Previous Uterine Scar Research Articles

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

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

Factors Associated with Women with Multiple Caesarean Deliveries Presenting in Labour and their Fetomaternal Outcomes in Mwanza Region, Tanzania.

Background: Emergency caesarean section(C-section) for women with two or more uterine scars is documented to be associated with poor fetomaternal outcomes. The World Health Organization recommends elective C-section for women with two or more previous scars. However, in Tanzania there is a paucity of data for women with two or more prior C-sections and how it contributes to increased maternal and perinatal morbidity and mortality when they come in active labour without a planned delivery. The purpose of the study was to determine factors associated with pregnant women with multiple C-section deliveries presenting in labour and their fetomaternal outcomes.
 Methods: This was a cross-sectional, hospital-based study, involving 275 pregnant women who underwent C-section due to multiple uterine scars in the Mwanza region. Socio-demographic and clinical characteristics were collected serially until the sample size was reached using a structured questionnaire and patients’ files. Data were analyzed using STATA version 13.0 software.
 Results: All pregnant women with two or more previous uterine scars attended antenatal care (ANC) and the majority, 62.2%, had four or more visits. However, 61.9% were not told of the need for elective C-section. In addition, 26% were not counselled about the obstetric danger signs. Among the study participants, 66.6% presented with labour pain requiring emergency C-section, 13.1% had postpartum hemorrhage and 3.3% had ruptured uterus. There were 3.3% peri-natal deaths and 10.9% required newborn resuscitation. The associated factors for women with two or more C-section scars presenting in active labour were: having the last ANC visit at primary healthcare (PHC) facility (p=0.046), unemployment (p<0.001), visiting ANC <4 visits (p=0.002) or being attended by a non-physician health provider in her last ANC visit(p<0.001).
 Conclusion: Parturient women with uterine scars, when attending primary health care facilities for their ANC visits, ought to be counselled and referred to high facilities with clinicians who can plan an elective c-section delivery.

Diagnostic accuracy of uterine artery doppler velocimetry in patients with placenta previa

Background; The placenta previa (PP) is an obstetric problem in which the placental tissue is improperly located inside the lower uterine segment. Aim and objectives: was to see how effective uterine artery Doppler velocimetry was in detecting unusually morbidly adhering placentas in patients who had had one or more prior caesarean sections with placenta previa. Subjects and methods; Cross-sectional research of 100 patients was undertaken in the Department of Gynecology and Obstetrics, El- Sayed Galal Hospital, AL- Azhar University. Result; Our results showed highly statistically significant correlation between the presence of abnormal lacunae and histopathological confirmation (P-value > 0.001). In addition, the overall Sensitivity, specificity, PPV, NPV and accuracy were 90%, 100%, 100%, 64.2%, 91.6%. This criterion showed very high sensitivity and specificity with very high positive predictive value and accuracy to become the most important criteria, Conclusion; As a result of this, we conclude that the accuracy of abnormal placental lacunae, loss of the reto-placental clear zone, myometrial thinning, and utero-vesical hypervascularity are the most critical ultrasound criteria for diagnosing placenta accreta in patients who had a previous CS with a placenta previa overlying the previous uterine scar.

Analysis Of Caesarean Sections Based On Robson Classification At A Tertiary Hospital In Ghana: A Cross-Sectional Pre- And Post-Intervention Study

