Previous Cesarean Section Scar Research Articles

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

Cesarean scar choriocarcinoma following a cesarean scar molar pregnancy: A case report

Gestational choriocarcinoma, a rare variant of gestational trophoblastic disease, typically arises from abnormal trophoblastic cell proliferation post-pregnancy, often associated with a hydatidiform mole. While most choriocarcinoma cases develop within the uterine cavity, an exceedingly rare manifestation occurs within a previous cesarean section scar. In our study, a 31-year-old woman with a history of hydatidiform mole presented with amenorrhea and spotting. Initial assessments revealed elevated beta-human chorionic gonadotropin (βhCG) levels and a heteroechoic mass at her prior cesarean section scar in sonographic examination. Histopathologic findings and the metastatic workup categorized the patient as FIGO stage I, indicating no metastasis. Due to the absence of metastasis, adjuvant chemotherapy was omitted. Total abdominal hysterectomy confirmed choriocarcinoma. Post-surgery, βhCG levels notably decreased, remaining negative during the two-year follow-up with no reported symptoms. Our findings suggest that surgical resection and meticulous βhCG monitoring may be a promising treatment strategy for non-metastatic choriocarcinoma.

Viable cesarean scar pregnancy from primary care perspective: A case report

Ectopic pregnancies within previous cesarean section scars are rare but potentially life-threatening complications. Diagnosis can be challenging, particularly in primary care settings, where the focus is often on routine primary care services. We present a case report of a patient who initially presented to a primary care clinic with non-specific symptoms of ectopic pregnancy and was referred to a tertiary center for incomplete miscarriage. It was found to be a viable ectopic pregnancy within a cesarean scar. This case highlights the importance of keeping an open mind in patients with a history of cesarean section and uterine manipulation procedures such as manually evacuating a retained placenta. It emphasizes prompt diagnosis and referral to a specialized healthcare facility.

Laparoscopic removal of heterotopic cesarean scar pregnancy

ObjectiveTo present the laparoscopic management of heterotopic cesarean scar pregnancy and discuss other treatment options. DesignSurgical video article. The Institutional Ethics Committee approved the video reproduction. SettingTertiary referral university hospital PatientA 29-year-old woman with spontaneous heterotopic cesarean scar pregnancy presented for vaginal spotting. Ultrasound revealed two gestational sacs at 7 weeks and 6 days of gestation with fetal cardiac activity. One sac was in a normal intrauterine location and the other in a previous cesarean section scar. InterventionsScar pregnancy was excised laparoscopically while preserving intrauterine pregnancy. No additional measures were taken to reduce bleeding. The bladder was filled with 150 cc isotonic to determine its boundaries. The peritoneum was dissected away from the cervix. After removing the ectopic pregnancy material, the myometrial defect was excised. The uterine wall was closed in three layers using 2-0 V-LocTM sutures. Main outcome measuresOngoing intrauterine pregnancy after laparoscopic removal of cesarean scar pregnancy and term delivery. ResultsThe procedure was completed in 67 min. Total blood loss was <100 cc. Ongoing pregnancy follow-up was uneventful. Delivery was planned for the 37th-38th weeks. Although instructed to visit immediately after experiencing pain, the patient arrived after the 38th week and reported having pain for 2 days. During cesarean section, a rupture was observed at the previous incision site, which was fortunately incomplete. A healthy male baby (weight, 3210 g; Apgar score, 9/10) was delivered. ConclusionsThe most common approach for heterotopic scar pregnancy is embryo reduction with potassium chloride injection. However, the mass persists in the scar area, resulting in complications associated with excessive bleeding during cesarean section in approximately half cases. Moreover, almost all published cases of embryo reduction resulted in premature births before week 36. Considering the present case, laparoscopic surgery may be appropriate for managing heterotopic cesarean scar pregnancy by preserving intrauterine pregnancy.

