Scar Dehiscence Research Articles

Postpartum Ultrasound: An Indispensable Tool in the Labor Ward.

Postpartum hemorrhage can occur because of different conditions. Apart from placental remnants and uterine atony, less common causes include uterine rupture, placental polyps, arteriovenous malformations, and pseudoaneurysms. Ultrasound plays a key role in the precise definition of the underlying pathology, which is necessary to initiate the appropriate therapy. It also helps to depict intraabdominal hematomas and uterine scar dehiscence, 2 conditions that do not necessarily lead to postpartum hemorrhage but are associated with increased maternal morbidity. This article presents 52 ultrasound images together with clinical and histopathologic images to give an overview of both frequent and rare pathologies in the postpartum period.

Peri-Operative Complications And Surgical Outcomes In Repeat Cesarean Section: A Retrospective Analysis

Introduction: Repeat cesarean sections are becoming increasingly common due to the global rise in cesarean deliveries. While cesarean sections can be life-saving for both mother and baby, the risks associated with multiple procedures tend to increase. This study aims to evaluate these complications and outcomes to guide safer practices. Methods: This observational cross-sectional study was conducted Department of Obstetrics & Gynaecology, Chittagong Medical College & Hospital, from December 16-June’17. All the pregnant women who underwent repeat Caesarean section in Chittagong Medical College Hospital, Chittagong during the study period were considered as the study population. A total of 100 study subjects were selected by consecutive convenient sampling techniques. Data analysis was done by SPSS (Statistical Package for Social Sciences) 16. In all cases, p-value <05 was considered significant. Result: most repeat cesarean sections (70%) lasted about 1 hour, with 99% utilizing the Pfannenstiel incision. Adhesions were observed primarily with the bladder (8%), peritoneum (5%), and omentum (5%). A lower transverse uterine incision was used in 99% of cases, while 5% experienced scar dehiscence. Challenges during fetal delivery occurred in 5% of cases, and 3% had difficulty entering the peritoneal cavity. Placental abnormalities like placenta previa were noted in 6% of cases, and placental adherence (accreta or percreta) was found in 3%. Urinary bladder injuries occurred in 2% of cases. Blood loss was below 1 liter in 95% of surgeries, but 3% required significant transfusions. Elective tubal ligation was performed in 15% of cases, and some patients underwent additional procedures like Lynch surgeries or uterine artery ligations (3%). Conclusion: Notable complications are observed in repeat cesarean sections, including adhesions with the bladder, scar dehiscence, and challenges during fetal delivery. Additionally, placental abnormalities, such as placenta previa and abnormal adherence, highlight the complexities associated with repeat procedures. Most patients experienced minimal blood loss, with 95% losing less than 1 liter.

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

Differentiating placenta accreta spectrum from scar dehiscence with underlying, non-adherent placenta: A systematic review of scoring systems and primary data analysis.

Accurate discrimination between placenta accreta spectrum (PAS) and scar dehiscence with underlying non-adherent placenta is challenging both on prenatal ultrasound and intraoperatively. This can lead to overdiagnosis of PAS and unnecessarily aggressive management of scar dehiscence which increases the risk of morbidity. Several scoring systems have been published which combine clinical and ultrasound information to help diagnose PAS in women at high risk. This research aims to provide insights into the reliability and utility of existing accreta scoring systems in differentiating these two closely related but different conditions to contribute to improved clinical decision making and patient outcomes. A literature search was performed in four electronic databases. The references of relevant articles were also assessed. The articles were then evaluated according to the predefined inclusion criteria. Primary data for testing each scoring system were obtained retrospectively from two hospitals with specialized PAS services. Each scoring system was used to evaluate the predicted outcome of each case. The literature review yielded 15 articles. Of these, eight did not have a clearly described diagnostic criteria for accreta, hence were excluded. Of the remaining seven studies, one was excluded due to unorthodox diagnostic criteria and two were excluded as they differed from the other systems hindering comparison. Four scoring systems were therefore tested with the primary data. All the scoring systems demonstrated higher scores for high-grade PAS compared to scar dehiscence (p < 0.001) with an excellent Area Under the receiver operator characteristic Curve ranging from 0.82 (95% CI 0.71-0.92) to 0.87 (95% CI 0.79-0.96) in differentiating between these two conditions. However, no statistically significant differences were noted between the low-grade PAS and scar dehiscence on all scoring systems. Most published scoring systems have no clearly defined diagnostic criteria. Scoring systems can differentiate between scar dehiscence with underlying non-adherent placenta from high-grade PAS with excellent diagnostic accuracy, but not for low-grade PAS. Hence, relying solely on these scoring systems may lead to errors in estimating the risk or extent of the condition which hinders preoperative planning.