Background: Globally, caesarean section (CS) rates are rising progressively in low- and middle-income countries (LMICs) similar to high-income countries creating huge clinical and public health concerns. The WHO recommends the use of Robson classificationsystem as a global standard in an attempt to understand the determinants of the increasing caesarean births.Objective: To determine baseline analysis of CS using Robson classification and to identify the trends and determinants of the rising CS rate.Methods: A cross sectional study was conducted with a pre-intervention (prior to implementation of Robson caesarean classification) and post-intervention (after implementation) phases at a tertiary maternity unit in GhanaResults: The study included 20270 deliveries comprising 9890 (48.8%) and 10380(51.2%) in the years 2012 and 2013 respectively with mean (±SD) maternal age of 28.6±5.8 years. Caesarean birth occurred in 8121 (40.1%). Caesarean rate was highest and lowest among Robson group 9 and 3 in both the preintervention (92.5% and 8.4%) and post-intervention (90.9% and 12.0%) phases respectively. Robson groups 5 and 9 had the highest (32.0%) and lowest (3.2%) relative contributions to the burden of CS in the preinterventionperiod respectively. There were mixed findings regarding the patterns of relative contribution of the Robson groups to the burden of CS with an increase in groups 1,3,6,7 and 10, and reduction in groups 2,4,5,8 and 9 in the post-intervention year. There was statistically significant increase in the CS rate in Robson groups 1 (17.2% to 26.5%; OR=1.735, 95%CI 1.482-2.031), group 3 (8.4% to 12.0%; OR=1.478,95%CI 1.237-1.768) and group 10 (33.8% to 38.7%; OR=1.236, 95%CI 1.056-1.449) in the post intervention phase.Conclusion: Implementation of Robson classification into the maternity care resulted in identification of characteristics of women associated with caesarean birth: nulliparous or multiparous women with spontaneous labour and no uterine scar (group 1 and 3)and preterm gestation including previous uterine scar (group 10). We recommend further research into the clinical integration of Robson’s caesarean classification with special focus on predicting maternal and perinatal outcomes.

Maternal and Perinatal Outcome in Placenta Previa: One Year Study in Enam Medical College Hospital

Introduction: Placenta previa is a key risk factor for obstetric hemorrhage particularly occurs in women with a previous uterine scar. It can be defined as an embedding of the placenta in the lower uterine segment, overlying or approaching the internal cervical os. One-third of all cases of APH caused due to placenta previa. Aim of the study: To assess the maternal complications and perinatal outcomes of patients with placenta previa by analyzing its obstetrical factors. Methods: This study is a cross-sectional observational study conducted at the Department of Obstetrics and Gynae, in Enam Medical College and Hospital, Savar, Bangladesh. The study was conducted for the duration of 1 year between January 21 to December 21. The sample size for this study was 109. Result: The most respondents 81(74.3%) were from the age group 25-29 years, 17(16%) were booked and 92(84%) were unbooked. 27(25%) were primi and 82(75%) were multi-para. Pain abdomen was present in only 2(1.8%) cases and absent in most 107(98.2%) cases. LSCS was done in 79(72%) patients and vaginal delivery was done in 30(28%) cases. Type 2b in most of the cases 50(45.9%). Blood transfusion was needed in 20(18.3%) and post hemorrhage was seen in 12(11%). APGAR at birth was 8-10 in 69(63.35) cases, 5-7 in 27(24.8%) cases and <5 in 13(11.9%) cases. Conclusion: Placenta previa is the main cause of maternal and perinatal morbidity and mortality. Maternal and fetal outcome can be improved by regular antenatal check-up, early diagnosis of case. Management should be done in tertiary care center with neonatal management facility.

Complete Uterine Rupture: A Case Report

Abstract Background: Uterine rupture during pregnancy is a considerable obstetric complication. The presence of a previous uterine scar is the most significant risk factor. Early clinical diagnosis is paramount to maternal and fetal survival. Case Report: A 36- year-old woman, gravida 2 para 2, presented with sudden acute abdominal pain at 38 weeks of gestation. The patient had a history of cesarean delivery one year ago. Ultrasound scans showed an empty endometrial cavity and fetus outside the uterus. Emergency laparotomy was performed, a live baby boy weighing 3.420 kg was delivered, and the uterine disruption was repaired. Conclusion: Increasing trends in the cesarean section may lead to a higher number of uterine ruptures. The survival of patients after uterine rupture depends on the time interval between rupture and intervention, and the availability of appropriate medical team and equipment. Health professionals caring for pregnant women should be alert for the symptoms and risk factors of uterine rupture.

