are women with a previous cesarean delivery - Group 5, followed by nulliparous women of Group 2 and Group 1.

A successful combined spinal-epidural anesthesia for cesarean section in a patient with neurofibromatosis type 1-associated dural ectasia.

Dural ectasia is a common manifestation of neurofibromatosis type 1. Although there have been reports of unsuccessful spinal anesthesia due to dual ectasia in Marfan syndrome, reports describing similar unsuccessful spinal anesthesia in neurofibromatosis type 1 are lacking. A parturient with neurofibromatosis type 1 was scheduled for a repeat cesarean section. During a previous cesarean section, she had experienced a failed spinal anesthesia, which resulted in a conversion to general anesthesia. Preoperative lumbar magnetic resonance imaging revealed dural ectasia, which was speculated to be the cause of the previous spinal anesthesia failure. Therefore, combined spinal-epidural anesthesia was implemented. Because the block level of spinal anesthesia was insufficient as predicted, supplemental administration of epidural anesthesia successfully provided adequate analgesia for the surgery. Combined spinal-epidural anesthesia can be useful for the management of cesarean sections in patients with neurofibromatosis type 1-associated dural ectasia.

Reduced Misoprostol Regimen versus Standard Misoprostol Regimen for Induction of Second Trimester Abortion in Patients with Previous Cesarean Section Scar

Reduced Misoprostol Regimen versus Standard Misoprostol Regimen for Induction of Second Trimester Abortion in Patients with Previous Cesarean Section Scar

Retrospective study on the outcomes and satisfaction with endometrial ablation by bipolar energy (NovaSure®) for the treatment of heavy menstrual bleeding.

To determine the effectiveness, safety, and participant satisfaction with endometrial ablation by bipolar energy (NovaSure®) in the treatment of heavy menstrual bleeding (HMB), and to investigate factors associated with poorer outcomes. Multicenter retrospective observational study based on medical record review of the outcomes related to endometrial ablation by the bipolar-energy technique procedure to treat HMB in the setting of three university teaching hospitals in Spain. A total of 333 women were included in the study. Most bipolar-energy ablations were successful (85.12%; n = 269 out of 316), with amenorrhea the most frequent outcome (39.6%, n = 131 out of 316). The majority of participants had no complications (95.5%; n = 317 out of 332), and of those who did, only 2.1% were related to the technique. No further treatment was required for HMB in 82.8% of women (n = 274 out of 331), and surgery was avoided in 91.8%; only 5.9% of women underwent ablation-related hysterectomy. In women with previous transverse cesarean sections (CS), 91.0% avoided subsequent surgical treatment. Eighty-six percent of women (n = 221 out of 257) were satisfied with the procedure. Bipolar-energy ablation is very effective and safe for the treatment of HMB and yielded a high rate of participant satisfaction in our setting. The presence of comorbidities or previous CSmay slightly reduce the effectiveness of the method, while performing concomitant surgery (mainly curettage) increases the rate of complications. Notably, despite the known increased risk of hysterectomy, most participants with previous CSs who underwent ablation avoided major surgery.

The Underlying Molecular Mechanisms of the Placenta Accreta Spectrum: A Narrative Review.

Placenta accreta spectrum (PAS) disorders are characterized by abnormal trophoblastic invasion into the myometrium, leading to significant maternal health risks. PAS includes placenta accreta (invasion < 50% of the myometrium), increta (invasion > 50%), and percreta (invasion through the entire myometrium). The condition is most associated with previous cesarean deliveries and increases in chance with the number of prior cesarians. The increasing global cesarean rates heighten the importance of early PAS diagnosis and management. This review explores genetic expression and key regulatory processes, such as apoptosis, cell proliferation, invasion, and inflammation, focusing on signaling pathways, genetic expression, biomarkers, and non-coding RNAs involved in trophoblastic invasion. It compiles the recent scientific literature (2014-2024) from the Scopus, PubMed, Google Scholar, and Web of Science databases. Identifying new biomarkers like AFP, sFlt-1, β-hCG, PlGF, and PAPP-A aids in early detection and management. Understanding genetic expression and non-coding RNAs is crucial for unraveling PAS complexities. In addition, aberrant signaling pathways like Notch, PI3K/Akt, STAT3, and TGF-β offer potential therapeutic targets to modulate trophoblastic invasion. This review underscores the need for interdisciplinary care, early diagnosis, and ongoing research into PAS biomarkers and molecular mechanisms to improve prognosis and quality of life for affected women.