Should a different Partogram be used for the Trial of Labour in Women with the Previous One Caesarean Section Scar as Compared to Primiparous Women; A Comparative study

Objective: To compare various labour parameters in partogram among primiparous women and women with one previous caesarean section scar Study Design: Comparative cross-sectional study Place and Duration of Study: Gynaecology and Obstetrics Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Oct 2021 to Sep 2022. Methodology: This study was conducted on primiparous women and women with one previous scar who were booked cases in our department for antenatal checkups and labour. Patients were divided into two groups for comparison. Group-I were primiparous, while Group-II had one previous scar. All women underwent detailed labour records via conventional partogram in the labour room. Duration of the active phase of labour, duration of the second stage, time to progress by 1 cm and time after the alert line were compared in partograms of both the study groups. Results: A total of 390 women who were either primiparous or had one previous caesarean section were recruited for this study. Of the study participants, 226(42.6%) were primiparous, while 164(57.4%) had one previous caesarean section scar. Statistical analysis revealed that the duration of the active phase of labour, time to progress by 1 cm and time after the alert line were statistically significant (p-value&lt;0.05) in partograms of women in Group-I (primiparous) as compared to those in Group- II (women with one previous scar) (p-value&lt;0.05). Conclusion: The main parameters of the partogram differ significantly among primiparous women and women with one previous caesarean section scar.

Reproductive outcomes after in vitro fertilization in women with cesarean section scar diverticulum: A retrospective study.

Some studies have suggested that cesarean section diverticulum may affect the pregnancy outcomes of assisted reproductive technology through a variety of mechanisms. This study aims to explore whether previous cesarean section and uterine scar diverticulum affect pregnancy outcomes after in vitro fertilization. This retrospective study included 954 infertile women with only one previous delivery who had in vitro fertilization treatment and underwent fresh embryo transplantation for the first time at our center between 2015 and 2019. We first divided the women into two groups by previous vaginal delivery (n = 557) or cesarean section delivery (n = 397), and the latter group included 88 women with cesarean diverticulum and 309 women without cesarean diverticulum. Baseline characteristics were compared and analyzed, and logistic regression analyses were performed to explore the different pregnancy outcomes among the above groups. Although the live birth rate, clinical pregnancy rate, and mean embryo implantation rate after in vitro fertilization were significantly reduced in patients with previous cesarean section (live birth rate: 26.45% vs. 43.99%, adjusted OR: 0.602, CI: 0.447-0.810; clinical pregnancy rate: 35.26% vs. 49.91%, adjusted OR: 0.724, CI: 0.544-0.962; mean embryo implantation rate: 0.227 ± 0.378 vs. 0.243 ± 0.397, adjusted OR: 0.860, CI: 0.514-1.439), there were no significant differences in pregnancy outcomes between the women with cesarean diverticulum and without cesarean diverticulum (p > 0.05) or between the two groups at different ages. The live birth and clinical pregnancy rates in the women with residual muscle thickness ≤2.2 mm or prolonged menstruation were reduced, but the difference was not statistically significant (p > 0.05). This study showed reduced pregnancy and live birth rates after in vitro fertilization in patients with previous cesarean section, while uterine scarring did not adversely affect pregnancy and delivery outcomes after in vitro fertiliazation.

Postcesarean disasters – Isthmocele, ventrofixed uterus, and cesarean scar pregnancy: A case series

Abstract Isthmocele is a niche defect in the area of previous cesarean scar. It is any indention representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity at the site of the previous cesarean section (CS) scar. Ventrofixed uterus is an adhesion between anterior surface of uterus and anterior abdominal wall secondary to Caesarean section. Cesarean scar pregnancy (CSP) pregnancy at a scar site is trouble either causing scar rupture or placenta accreta syndrome. Here are the seven cases of having a problem of isthmocele or ventrofixed uterus or both. All these cases had previous CS done at peripheral hospitals. The intension of this case series is to study preoperative symptoms, clinical and investigation findings, intraoperative presentation, and challenges with postoperative recovery in cases of previous CS-related problems. All these cases presented with us post-CS either lower abdominal pain, intermenstrual spotting, menorrhagia, or secondary infertility, and one had emergency abdominal pain with pregnancy. On hysteroscopy, a large niche at CS scar with trenches was detected in five cases, and on laparoscopy, ventrofixed uterus in five cases, and four cases have both. One has multiple fibroids, one has associated ventrofixed ovarian endometrioma. One case has ruptured CSP. After corrective hysterolaparoscopy surgery, all patients recovered well. Hysterolaparoscopic corrective surgery is a real need and challenge in cases of symptomatic ventrofixed uterus and isthmocele. The incidence and prevalence of isthmocele are greater than most gynecologists realize. It is imperative to understand the etiology and adopt preventive measures during CS to reduce its incidence and also to reduce the incidence of CSP.