Audit of Singleton Breech Delivery in a Tertiary Hospital

Background: The 2000 Term Breech Trial (TBT) demonstrated that planned caesarean section was safer for the 3-4% of pregnancies in which the fetus will be in the breech presentation at term. However, the approach to delivery has been a topic of interesting debate and heated controversy among obstetricians. Objectives: The aim of this study was to find out the incidence and perinatal outcome of singleton breech delivery at the University of Abuja Teaching Hospital, Abuja, and North-Central Nigeria. Methodology: This was a retrospective study of singleton breech deliveries managed at the University of Abuja Teaching Hospital between 1st January 2015 to 31st December 2019. Data on social-demographic characteristics, presentation, mode of delivery and neonatal outcome were obtained from the case notes retrieved from the Medical health information Department. Result: There were 287 singleton breech deliveries out of 10416 deliveries during the study period given an incidence rate of 2.8%. Majority of the women 265 (92%) were between 21-40 years with a mean age of 30.27 +/-5.66 years. There were 144 (50.2%) unbooked patients. Majority of the women 188 (65.5%) were multipara. About 108 (37.6%) of the babies were delivered as preterm. Assisted breech deliveries was conducted in 162 (56.44%) while 125 (43.55%) were via caesarean section with a caesarean section rate of 43.55%. The commonest indication for caesarean section was Breech plus previous uterine scar in 36 (28.8%). About 28 (9.8%) babies were born with low APGAR scores and had severe birth asphyxia. Majority of the babies, 23 (8.1%) delivered through assisted breech delivery suffered severe birth asphyxia compared to 3 (1.0%) babies who were delivered via caesarean section. Significant association was noted between route of delivery and perinatal outcome. Again, 77 (27.8) primigravidae had breech delivery in this study. About 9 (3.1%) babies delivered to these primigravidae had poor APGAR scores and suffered severe birth asphyxia. However, 8 (2.8%) babies were delivered through assisted vaginal delivery compared to 1 (0.3%) baby who was delivered through caesarean section. The test showed a significant association in perinatal outcome in primigravidae who were allowed to have assisted breech delivery with Chi-Square value of 50.551, df =2 and p-value of 0.0002 which is less than the significant level of 0.05. There were 41 perinatal deaths given a perinatal mortality rate of 143/1000. It was noted that 10 (3.5%) babies had intrauterine fetal death before delivery, while 31 (10.8%) occurred as fresh stillbirth and early neonatal death. About 26 (9.1%) of the perinatal were through assisted breech delivery and 5 (1.7%) were through caesarean section. The mean birth weight was 2.6 +/- 0.92 years. Maternal morbidities were associated with mothers who had caesarean section, this however was not significant. Conclusion: Breech delivery was common and was associated with high perinatal morbidity and mortality. Route of delivery has significant association with perinatal outcome. Careful case selection and skillful delivery protocol would ensure optimal perinatal outcome that will in turn reduce caesarean section rate and reduce the morbidities associated with caesarean section.

Safety of Vaginal Misoprostolfor the Termination of Second Trimester Miscarriage in Women with Previous Uterine Scar in Iraq.