Nonpalpable implant removals at centre of experience in France: a cohort study

Objective(s) Management and localisation strategies to remove nonpalpable contraceptive implants may be difficult. We aimed to evaluate our imaging modalities to identify deep implant and patient outcomes related to removal. Study design In this retrospective study, we reviewed all cases referred to our specialised centre for nonpalpable contraceptive implants from January 2018 to August 2022. Results Out of the cohort studied, 47 female subjects exhibited nonpalpable implants. The implant was nonpalpable for thirty-six patients (76,6%) immediately after the insertion whereas it was not palpable several months after the insertion for eleven patients (23.4%). Twelve patients (25.5%) had one or more failed removal attempts before referral. All 47 implants were successfully visualised via ultrasound in the upper arm: 40 implants (85.1%) were located in the subdermal tissue, 4 (8.5%) were intrafascial and 3 (6.4%) were intramuscular. Depth of the implant was 4.0 mm [1.7 − 12.0]. No clinical factors were statistically associated with differences in depth or location (subdermal vs subfascial). Removal procedures were mainly under local anaesthesia in 74.5% of cases in an outpatient setting. There were two Clavien-Dindo grade 1 complications (one case of cutaneous scar dehiscence and one transient postoperative neuropathic complaint in the upper arm resolved within 3 months under analgetics) Conclusions Identification of deep implants requires following the ultrasound modality protocol. Ultrasound detection makes easy and safe implant removal. Training programs for the insertion as well as for the removal of correct and incorrect inserted implants should be continued and developed all around the world.

An unusual case of Uterine window revealing the placenta: A Diagnostic dilemma between Scar dehiscence and the Placenta Accreta Spectrum.

Uterine scar dehiscence, or the "uterine window," is a complication of a repeat cesarean section. Preterm delivery, caesarean sections performed more than twice in the past, or less than a 24-month interval between deliveries are all connected with an increased risk. The terms Placenta Accreta Spectrum (PAS) and uterine scar dehiscence are frequently used interchangeably. A 25-year-old unbooked pregnant woman, gravida 3 para 2 live 1, presented to OPD at 37 weeks gestation. During the intraoperative phase, we discovered a silent scar dehiscence with partially visible placental lobes under the intact serosa mimicking the Placenta Accreta Spectrum. A lower-segment caesarean section was performed, and the placenta was totally separated. After the cesarean incision was closed, the myometrial defect was corrected. It is crucial to distinguish it from disorders in the Placenta Accreta Spectrum, as prenatal imaging can be deceptive if not performed with the requisite expertise to distinguish between the two conditions. This distinction will inform the treatment strategies for uterine dehiscence and PAS disorders, which are distinct.

Current understanding of the pathogenesis of placenta accreta spectrum disorder with focus on mitochondrial function.