Prediction of Preoperative Cesarean Scar Dehiscence by Using 2D Ultrasound in Pregnant Women with Previous Cesarean Section

Prediction of Preoperative Cesarean Scar Dehiscence by Using 2D Ultrasound in Pregnant Women with Previous Cesarean Section

Maternal mortality due to obstetric hemorrhage by surgical injury during cesarean section: A nationwide study.

Obstetric hemorrhage remains a largely preventable cause of maternal mortality globally. The contribution of uterine atony to hemorrhage-related maternal mortality has decreased in France, while the contribution of other causes of obstetric hemorrhage such as surgical injury during cesarean has been reported to increase. However, little evidence exists regarding the risk factors and care processes of women who died from this cause of hemorrhage. Therefore, we aimed to describe the clinical profile, underlying mechanisms, and preventability factors among women who died from obstetric hemorrhage by surgical injury during cesarean section. Nationwide analysis of all hemorrhage-related maternal deaths by surgical injury during cesarean in France identified by the nationwide permanent enhanced maternal mortality surveillance system (ENCMM) between 2007 and 2018. We described the characteristics of the women, delivery hospitals, circumstances of hemorrhage, features of obstetric and resuscitation/transfusion care, and main preventability factors. Between 2007 and 2018, hemorrhage-related maternal mortality in France decreased from 1.6/100 000 live births (95% CI 1.1-2.2) (39/2 472 650) in 2007-2009 to 0.8/100 000 live births (95% CI 0.5-1.3) (19/2 311 783) in 2016-2018. Hemorrhage-related maternal mortality ratio due to surgical injury during cesarean increased from 0.08 (95% CI 0.01-0.3) (2/2 472 650) to 0.2 (95% CI 0.07-0.5) (5/2 311 783) per 100 000 live births. Among the 18 women who died from surgical injury during cesarean over the 12-year study period, we report a high prevalence of obesity (67%, 12/18), previous cesarean (72%, 13/18), and second-stage cesareans (56%, 10/18). In 22% (4/18), cesarean section was performed in a hospital providing <1000 births annually, with no blood bank (39%, 7/18) or no adult intensive care (44%, 8/18) on-site. Overall preventability of deaths was 94% (17/18). Main preventability factors were related to delay in hemorrhage diagnosis (77%, 14/18) due to late recognition of abnormal parameters (33%, 6/18) and late bedside ultrasound (56%, 10/18), and delay in management due to insufficient surgical skills (56%, 10/18). In France, surgical injury during cesarean section is an increasing, largely preventable contributor to hemorrhage-related maternal mortality, as other causes of fatal hemorrhage have become less frequent. The profile of these women showed a high prevalence of obesity, previous cesarean, second-stage cesarean, and delivery in hospitals with limited medical and surgical resources, which suggests explanatory mechanisms for the fatal outcome and opportunities for prevention.

Systemic Immune-Inflammation Indices Could Be Additional Predictive Markers for Cesarean Scar Pregnancy.

Cesarean scar pregnancy (CSP) is characterized by a gestational sac fully or partially implanted in the scar from a previous cesarean section. Systemic immune-inflammation indices (SIIs) have recently been discussed as additional diagnostic markers in placenta accreta and preeclampsia. CSP shares a similar pathogenesis with these diseases, suggesting that assessing the SIIs and neutrophil-to-lymphocyte ratio (NLR) could enhance additional predictability in diagnosing CSP. In this study, we analyzed the complete blood counts between 264 women who were confirmed with CSP by ultrasound and 295 women who underwent elective termination. The mean counts of total white cells and neutrophils were significantly higher, whereas the counts of monocytes, lymphocytes, and platelets were significantly lower in the CSP group compared to the control group (p<0.001). Additionally, the SII, systemic inflammation response index (SIRI), or NLR was significantly higher in the CSP group compared to the control group (p<0.0001). Given the limited effect of SII and SIRI on the increased risk of developing CSP, the optimal cut-off value for NLR in predicting CSP was 2.87 (area under the curve [AUC] 0.656, 68% sensitivity). The optimal cut-off value for NLR in predicting type 2 CSP was 2.91 (AUC 0.690, 71% sensitivity). Although ultrasound or magnetic resonance imaging images are a gold standard for visualizing the gestational sac's location in the diagnosis of CSP, assessing peripheral blood tests is cost-effective, and NLR may provide additional diagnosis value for CSP.