Pregnancy termination for a variety of fetal or maternal conditions has been defined as one of the common obstetrical procedures. The presence of an earlier uterine scar has been found as a highly significant risk factor, which needs to be considered before the election of the misoprostol for the termination of pregnancy (TOP) uses. This study aimed to evaluate the safety of vaginal misoprostol in patients who had an earlier uterine scar, and whether its utilization might result in increasing the risks of uterine ruptures. In total, 250 participants were included in the experimental model and divided into two groups including 95 patients in their 2nd trimesterofpregnancy with confirmed non-viable fetus and scarred uterus (study group) and 155 pregnant women with no scar in their uterus and missed miscarriage (control group). They received misoprostol tablets in accordance with the Security Hospital Protocol for the TOP. The safety has been specified according to the number of women that had full abortions with no complications. The study group with uterine scar included 95 cases that comprised 38% of the total participants in the study (n=250). Out of 95 cases, 64 (67.3%) patients had successful abortions completely, compared to the control group (the patients with no scar), 111 (71.6%) of whom had complete abortions (P<0.001). However, 44 (28.4%) and 31 (32.6%) patients in the control and study groups, respectively, were in need of surgical evacuations either for the incomplete conception product expulsion or as a result of the excessive per-vaginal bleeding. The use of the misoprostol for the TOP has not been contra-indicated in the females who had Caesarean scars. Moreover, it is efficient in females who do not have scarred uterus.

Mifepristone-Misoprostol Use for Second- and Third-Trimester Medical Termination of Pregnancy in a Canadian Tertiary Care Centre

ObjectiveThis study aims to evaluate the impact of the implementation a mifepristone-misoprostol protocol (MIFE/MISO) on the induction-to-expulsion interval in the context of second- and third-trimester pregnancy termination or intrauterine fetal death (IUFD) compared with misoprostol alone (MISO), and to share the experience of a Canadian tertiary hospital concerning the feasibility and safety of such a protocol. MethodsThis is a single-centre retrospective pre–post cohort study carried out at the Centre Hospitalier Universitaire (CHU) Sainte-Justine between 2017 and 2019. Women in the MIFE/MISO group were instructed to take mifepristone 24-48 hours before induction. Induction in the MIFE/MISO group was performed with misoprostol dosages adjusted to gestational age and the presence of previous uterine scars, while, in the MISO group, all patients received 400 μg of misoprostol vaginally every 4 hours. ResultsNinety-four patients were included in the MIFE/MISO group and 103 patients, in the MISO group. Median time to expulsion was significantly lower in the MIFE/MISO group than the MISO group (13.5 and 19.5 h respectively; P < 0.001). The total dose of misoprostol administered was significantly lower in the MIFE/MISO group than the MISO group, and adverse effects were reported in 60% and 82% of patient records, respectively (P < 0.001). Complication rates were similar between the 2 groups. ConclusionThe MIFE/MISO protocol is highly effective for second- and third-trimester induction for pregnancy termination or IUFD, without increasing complication rates and with fewer reported adverse effects. Its implementation is safe and feasible in a tertiary medical centre.

Caesarean scar pregnancy-a rare case report

&lt;p&gt;Caesarean scar pregnancy is defined as implantation into the myometrial defect at the site of the previous uterine scar of the caesarean delivery. Here in, we report a case caesarean scar pregnancy in a 28 years old woman. The patient underwent laparotomy for removal of products of conception and resuturing of scar done. Overall prevalence is I in 2000 pregnancies. Caesarean scar ectopic pregnancy is rare, but its incidence is increasing with rise in trend of caesarean sections. It is important to have early and accurate diagnosis of caesarean scar pregnancy to avoid life threatening complications.&lt;/p&gt;

Pre-induction cervical ripening with different initial doses of intravaginal misoprostol: time to delivery and peri-natal outcomes