The refinement of assisted reproductive technology, including the development of cryopreservation techniques (vitrification) and ovarian stimulation protocols, makes frozen embryo transfer (FET) an alternative to fresh ET and has contributed to the success of assisted reproductive technology. Compared with fresh ET cycles, FET cycles were associated with better in vitro fertilization outcomes; however, the occurrence of pregnancy-induced hypertension, preeclampsia, and placenta accreta spectrum (PAS) was higher in FET cycles. PAS has been increasing steadily in incidence as a life-threatening condition along with cesarean rates worldwide. In this review, we summarize the current understanding of the pathogenesis of PAS and discuss future research directions. A literature search was performed in the PubMed and Google Scholar databases. Risk factors associated with PAS incidence include a primary defect of the decidua basalis or scar dehiscence, aberrant vascular remodeling, and abnormally invasive trophoblasts, or a combination thereof. Freezing, thawing, and hormone replacement manipulations have been shown to affect multiple cellular pathways, including cell proliferation, invasion, epithelial-to-mesenchymal transition (EMT), and mitochondrial function. Molecules involved in abnormal migration and EMT of extravillous trophoblast cells are beginning to be identified in PAS placentas. Many of these molecules were also found to be involved in mitochondrial biogenesis and dynamics. The etiology of PAS may be a multifactorial genesis with intrinsic predisposition (e.g., placental abnormalities) and certain environmental factors (e.g., defective decidua) as triggers for its development. A distinctive feature of this review is its focus on the potential factors linking mitochondrial function to PAS development.

Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence

Prenatal ultrasound discrimination between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta is challenging both prenatally and intraoperatively, which often leads to overtreatment. In addition, accurate prenatal prediction of surgical difficulty and morbidity in placenta accreta spectrum is difficult, which precludes appropriate multidisciplinary planning. The advent of advanced 3-dimensional volume rendering and contrast enhancement techniques in modern ultrasound systems provides a comprehensive prenatal assessment, revealing details that are not discernible in traditional 2-dimensional imaging. This study aimed to evaluate the use of 3-dimensional volume rendering ultrasound techniques in determining the severity of placenta accreta spectrum and distinguishing between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta. A prospective, cohort study was conducted between July 2022 and July 2023 in the fetal medicine unit of Dr Soetomo Academic General Hospital, Surabaya, Indonesia. All pregnant individuals with anterior low-lying placenta or placenta previa with a previous caesarean section who were referred with suspicion of placenta accreta spectrum were consented and screened using the standardised 2-dimensional and Doppler ultrasound imaging. Additional 3-dimensional volumes were obtained from the sagittal section of the uterus with a filled urinary bladder. These were analyzed by rotating the region of interest to be perpendicular to the uterovesical interface. The primary outcomes were the clinical and histologic severity in the cases of placenta accreta spectrum and correct diagnosis of dehiscence with nonadherent placenta underneath. The strength of association between ultrasound and clinical outcomes was determined. Multivariate logistic regression analyses and diagnostic testing of accuracy were used to analyze the data. A total of 70 patients (56 with placenta accreta spectrum and 14 with scar dehiscence) were included in the analysis. Multivariate logistic regression of all 2-dimensional and 3-dimensional signs revealed the 3-dimensional loss of clear zone (P<.001) and the presence of bridging vessels on 2-dimensional Doppler ultrasound (P=.027) as excellent predictors in differentiating scar dehiscence and placenta accreta spectrum. The 3-dimensional loss of clear zone demonstrated a high diagnostic accuracy with an area under the curve of 0.911 (95% confidence interval, 0.819-1.002), with a sensitivity of 89.3% (95% confidence interval, 78.1-95.97%) and specificity of 92.9% (95% confidence interval, 66.1-99.8%). The presence of bridging vessels on 2-dimensional Doppler demonstrated an area under the curve of 0.848 (95% confidence interval, 0.714-0.982) with a sensitivity of 91.1% (95% confidence interval, 80.4-97.0%) and specificity of 78.6% (95% confidence interval, 49.2-95.3%). A subgroup analysis among the placenta accreta spectrum group revealed that the presence of a 3-dimensional disrupted bladder serosa with obliteration of the vesicouterine space was associated with vesicouterine adherence (P<.001). Three-dimensional volume rendering ultrasound is a promising tool for effective discrimination between scar dehiscence with underlying nonadherent placenta and placenta accreta spectrum. It also shows potential in predicting the clinical severity with urinary bladder involvement in cases of placenta accreta spectrum.