O-054 Live Births following Laparoscopic Caesarean Scar Niche Repair in patients with Secondary Infertility: A Self-Controlled Case Series and Literature Review.

Abstract Study question Does laparoscopic repair of caesarean scar niches as a treatment for secondary infertility improve live birth rates? Summary answer In our self-controlled case series, the laparoscopic repair of caesarean section niches in patients with secondary infertility has improved pregnancy and live birth rates. What is known already A niche is an iatrogenic myometrial defect due to abnormal tissue healing at a previous caesarean section scar site. Patients with a niche present with symptoms of vaginal discharge, abnormal uterine bleeding, chronic pelvic pain, dyspareunia and secondary infertility. As a niche is secondary to caesarean sections, rising caesarean section rates will lead to an increase in the rate of niche presentation and diagnosis. Study design, size, duration A retrospective review was performed of all women undergoing a hysteroscopy assisted laparoscopic niche repair between 2016 and 2023 at Guy’s and St Thomas’ Hospital in London. The primary outcome measure was live births. A literature review was performed to interrogate the currently available evidence on live birth rate following niche repair. Ultrasound images of the niche prior to and post repair, as well as intra-operative laparoscopic and hysteroscopic images and videos, are also presented. Participants/materials, setting, methods The cases were identified from the Assisted Conception Unit database. Only women who presented with secondary infertility with a diagnosis and repair of a niche were reported. Niche diagnosis was made in patients presenting with abnormal discharge, bleeding and fluid in the uterine cavity. Any incidental myometrial defect found on transvaginal ultrasound was also a diagnostic characteristic. Main results and the role of chance There are some reports in the literature on pregnancy outcome following niche repair. A scarcity of studies reporting specifically on live birth rates following repair, suggests this case series as unique. Eleven patients underwent caesarean section niche repair by two surgeons at our unit. The mean age at repair of the patients was 36. All patients had two or more years of subfertility on presentation, with a proportion having several failed in-vitro fertilisation (IVF) cycles prior to repair. The pregnancy rate, clinical pregnancy rate and live birth rate were 73% (8/11), 64% (7/11) and 45% (5/11) respectively. One patient had an early miscarriage at age 48 following repair and has not conceived again since. One patient underwent a second repair and is awaiting further investigations. Two patients have not yet conceived following repair, one of which had sickle cell disease, age factor and endometriosis. Our findings suggest a positive correlation between surgical repair of the niche and live births. However, this could be due to a strict selection criteria in a small sample size. In the two patients that did not have live births following repair, other factors of subfertility such as age, male factor and comorbidities could also play a role. Limitations, reasons for caution The small sample size can lead to selection bias and impairs the external validity of our findings. The likelihood of random error is high. Lack of a control group prevents any comparisons. Furthermore, all repairs were performed by the two surgeons which introduces operator bias. Outcome assessors were not blinded. Wider implications of the findings Subfertility secondary to niches is likely to be a growing challenge as caesarean section rates continue to increase. Our study suggests that surgical repair may improve live birth rates. We present our findings to augment the current international data on live birth rates following niche repair. Trial registration number not applicable

Scarred for life: a review of cesarean section scar pregnancy and potential pitfalls in diagnosis.