From 2016 to 2018, a total of 300 pregnant women underwent induction of labour. Those women were allocated in two groups according to the initial dose of misoprostol. Group I (150 women) received intravaginally 50 µg misoprostol followed by 25 µg every four hours, up to a maximum of four doses whereas in group II (150 women) the initial dose was 25 μg intravaginal followed by the same dose every four hours up to a maximum of four doses. Women with previous uterine scar, abnormal foetal heart rate, severe foetal malformation, foetal growth restriction or multiple pregnancy were excluded. The aim of study was to compare the effectiveness (hours until delivery) and perinatal outcomes of both schemes of cervical ripening. Initial doses of 50 μg of misoprostol reduced the time until delivery (17.65 ± 8.2 hours vs. 20.85 ± 9.3 hours; p=.007) and the need of oxytocin (34.6% vs. 46.67%; p=.046), compared to the use of 25 μg misoprostol in all doses. No differences were observed regarding perinatal outcomes. In conclusion, starting with 50 µg of misoprostol in the first dose reduced time to vaginal delivery and decreased the use of oxytocin without worse perinatal outcomes. Impact Statement What is already known on this subject? The rate of labour induction is increasing. Mechanical and medical methods try to establish the active phase of labour as quickly and safely as possible. For this reason, there are numerous studies assessing different protocols, dosages and indications. What do the results of this study add? Despite the numerous studies, due to ethical restrictions, it is difficult to carry out prospective studies. For this reason, studies like this help to establish the most appropriate dose of misoprostol in two of the most common indications for induction of labour. We demonstrated that increasing initial doses up to 50 mg of misoprostol are safer and more effective. What are the implications of these findings for clinical practice and/or further research? This study could be useful for future prospective and randomised studies as well for including these data in a meta-analysis. In addition, these results may update the clinical protocols and reduce hospital stay without worse perinatal outcomes.

Placenta accreta index as a predictor of placental invasion in cases of placenta previa

ObjectiveThis study aims to evaluate the role of the placenta accreta index in predicting placental invasion in patients with placenta previa.Patients and methodsThis study was carried on 60 pregnant women with placenta previa (after 30 weeks gestation). They were recruited from the Obstetrics and Gynecology clinic of Menoufia University hospitals and Shebin El Kom Teaching Hospital in the period from January 2019 to December 2020.ResultsPreterm labor was found in 15 (78.95%) patients in the accreta group and six (14.36%) patients in the nonaccreta group (P = 0.000). Hysterectomy was performed in 14 (73.68%) patients in the accreta group and four (9.76%) patients in the nonaccreta group (P = 0.000). Urological complications occurred in five (26.32%) patients in the accreta group and one (2.44%) patient in the nonaccreta group (P = 0.004). Blood transfusion was needed in 16 (84.21%) patients in the accreta group and seven (17.07%) patients in the nonaccreta group (P = 0.000). ICU transfer was needed in 10 (52.63%) patients in the accreta group and two (4.88%) patients in the nonaccreta group (P = 0.000).ConclusionsBoth grayscale and color Doppler ultrasound were very important in the prenatal diagnosis of placenta accreta to reduce maternal and perinatal mortality and morbidity, but color Doppler had higher sensitivity and specificity. Placenta accreta index score 4 can be used as a predictive cutoff value for prediction of placental invasion in patients with placenta previa. Placenta previa in current pregnancy, previous uterine scar, increased maternal age, number of dilation and curettage and number of pregnancies and labors, and the presence of previous history of placenta previa are all risk factors for placenta accreta, and placenta accreta is associated with increased postoperative morbidity. It is associated with increased blood loss, risk of blood transfusion, ICU admissions, wound sepsis, urological complications, and poor neonatal outcome.

Early-term birth and its association with universal two-child policy: a national cross-sectional study in China

ObjectiveTo describe the epidemiology of early-term birth (ETB) at the national level in China, and explore the association and mediating factors between ETB and policy between universal two-child policy and...

Role of Decapitation in Management of A Case of Complete Shoulder Dystocia with Rupture Uterus - A Case Report

Complete Shoulder dystocia in the presence of scarred uterus is an acute obstetrical emergency and if not properly handled can lead to serious fetal and maternal complications. A G5P4AO previous II cesarean sections, presented in emergency after delivery of fetal head and impacted shoulders, at a small private clinic in a village, four hours back. On laparotomy, there was uterine rupture from the previous uterine scar along with posterior bladder wall rupture . The shoulder dystocia was relieved by decapitation and breech extraction abdominally. Subtotal hysterectomy and repair of the bladder wall was done. This case highlight the dilemma of lack of regular antenatal care and maternal education, malpractices by untrained health professionals and time lapse in referral system that is still a very serious and major issue in developing countries like Pakistan . Keywords: Shoulder dystocia, obstructed labor, and uterine rupture