Importance of hemogram parameters for predicting uterine scar dehiscence

The pathophysiology of uterine scar dehiscence is not yet clear. The aim of this study was to investigate whether preoperative hemogram parameters can be used as predictive markers of uterine scar dehiscence, thus improving prediction and contributing to management of repeat Cesarean section. Between 2015 and 2020, 36670 (47.6%) cesarean sections were delivered in our hospital and 16943 of them had a previous Cesarean section. All cases of uterine scar rupture detected during Cesarean section were identified, and a total of 40 patients were included after excluding cases with impairment of the systemic inflammatory response (SIR). Controls consisted of 40 randomly selected, age-and body mass index (BMI)-matched patients, and the groups were compared. Age, BMI, and gravidity were similar (p>0.05). Although the gestational week and Apgar scores were similar between the groups (p>0.05), the birth weight amongst controls was significantly higher than the uterine dehiscence group (p=0.028). Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and other hemogram values were similar in both groups (p>0.05). Mean platelet volume (MPV) in the control group was significantly higher than in the uterine rupture group (p=0.049). Regression analysis found no significant result between hemogram parameters, birth weight, and dehiscence. In this study, which set out to identify predictors of the risk of uterine scar dehiscence with SIR parameters, only the MPV value was lower in the dehiscence group.

Terine rupture in the first trimester: A case report and literature review

Background: Uterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, mostly because of catastrophic bleeding. First-trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding, such as an ectopic pregnancy. We present a case of first-trimester scar dehiscence and conduct a literature review of this rare condition. Case presentation: A 39-year-old patient with 4 previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. The patient had two previous histories of third-trimester uterine rupture in previous pregnancies with subsequent hysterotomy and repair. The patient underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently performed. Conclusion: This case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The outline risk factors, clinical presentation, diagnostic imaging, and management may help in the early identification and management of this rare but life-threatening condition.

Uterine rupture in the first trimester: a case report and review of the literature

BackgroundUterine rupture is a rare complication that can occur in the first trimester of pregnancy. It can lead to serious maternal morbidity or mortality, which is mostly due to catastrophic bleeding. First trimester uterine rupture is rare; hence, diagnosis can be challenging as it may be confused with other causes of early pregnancy bleeding such as an ectopic pregnancy. We present a case of first trimester scar dehiscence and conduct a literature review of this rare condition.Case presentationA 39-year-old African patient with four previous hysterotomy scars presented with severe lower abdominal pain at 11 weeks of gestation. She had two previous histories of third trimester uterine rupture in previous pregnancies with subsequent hysterotomies and repair. She underwent a diagnostic laparoscopy that confirmed the diagnosis of a 10 cm anterior wall uterine rupture. A laparotomy and repair of the rupture was subsequently done.ConclusionIn conclusion, the case presented adds to the body of evidence of uterine scar dehiscence in the first trimester. The risk factors, clinical presentation, diagnostic imaging, and management outlined may help in early identification and management of this rare but life threatening condition.

Uterine Rupture: A Literature Review and Case Presentation Highlighting Diagnostic and Clinical Challenges Posed by this Rare and Potentially Catastrophic Obstetric Emergency

Uterine rupture is a rare but life-threatening condition, with incidence ranging from 1 in 5,700 to 1 in 20,000 pregnancies. It is an obstetrical emergency requiring rapid intervention to mitigate harm and allow the best possible chance of survival for mother and baby. While the most frequent antecedent is scar dehiscence associated with previous uterine surgeries such as caesarean section or, less commonly, myomectomy or curettage, other non-iatrogenic aetiologies must also be considered to allow a fully inclusive approach sufficient to spur acute clinical care. This review highlights these factors and the limitations of diagnostic imaging modalities in an acute management setting. It aims to accrue the importance of broad clinical suspicion and pre-emptive action in patients presenting with pain during pregnancy regardless of predisposing risk and the assurances of non-interventional scanning. We offer this review to share an experience of clinical care and improve knowledge and understanding to improve future patient care.