A RETROSPECTIVE STUDY OF RISK FACTORS, CLINICAL PRESENTATION, OUTCOME OF ECTOPIC PREGNANCY

Introduction: Ectopic pregnancy refers to a pregnancy where the fertilized egg implants outside the uterus, in a location unsuitable for its growth and development. The significance of ectopic pregnancy has increased due to its rising incidence and its impact on female fertility. It continues to be a major challenge in modern gynecology and is a significant cause of morbidity and mortality among women. Methodology: This study is a retrospective analysis of 40 cases of ectopic pregnancy conducted in the Department of Obstetrics and Gynecology at Basaveshwara Teaching and General Hospital, Kalaburagi, over a two-year period. The study examined detailed patient histories to identify risk factors, clinical presentations, and outcomes. Results: Out of 3600 confirmed pregnancies during the study period, 40 were ectopic, resulting in an incidence rate of 70% and 30% in the age group of 21-30 years and 31-40 years respectively. Identifiable risk factors were present in 58% of cases, with 26% having a history of pelvic inflammatory disease, 13.3% with infertility, 15% with a history of abortion, 23% with tubectomy, 3% were smokers, and 46% had a previous cesarean section. Among the patients, 16% were primigravida, 83% were multigravida, and 100% presented with amenorrhea. Additionally, 80% reported abdominal pain, 70% experienced vaginal bleeding, 16% had fainting or syncopal episodes, 56% showed signs of pallor, and 5% were in shock. Conservative treatment was administered to 5% of patients, while 95% underwent exploratory laparotomy, and 90% required blood transfusions. Conculsion: Early diagnosis of ectopic pregnancy is crucial and necessitates a high degree of clinical suspicion, particularly in cases presenting with amenorrhea, abdominal pain, and vaginal bleeding. The importance of timely diagnosis lies in the potential to offer conservative management, which can positively impact the patients future fertility.

Trial of labor after caesarean section in low risk pregnancies: is it risky?

To evaluate the influence of a previous caesarean section on adverse composite maternal and perinatal outcome in women who attempted a trial of labor. This historical cohort study analyzed maternal and perinatal outcome in women with otherwise low risk pregnancies at term who underwent a trial of labor after a caesarean section (TOLAC). The primary outcome measure was the adverse composite outcome. Secondary outcome measures were amongst others the caesarean section rate and the mode of vaginal delivery. The adverse composite outcome was more frequently in the previous caesarean section group compared to women with no previous caesarean Sect.(22.3% vs. 15.6%, p < 0.0001). The percentage of caesarean Sect.(15.4% vs. 8.2%, p < 0,0001), uterine rupture (1.0% vs. 0.02%, p < 0.0001), placental abruption (1.1% vs. 0.3%, p = 0.0014), vaginal operative delivery (16.0% vs. 8.6%, p < 0.0001), pH < 7.10 (3.7% vs. 2.5%, p = 0.0151), base excess < -12 (3.2% vs. 2.2%, p = 0.0297), abnormal cardiotocography (22.5% vs. 13.9%, p < 0,0001) and fetal blood analysis (6.2% vs. 2.6%, p < 0.0001) was significantly higher in women with a previous caesarean section. Taking the parity into account, these differences could only been seen in women without a previous vaginal delivery. In parous women with a previous vaginal delivery and a caesarean section in history, the adverse composite did not differ between the groups. Only the rate of pH < 7.1 was higher in women after a caesarean Sect.(4.5% vs. 1.8%, p = 0.0436). Trial of labor after caesarean in otherwise low risk pregnancies is associated with a higher rate of complications especially if there is no history of vaginal delivery.

Diagnosis on dilemma: Arteriovenous malformation with scar pregnancy with old retained product of conception

Cesarean scar pregnancy (CSP) is described as the placement of a gestational sac within the scar from a previous cesarean operation and is considered an ectopic pregnancy. Ectopic pregnancy situated in a cesarean section scar is a rare but potentially life-threatening event. Because of its rarity, there are no universal guidelines to manage this condition. CSP has no pathognomonic signs or symptoms and its presentation varies considerably. Here, we report a case of scar pregnancy containing an old retained product of conceptus.