Comparison Between the Roles of Trans-abdominal 3D Ultrasound Versus Transvaginal 2D Ultrasound in Evaluation of Placental Invasion in Cases of Placenta Previa with Previous Uterine Scar

Comparison Between the Roles of Trans-abdominal 3D Ultrasound Versus Transvaginal 2D Ultrasound in Evaluation of Placental Invasion in Cases of Placenta Previa with Previous Uterine Scar

Delayed, Stable Presentation of Complete Uterine Rupture

Complete prelabor ruptures in women with a previous uterine scar are rare but are associated with catastrophic outcomes. Intrauterine fetal demise should be recognized as a sign, not necessarily a sole diagnosis, until other etiologies are excluded.

Scar Ectopic Pregnancy - An Emerging Challenge.

Cesarean scar ectopic pregnancy (SEP), a rare type of ectopic pregnancy, is the implantation of a gestational sac in the myometrium and fibrous tissues at the site of a previous uterine scar (mostly cesarean section scar). The condition can be catastrophic if not managed on time, leading to significant morbidity and mortality. Early diagnosis made by transvaginal ultrasonography and a high degree of suspicion for the probability of SEP in previous uterine surgery patients may help in the initiation and success of conservative treatment, prevention of complications, and preservation of fertility. We present here the analysis of 22 cases of SEP managed at our institute between 2013 to 2020.The mean gestational age at the time of diagnosis was 8.6±2.2 weeks. The majority of the women presented with either pain or bleeding, but few cases (7 cases) were asymptomatic and were diagnosed with SEP during routine obstetric ultrasonography. Out of these cases, a single case was admitted with shock due to uterine rupture. The mean serum β-hCG level was 29,543 mIU/ml (range, 2105-61590). Asymptomatic patients with low serum β-hCG levels(<15,000 mIU/ml) were given a single dose of methotrexate. Methotrexate was given as a single dose or 4 doses regimen in total 13 cases. Laparotomy with wedge resection of the scar ectopic was done in 8 cases.Overall primary treatment success was recorded in 20 of 22 cases (91%). 2 cases underwent dilatation and curettage due to retained product of conception after primary treatment with methotrexate. The serum β-hCG levels were normalized in an average time period of 53 days.This retrospective case series has proved the role of early and accurate diagnosis of SEP for initiating the treatment in order to minimize maternal morbidity and mortality related to this rare and unusual form of ectopic pregnancy.

English

BACKGROUND Uterine rupture is defined as the tearing of the muscular wall of the uterus during pregnancy or labour.1 Often it occurs from the tearing of previous caesarean scar during labour.2 The other known risk factors for uterine rupture include, maternal age, height, body mass index (BMI), education, birth weight, gestational age, induction of labour, instrumental vaginal delivery, interpregnancy interval, congenital uterine anomaly, grand multiparity, previous uterine surgery, fetal macrosomia, fetal malposition, obstructed labour, uterine instrumentation, attempted forceps delivery, external version, and uterine trauma. 2-6This study was done to find out the prevailing risk factors associated with this grave condition in Bundelkhand region, so that mortality and morbidity associated with it could be prevented. METHODS We have studied 37 cases of uterine rupture, operated in our institution from Jan. 2018 to Oct. 2019. During this period a total of 2986 Caesarean sections (CS) were performed. Of these 37 cases, 5 were Nullipara (13.51 %), 16 primipara (31.25 %) and 16 were grand multipara (31.25 %). 24 cases (64.86 %) had previous uterine scar while 13 (35.13 %) had no scar. RESULTS In our study major risk factors for uterine rupture were found to be previous scars (64.68 %). Obstructive labour (23.07 %), malpresentation (7.69 %), grand multiparity (38.46 %) and prolong labour (30.76 %), were responsible for rupture in unscarred uterus. In all cases we first tried to repair the tear and only 9 (24.32 %) needed hysterectomy. In our study 28 patients (75.67 %) required only repair whereas 24.32 % cases needed hysterectomy. Maternal death was just 1 case (2.7 %) and (51.35 %) babies survived. CONCLUSIONS Majority of uterine rupture cases were found in women who had previous CS. So, first CS should be performed after very careful understanding of its indications. 2.7 % maternal mortality and 51.35 % delivery of live birth babies in our study proves that early detection and proper managing of the case can reduce maternal and fetal mortality in uterine rupture cases. KEY WORDS Uterine Rupture, Previous Scar, Inter-Pregnancy Interval