Placenta Accreta Spectrum: Evaluation of classic and non-classic presentations, pathologic grading, and uterine scar dehiscence features in a modern institutional series

IntroductionThe aim of this study is to document the distribution of classic versus non-classic presentation of Placenta Accreta Spectrum (PAS) disorders as well as grading categories by the Society for Pediatric Pathology (SPP) and FIGO systems in an institutional cohort of gravid hysterectomies. We also document the prevalence of uterine scar as a histologic correlate for uterine scar dehiscence, a phenomenon raised by some as central to PAS pathogenesis. MethodsPAS cases were assigned grade and designated as classic (anterior lower uterine segment implantation, prior C-section) or non-classic (implantation away from anterior lower uterine segment and/or no prior C-section). Features of dehiscence (uterine window, histologic evidence of scar) were recorded. ResultsSixty-two patients were included: 76 % had prior C-section; 55 % had other forms of uterine instrumentation. Classic PAS was recorded in 52 % patients; notably, 48 % had non-classic presentation; of these, all but one had prior instrumentation (curettage, myomectomy, laparoscopy). Uterine window was described in 53 % classic and 23 % non-classic PAS. Scar was demonstrated in 31 % classic and 23 % non-classic PAS; trichrome/reticulin stains were confirmatory. 32 % cases were SPP grade 1, 18 % grade 2, 18 % grade 3a and 32 % grade 3d. Grade 3 was significantly more common in classic (72 %) than non-classic (27 %) PAS. DiscussionWhile most PAS patients have classic presentation, a large subset does not; in addition, scar tissue is not identified histologically in most PAS hysterectomies; in these settings, PAS cannot be fully attributed to scar dehiscence. Uterine instrumentation often precedes non-classic PAS reinforcing the concept of decidual disruption as central to PAS pathogenesis. PAS grading as defined correlates with presentation (classic vs non-classic).

Complications of ankle arthroscopy: frequency, prevention, and treatment.

The complication rate of ankle arthroscopy (AA) ranges from 3.5% to 14%. To avoid such complications, it is essential to have a thorough understanding of the anatomy of the ankle, to perform the procedure very carefully and with appropriate instrumentation, and to use a non-invasive distraction technique. The most frequent complications are neurological (cutaneous nerve injuries), which are usually caused by direct injury during arthroscopic portals or by a distracting pin when using an invasive distraction technique. They usually resolve spontaneously within a few months. The iatrogenic formation of a pseudoaneurysm is a severe but extremely rare complication (an incidence of 0.008%). There are several treatments for pseudoaneurysms: external compression; direct thrombin injection, surgical intervention (resection of the damaged segment of the artery and reconstruction with a reversed long saphenous vein interposition graft), and endovascular embolisation. Other rare complications include wound infections (localised superficial infection), problems at the portal incisions (prolonged portal drainage, residual pain in the portal, portal scar dehiscence, cyst at the portal site), type I complex regional pain syndrome, instrument breakage, painful scars and nodules, and a number of other rarer complications. In conclusion, when performing AA, it is important to remember the potential complications and try to avoid them. When they do occur, it is essential to diagnose and treat them appropriately.