Cesarean section scar pregnancy (CSSP) is defined as abnormal implantation of a gestational sac on or in a previous cesarean section scar. There is an increasing incidence of detection of CSSP, likely in part due to the growing rates of cesarean deliveries and the improved rates of detection with advancing ultrasound technology. Diagnosis of CSSP is critical due to the potentially life-threatening complications to the mother if left untreated. Pelvic ultrasound is the imaging modality of choice in the initial evaluation of suspected CSSP, with MRI potentially useful if ultrasound findings are equivocal, or if confirmation is requested prior to definitive intervention. Early and accurate diagnosis of CSSP allows for prompt management to avoid severe complications and the potential to preserve the uterus and future fertility. A combination of medical and surgical treatment strategies may be needed with specific therapy tailored to each patient. Follow-up after treatment should include serial beta-hCG levels and possible repeat imaging if there is clinical concern for complications or treatment failure. This article will provide a comprehensive review of this uncommon but important phenomenon, detailing the pathophysiology and types of CSSP, imaging presentations, potential pitfalls in diagnosis, and management options.

Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis

ObjectiveTo evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS).Data sourcesScreening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis.Study eligibility criteriaAll available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them.Study appraisal and synthesis methodsExtracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity.ResultsThe overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively.The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively.ConclusionsThe accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases.Trial registrationNumber CRD42021267501.

Uterine rupture; An obstetric tragedy still with us. A six year review of cases in a specialist hospital, NorthWest Nigeria

Background: Uterine rupture is a major cause of perinatal and maternal morbidity and mortality, it usually has a devastating outcome if not promptly attended to. The study determined the trends, risk factors, feto-maternal outcomes following uterine rupture as seen at ASYBSH.&#x0D; Method: The study was a retrospective review of cases of uterine rupture managed at the ASYBSH between March 2015 and February 2021. Records of the theatre and labour wards were searched and the folders of patients with uterine rupture were retrieved. Relevant information such as socio- demographic variables, booking status, clinical presentations were retrieved and entered into a structured profoma.&#x0D; Results: Deliveries in the hospital during the period were eleven thousand four hundred and twenty (11,420), out of which one hundred and fifty-six (156) were complicated by uterine rupture giving an overall incidence of 1.36 percent or one in every seventy-four (74) deliveries. Uterine rupture occurred mainly among women of low socio-economic status and high parity. The major predisposing factors were injudicious use of oxytocin (62.8%) prolonged obstructed labour (19.8%), previous caesarean section scar (8.5%), use of misoprostol (5.3%), fundal pressure (2.4%) and unexplained factors (1.2%)&#x0D; Conclusion: Uterine rupture remains a devastating obstetric calamity with a high incidence. Injudicious use of oxytocin, prolonged obstructed labour and previous caesarean section scar were the three leading predisposing factors identified in this study.

Uterine Rupture at Federal Teaching Hospital, Katsina: A Five Year Review

Background: Uterine rupture, despite being one of the most devastating obstetric complication associated with significant maternal and perinatal morbidities and mortality, is still prevalent in developing countries. Objectives: To determine the prevalence, aetiologic risk and other contributing factors, complications as well as outcome of Obstetric Uterine rupture at Federal Teaching Hospital, Katsina. Study Design: A Five year retrospective study that reviewed uterine rupture in Obstetrics and Gynaecology department of Federal Teaching Hospital, Katsina from 1st January 2010 to December 31st 2014. Results: There were 42 uterine ruptures out of 9995 deliveries, with an incidence of 4.2 per 1000 deliveries. The mean age of the patients was 31yrs± 0.9. The highest incidence was among unbooked patients (85%). The diagnosis was made pre-operatively in 88.1% of the cases. Major risk factors were prolonged obstructed labour (26.2%), previous caesarean section scar (19%) and Oxytocin infusion in unscarred (14.3%) and scarred Uteri (11.9%) as well as use of Misoprostol (11.9%). Majority of the ruptures occurred anteriorly (52.4%) while scar dehiscence accounted for 23.8% of cases. Repair with bilateral tubal ligation was the most frequent mode of treatment (47.6%), while hysterectomy was done for patients with extensive ruptures (34.3%). The commonest complication was postoperative Anaemia (38.1%). There were two maternal deaths, with a case fatality rate of 4.8%, while the perinatal mortality was 78.6%. Conclusion: Uterine rupture is still a major cause of maternal and perinatal morbidities and mortality in our setting. Antenatal care with skilled facility-based deliveries will reduce its incidence and associated complications.