Risk factors of placenta previa with maternal and neonatal outcome at Dongola/Sudan.

Background:Placenta previa is a major cause of hemorrhage affecting 0.4–0.5% of all pregnancy's early detection of cases and senior input will significantly reduce maternal and fetal morbidity and mortality.Objectives:The aim of the study is to determine risk factors, fetal and maternal outcome in pregnancy complicated by placenta previa.Method:This is descriptive cross-sectional study in women diagnosed with placenta previa at Dongola maternity hospital, Sudan from December 2018 to June 2019.Results:There were 3,674 deliveries and 52 cases of placenta previa during the study period with prevalence of 1.4%. The average age of the patients was 34.8 years and most of them were above 35 years (53.8%), and (63.5%) were para 3 and more. Other identified risk factors included previous cesarean section (69.1%), previous uterine evacuation (13.5%), and assisted reproductive technique (5.8%). Maternal complications were hemorrhage needing blood transfusion (40.4%), cesarean hysterectomy (21.2%), and bladder injury (3.8%), but (34.6%) were with good outcome and no maternal death. NICU admission with RDS (25%), prematurity (25%), and death (5.8%) were the fetal complications, while in (44.2%) fetal outcome was good.Conclusion:The most identifiable risk factors for placenta previa were previous uterine scars, advanced maternal age, and multiparity. And it is associated with adverse maternal and fetal outcomes.

Trial of labor after previous single cesarean delivery in grand-multiparous women: a retrospective cohort study

To compare pregnancy outcomes in grand-multiparous (GMP) women with and without one previous cesarean delivery (CD), and to evaluate the number of previous successful vaginal deliveries after a CD needed to reduce the complication rate of trials of labor after a previous CD. This is a retrospective cohort study of women with singleton pregnancy at term who had a trial of vaginal delivery between 2007 and 2014 at a tertiary medical center. We compared pregnancy outcomes in GMP women with and without one previous cesarean delivery. The primary outcome was mode of delivery and secondary outcomes were uterine rupture and composite maternal and neonatal morbidity. For the secondary objective, we compared pregnancy outcomes in women in TOLAC, stratified by the number of previous vaginal deliveries. Overall, 2815 GMP women met the study criteria, of which 310 (11%) had a previous cesarean delivery. The rate of a successful vaginal deliveries (VBAC) was similar, regardless of the presence of a previous cesarean delivery. No other differences in outcomes were found between the groups. In a secondary analysis, it was found that the presence of a single previous VBAC (compared to no previous VBACs) increased the odds of achieving a vaginal delivery in the next trial of labor after cesarean delivery (TOLAC) (aOR 5.66; 95% CI 3.73-8.60), and decreased the risk of maternal or neonatal adverse outcomes (aOR 0.62; 95% CI 0.39-0.97, and aOR 0.49; 95% CI 0.25-0.97, respectively). Multiple prior VBACs (as compared to a single prior VBAC) did not increase the odds of achieving another VBAC. Grand-multiparous women with and without previous uterine scar have comparable pregnancy outcomes. Additionally, after the first VBAC, additional successful VBACs do not improve the success rate in the next TOLAC.