Outcome of subsequent pregnancies in women with prior uterine rupture

ObjectiveTo report maternal and neonatal outcomes of subsequent pregnancies in a series of women with a prior uterine rupture. MethodsThe records of all 103,542 deliveries (22,286 by cesarean section) performed in a single tertiary medical center from 2009 to 2021 were reviewed. Women with a prior uterine rupture, defined as a separation of the entire thickness of the uterine wall, with extrusion of fetal parts and intra-amniotic contents into the peritoneal cavity documented in the operative report of the previous cesarean delivery or laparotomy, were identified for inclusion in the study. ResultsThe cohort included 38 women with 50 pregnancies (50 neonates). Women had been scheduled for elective cesarean delivery at early term. Mean gestational age at delivery was 36 + 4 weeks (±5 days). In 7 pregnancies (14 %), spontaneous labor occurred before the scheduled cesarean delivery (at 36 + 6, 35 + 4, 35 + 3, 34 + 6, 34 + 3, 32 + 6 and 31 + 0 gestational weeks). A recurrent uterine scar rupture was found in 4 pregnancies (8 %), and uterine scar dehiscence, in 2 pregnancies (4 %), all identified during elective repeat cesarean delivery. In none of these cases was there a clinical suspicion beforehand; all had good maternal and neonatal outcomes. One parturient with placenta previa-accreta had a planned cesarean hysterectomy. ConclusionWomen with prior uterine rupture have good maternal and neonatal outcomes in subsequent pregnancies when managed at a tertiary medical center, with planned elective term cesarean delivery, or even earlier, at the onset of spontaneous preterm labor.

Transvaginal Ultrasound Evaluation Of Cesarean Section Niche Scar During Pregnancy: A Prospective Longitudinal Study

Background and Objectives: To determine the prevalence of a CS scar niche during pregnancy using transvaginal ultrasound imaging, and to determine the relationship between the evolution of the CS scar niche and the ultimate pregnancy result. Materials and Methods: Transvaginal sonography was used in this prospective observational research to look at the uterine scars of 100 women at 11+0-13+6, 18+0-20+6 and 32+0-35+6 weeks of pregnancy. When the region of hypoechogenic myometrial discontinuity of the lower uterine section was discovered, a scar was discernible while pregnant. An indentation at the location of the CS scar with a depth of at least 2 mm in the sagittal axis was designated as the CS scar niche (or "defect"). Myometrial thickness next to the niche and the remaining myometrial thickness were used to quantify the hypoechogenic portion of the CS niche in two dimensions. (RMT). The entire lower uterine segment (LUS) thickness and the myometrial layer thickness were measured during the second and third trimesters of pregnancy at the thinnest portion of the scar area. In a non-selected subset of patients (n=20), CS scars were measured by two separate examiners. Scar visibility was evaluated using descriptive analysis, and the intraclass correlation coefficient (ICC) was computed to demonstrate the degree of absolute agreement between two observers for measuring scars. Maternal age, BMI, smoking status, prior vaginal deliveries, obstetric complications, and a history of uterine curettage were among the factors looked into as potential contributors to the CS scar niche. The hospital's computerized medical database provided clinical statistics on pregnancy outcomes and complications. Results: 80.9% of the ladies could see the scar. A CS scar niche was prevalent in 53.6% of people with a noticeable CS scar. Excellent intra- and interobserver agreement was observed for CS scar niche readings. There was no statistically significant correlation between maternal age, BMI, gestational diabetes, smoking status, previous vaginal delivery after CS, and niche development when subgroups of women were compared in terms of CS scar niche and non-niche. In contrast to 34.4 % of the women who did not have uterine curettage, 56.3% of the women who had done uterine curettage had uterine scar niches. Conclusions: The CS scar niche could be reproducibly measured by a transvaginal scan in half of the cases with a visible CS scar at the first trimester of pregnancy, according to an ultrasonography evaluation. An increased chance of uterine niche formation in a subsequent pregnancy was linked to prior uterine curettage. The CS scar area may be connected to uterine scar dehiscence.

Frequency Of Vaginal Birth After Caesarean Section And Its Fetomaternal Outcome.