Uterine Rupture and its Fetomaternal Outcome: A Tertiary Care Hospital Study

Objective: To analyse the frequency, predisposing factors, site of rupture management and fetomaternal outcome in uterine rupture. Study design: prospective observational study Methods: This study was conducted at the Department of obstetrics and gynecology in Lalla Ded hospital, from august 2020 to august 2022. All cases of ruptured uterus, who were either admitted with this complication or who developed it in the hospital, were included in the study. Patients having ruptured uterus due to congenital abnormality were excluded from the study. Patient’s parity, age, details of predisposing factors, type of rupture, the management, maternal and fetal outcome were taken into consideration for analysis. Data was analyzed using SPSS version 20.0.(SPSS Inc., Chicago, Illinois, USA). Continuous variables were expressed as Mean ± SD and categorical variables were summarized as frequencies and percentages. Graphically the data was presented by bar and pie diagrams. Results: The total number of deliveries during the course of 2 years from august 2020 to august 2022 were 44236. There were 15 cases (0.034%) of uterine rupture. Out of these only three (20%) were booked. Most of the patients (53.3%) presented between the ages 30-35. Majority of uterine rupture occurred in para 3 (46.7%) followed by para 2 (33.3%). Common cause of uterine rupture was prolonged neglected obstructed labour (60%). Rupture of Previous caesarean section scar was found in 40%. Anterior uterine wall was involved in 46.7% of cases. Posterior wall rupture in 33.3% and posterior along with lateral wall in 20%. Hysterectomy was performed in 40%. There were two maternal (13.3%) and 8 intrauterine deaths (53.3%). Live birth rate was 46.6%. Conclusion: This study showed that prolonged neglected obstructed labour is the main cause of uterine rupture followed by scarred uterus in our setting. Proper antenatal care and timely intervention with prompt referral to higher center and updated training programs for health care providers is the need of time to prevent this catastrophic but avoidable complication. Keywords: uterine rupture, scarred uterus, obstructed labour (cephalopelvic disproportion)

7692 An Approach to Imaging and Surgical Excision of Abdominal Wall Endometriosis

<h3>Study Objective</h3> To demonstrate an approach to the imaging and surgical management of abdominal wall endometriosis (AWE) including the surgical repair of abdominal wall defects. <h3>Design</h3> Video case presentation. <h3>Setting</h3> Pre-operative imaging suite and operating room. <h3>Patients or Participants</h3> To illustrate our approach, we present two surgical cases. The first is of a patient who was referred with catamenial pain in the left lower abdominal wall. She has a history of 2 previous cesarean sections and a lesion, consistent with abdominal wall endometriosis was demonstrated on ultrasound, adjacent to her previous cesarean section scar. The second case is a patient with peri-umbilical abdominal wall endometriosis. <h3>Interventions</h3> In both cases, we demonstrate our technique for resection of abdominal wall endometriosis. We discuss a 3-step approach: 1. Landmarking and incision making 2. Dissection and excision 3. Fascial repair. Larger fascial defects may require fascial mobilization off surrounding tissue to allow for a tension-free closure or mesh placement in the abdominal wall. These techniques may be performed together in consultation with a general surgeon and are further described within this video. <h3>Measurements and Main Results</h3> Pre-operative ultrasound accurately predicted abdominal wall endometriosis and surgical excision results in symptom relief. <h3>Conclusion</h3> Ultrasound is the first line diagnostic test to confirm clinical suspicion of abdominal wall endometriosis. MRI can be used to further characterize lesion extent and structures involved. Surgical excision of abdominal wall endometriosis can be safely performed by the gynecologic surgeon in conjunction with general surgery if resection results in a large abdominal wall defect.

Creatine kinase and alpha-fetoprotein as biochemical markers in diagnosis of placenta increta and percreta

Background: placenta accreta is a life-threatening pregnancy complication which usually accompanied with placenta previa. It is important to make the diagnosis before delivery therefore a preoperative planning will decrease complications. The aim of this study: was to compare between creatine kinase and α-fetoprotein as biological markers with ultrasound &amp; Doppler findings for the sake of prenatal detection of morbid placentation in anterior placenta on scar of previous cesarean section. Patients and Methods: The present study was Prospective cohort observational study carried out at Beni Suef University Maternity Hospital and MUST Teaching Hospital. Women were recruited from the outpatient obstetrics clinic or emergency room and admitted to antepartum inpatient high risk service. Results: This study showed a significant increase in both CK (p value =0.014) and msAFP (P value=0.028) levels in cases compared to the control group.

Uterine dehiscence: a laparoscopic uterine repair in early pregnancy

To review the existing literature on uterine cesarean scar defect repair in pregnancy and describe an approach to minimally invasive surgical repair in early pregnancy to facilitate a term live birth. A case study and literature review, followed by a demonstration of the procedure with surgical video and concurrent ultrasound footage. Academic medical center. This video is a case presentation of a 35-year-old, gravida 2, para 1 woman with a previous cesarean section. She presented at 10 weeks and 3 days gestational age with complete uterine dehiscence at the site of her previous cesarean section scar, which was diagnosed by ultrasound. Surgical video and medical images have been extracted from this patient's chart after consent was obtained. Ultrasound-guided laparoscopic repair of cesarean scar defect at 11 weeks and 3 days of gestation. The video showed a large 2.6-cm uterine scar defect in early pregnancy confirmed using ultrasound and magnetic resonance imaging. This diagnosis was confirmed by direct visualization at the time of surgery. This video demonstrates our surgical approach as follows: careful uterine manipulation and identification of the defect with laparoscopy and concurrent transvaginal ultrasound; reflection of the bladder using an ultrasound-guided approach to confirm the borders of the defect; and repair with a running 2-layer closure under transvaginal ultrasound guidance. Through ultrasound-guided laparoscopic repair, we were able to demonstrate a restoration of approximately 8 mm of myometrial thickness across the cesarean scar defect on antenatal follow-up. The patient had a term live birth via cesarean section. With an increased number of cesarean sections and improved quality of ultrasound imaging, an increase in the incidental findings of cesarean scar defects has been observed. The risk of spontaneous prelabor uterine rupture remains unknown. There is a literature gap in this area regarding the appropriate standard of care. This video demonstrates that ultrasound-guided laparoscopic repair was possible, safe, and effective in our patient. However, further studies are required to establish the safety and efficacy of this approach.

ANALYSIS OF CESAREAN SECTION RATE USING THE 10-GROUP ROBSON CLASSIFICATION SYSTEM AT ABU ALI SINA TEACHING HOSPITAL

Background: Cesarean section (CS) rate is rising worldwide including in Afghanistan. Access to CS indicates maternal quality care in a healthcare system, but higher rates are associated with increased maternal-fetal mortality due to CS severe complications. The WHO recommends the Robson classification to monitor the rational use of CS. This study aims to analyze the CS rate at Abu Ali Sina Hospital based on the 10-Group Robson classification. Methods: This retrospective cross-sectional study was conducted at Abu Ali Sina Hospital, a tertiary care teaching hospital in Balkh, Afghanistan. The data was collected from medical documents of all women who delivered in February-March 2022. Women were classified into Robson 10 groups then the total rate of CS, absolute, and relative contribution of each group to the overall CS rate was calculated.Results: Among 2858 women delivered during the study period, 567 (19.8%) had CS. Group 5 (35.8%) was the largest contributor to the overall CS rate. 122 (61%) of women in this group had undergone pre-labor CS. Group 1 (18.5%), and Group 3 (13.2%) were the second and third largest contributors to the total CS.Conclusion: This study revealed that Group 5 was the main contributor to the overall CS. The previous CS scar was the most common indication of repeated cesarean delivery. Furthermore, high rates of CS were observed in low-risk group women. We also identified that the Robson classification can be implemented as a monitoring tool in all settings in Afghanistan even those with a lack of facilities.&nbsp;

Local treatment with methotrexate of cesarean scar pregnancy: A case report

Cesarean scar pregnancy, is the implantation of a gestational sac within the myometrium at the side of previous cesarean section scar, is a rare type of ectopic pregnancy. Ultrasonography is the first and most important diagnostic method of this condition. Increased suspicion with widespread use of ultrasound lead to the recognition of most cases of Cesarean scar pregnancy in early pregnancy. This allows for rapid interventions and preservation of the uterus and fertility. The use of conservative treatments, including medical treatment, especially with methotrexate, saves from surgeries such as hysterectomy and preserves women's fertility. In this study, we presented a case of cesarean scar pregnancy which was successfully treated with transvaginal ultrasound-guided injection of methotrexate.