Vaginal birth after caesarean section (VBAC) is associated with reduced blood loss and transfusions, fewer infections, and fewer thromboembolic events as compared to caesarean delivery. The current rate of repeat caesarean after one previous caesarean is above the WHO standard of 15%. We aimed to determine the occurrence of VBAC and to determine the occurrence of feto-maternal outcomes in successful VBAC cases so that trials of VBAC can be given to carefully selected patients to reduce the rate of repeat caesarean section. The Combined Military Hospital (CMH) Rawalpindi's Obstetrics and Gynaecology department conducted this cross-sectional study from March 20 to September 19, 2021. After obtaining ethical committee approval, data was collected using a non-probability, consecutive sampling technique from 150 patients on a self-developed structured proforma. Patients between the age range of 20-35 years with a history of previous lower segment caesarean section, having gestational age between 37-41 weeks and who presented in spontaneous labour were included in this study. After taking informed consent, all women were given a trial of labour and the outcome of the trial was noted. Women were followed for the feto-maternal outcomes. The gathered information was analysed using SPSS version 25.0. Post-stratification, a p-value of 0.05 or lower on the chi-square test was deemed statistically significant. Following a C-section, 28.67% of patients experienced successful vaginal births. PPH was found in 2.32%, scar dehiscence in 0.0%, low birth weight babies in 16.28%, APGAR score <7 at 1 minute was 23.26% and NICU admission as 9.30% in women undergoing vaginal birth after caesarean section. Appropriate selection of patients for the trial of VBAC can help reduce the higher rate of repeat caesarean section after a previous caesarean section and increase the chances of successful vaginal birth.

EP16.03: Pandora's Box: a challenging case of chronic uterine scar dehiscence masked by placenta accreta

EP16.03: Pandora's Box: a challenging case of chronic uterine scar dehiscence masked by placenta accreta

FREQUENCY OF SCAR DEHISCENCE IN PATIENTS WITH PREVIOUS ONE CAESAREAN SECTION HAVING SCAR TENDERNESS

Objectives: To determine the frequency of uterine scar dehiscence in patients with previous one cesarean section having scar tenderness. Materials and Methods: This Descriptive Cross Sectional Study was conducted in the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar from 28th Jan 2021 to 28th July 2021. Total 222 pregnant women with singleton pregnancy more than 28 weeks of gestation and history of previous one lower segment Caesarean Section presenting with scar tenderness were included in the study while patients having previous classical caesarean section, multiple pregnancies, not fi t for VBAC and without scar tenderness were excluded .Study was started after taking approval from IREB. Sampling was done in consecutive manner and followed to determine the occurrence of scar dehiscence. Results: The mean age of the participants was 27.1 + 5.3 years and mean BMI was 25.2 + 2.5kg/ m2 . The mean gestational age was 38.7 +1.9 weeks. Among the participants 43.7% had parity of 1-4 and 56.3% had more than &gt; 5. Maternal tachycardia was present in 32% and on follow up, scar dehiscence was recorded in 14.9%. Conclusion: Scar dehiscence after previous CS is relatively common in women presenting at term pregnancy with scar tenderness. Further studies are recommended on relationship between CS, common factors which can lead to scar dehiscence and its outcome mother and new born.

Clinicopathological features of gestation course associated with uterine scar dehiscence in women with a past medical history of a single caesarean section

Aim. To compare the clinicopathological features, the course of pregnancy and its outcomes with the results of histological examination of the uterine scar in women with a past medical history of a single caesarean section.Materials and Methods. We analysed the associations between histological features of scarred myometrium and clinicopathological parameters of 48 pregnant women aged 19 to 40 years with a past medical history of a single caesarean section. All women were divided into two groups depending on the uterine scar condition. Tissue sampling for histological examination was performed during lower segment caesarean section from the scar area after fetal extraction.Results. 26 women had non-defective uterine scar and 22 women had uterine scar dehiscence (an overstretched inferior uterine segment with little or no muscle fiber and disorganised connective tissue at histological examination). Clinicopathological parameters associated with a uterine scar dehiscence were are ≤ 2-year interval between deliveries (OR = 6.85, 95% CI = 1.27-36.90, p = 0.025) and obesity (OR = 3.5, 95% CI = 0.97-12.70, p = 0.056). Typical pregnancy complication in patients with uterine scar dehiscence was placental insufficiency (OR = 4.75, 95% CI = 1.39-16.2, p = 0.013).Conclusion. Identification of the risk factors for uterine scar dehiscence may assist in selecting a method of delivery for women with a past medical history of caesarean section.