Complete Uterine Rupture a Stigma for Modern Obstetrics: An Observational Study

Aims:: To know the maternal and perinatal outcome in women with complete uterine rupture. Background: Uterine rupture is a catastrophic obstetric event associated with high maternal, perinatal morbidity, and mortality. Objective: The present study was conducted to know prevalence, risk factors, presentation, the maternal, perinatal outcome in women with complete uterine rupture. Methods:: Present retrospective observational study was conducted on 31 women admitted to the Obstetrics ward of the rural tertiary center of Northern India with complete uterine rupture between January 2016 and December 2018 after Institutional ethical committee approval and informed written consent from participants. Data included socio-demographic parameters, gestation, predisposing factors, clinical features, site of rupture, associated bladder injury, need for hysterectomy, perinatal, and maternal outcome. Statistical analysis was conducted using Statistical Package for the Social Sciences software version 22.0. Results:: Of the total of 9,156 deliveries during the study period, 31 women had a uterine rupture, indicating the prevalence of 0.34%. Of all 21(67.7%) women had an unscarred uterine rupture, and 10(32.3%) scarred uterine rupture. The majority cases were un-booked (77.4%), multiparous (90.3%), and term at gestation (66.7%), with an average age of all cases as 26.97±3.73 years. The most common risk factor was injudicious use of oxytocic (29.0%) and previous cesarean section scar (22.6%). The most common site of unscarred uterine rupture was the lower uterine segment (26.7%) and in the scarred uterus, the site of previous cesarean section (26.7%). Eight (25.8%) women had bladder injury. Total 24 (77.4%) fetuses were stillborn. Seventeen (54.8%) women needed hysterectomy as a lifesaving procedure, and three (9.7%) succumbed to death despite all resuscitative measures. Conclusion:: Hence, complete uterine rupture is common in rural areas and is serious obstetric emergency with high perinatal, maternal morbidity and mortality. Other: As most of the cases of complete uterine rupture occur in unbooked women, hence, motivating all antenatal women for regular antenatal visits can prevent the dreadful condition to a large extent, thereby saving many maternal and fetal lives.

Serum β-HCG Level in Women Diagnosed as Having Retained Products Of Conception: A Prospective Cohort Study

Retained products of conception (RPOC) may occur after delivery or abortion, often necessitating operative hysteroscopy for their removal. A preoperative diagnosis of RPOC by ultrasonography is not always accurate and may lead to unnecessary surgical procedures. We sought to evaluate whether serum level of β-human chorionic gonadotropin (β-HCG) may aid in the preoperative diagnosis of RPOC. A prospective cohort study. Gynecology department in a university affiliated medical center. Women undergoing operative hysteroscopy for removal of RPOC between December 2019 and January 2021. Operative hysteroscopy for RPOC removal. Serum β-HCG levels were obtained on the day of surgery, and level ≥5.0 mIU/mL was considered positive. All operative specimens were evaluated by pathology for the presence of trophoblastic tissue. Of the 105 women recruited to the study, the operative pathology showed trophoblastic tissue in 81 cases (77.1%), and they were included in the data analysis. The β-HCG level was positive in 16 of those 81 cases (19.8%). Positive β-HCG level was significantly associated with RPOC after an abortion (surgical or medical) compared with RPOC after delivery. In addition, the mean RPOC mass was larger in the β-HCG-positive group than the β-HCG-negative group (29.1 ± 9.5 mm vs 23.8 ± 8.9 mm, respectively, p=.004), and the interval from termination of pregnancy to surgery was shorter (4.8 ± 1.7 weeks vs 7.5 ± 2.1 weeks, respectively, p <.001). Relatively high β-HCG level (352 mIU/mL and 3561 mIU/mL) were found in 2 cases in which the RPOC mass was implanted on a previous cesarean section scar. β-HCG level is noncontributory to the preoperative diagnosis of RPOC.