Scar Dehiscence Research Articles

Uterine Isthmocele (Niche after Cesarean Section)

An isthmocele, also called a niche, cesarean scar defect, or cesarean scar dehiscence is a pouchlike defect of the anterior uterine isthmus at the site of a prior cesarean section. Its occurrence has been increased in the last years secondary to the increased incidence of cesarean section. Many patients with isthmocele are asymptomatic. The most frequent complaint relates to intermittent postmenstrual bleeding as the isthmocele functions as a reservoir collecting blood during menstruation, with irregular menses that can run for 2 to 12-days. Various sources have described isthmocele as a case of infertility, pain and dysmenorrhea. An isthmocele is typically diagnosed on transvaginal sonography, hysterosalpingography and hysteroscopy. Magnetic resonance tomography is useful to measure the thickness of the lower uterine segment, the profundity of the isthmocele. The treatment of isthmocele includes laparotomy, laparoscopy, hysteroscopy, vaginal repair, and several combined techniques with no statistically superior outcome noted in the literature. In that respect is no gold standard treatment for isthmocele.

Systemic retinoids and scar dehiscence

Systemic retinoids such as isotretinoin and acitretin are associated with numerous side effects but are therapeutically valuable in dermatological practice. Several studies have reported the wound-healing effects of treatment with concurrent systemic retinoids in addition to surgical treatments. Herein, we describe two patients with scar dehiscence that developed after initiation of systemic retinoid treatment following cutaneous surgery. In Case 1, isotretinoin was thought to decrease collagen production to a greater degree than did degradation during the wound remodeling phase, which resulted in wound dehiscence. In Case 2, acitretin was thought to decrease fibroblast proliferation and collagen production during the proliferation phase of wound healing, which resulted in wound dehiscence. Based on the two presented cases, it is advisable to postpone systemic retinoid treatment for 6 months to 1 year following cutaneous surgery, located especially in cosmetically important sites.

Novel technique to manage pacemaker exposure with buried flap reconstruction: case series

ObjectiveExposure of implantable electrical devices may increase morbidity and mortality significantly. Usually superficial infections are conservatively managed whereas invasive infections necessitate complete capsulectomy, sub-pectoral placement or implant exchange. Most commonly...

Пластика несостоятельного рубца на матке влагалищным доступом при сопутствующей дисплазии соединительной ткани

Пластика несостоятельного рубца на матке влагалищным доступом при сопутствующей дисплазии соединительной ткани

68: Prenatal open hysterotomy vs. two-port exteriorized uterus fetoscopic myelomeningocele repair. perinatal outcomes from a single center

To assess obstetrical and perinatal outcomes after fetal open or fetoscopic myelomeningocele (MMC) repair. Retrospective cohort study from 2011-2018. 66 patients diagnosed with fetal MMC who underwent a prenatal repair in our center via open-hysterotomy (N=33) or fetoscopic repair (N=33) were included. All patients fulfilled Management of Myelomeningocele Study (MOMS) inclusion and exclusion criteria. Open-hysterotomy repair was performed as reported in MOMS trial. Our standardized fetoscopic repair is a two port, exteriorized uterus, technique in CO2, using interrupted sutures for the neurosurgical repair.13 of the fetosocpic and 8 of the open repaired patients received a dural patch. Obstetrical and perinatal outcomes were compared between groups using Student's t-test for independent samples or Mann-Whitney U test if they had normal or non-normal distribution, respectively. Chi-square or Fisher's exact tests were used to compare qualitative data. Duration of surgery and spinal defect repair were lengthier in the fetoscopic group. There were no differences in intraoperative fetal bradycardia or postoperative complications. Fetoscopically repaired cases were delivered later [38.6 (29.9-40.9) weeks vs. 35.7 (27.3-37.9) weeks; p<0.01] with higher birth weight [3120(1375-4430)grams vs. 2611 (624-3623)grams; p<0.01] and a lower rate of cesarean delivery (43% vs. 100%; p<0.01). Intact surgical sites were seen in all 14 fetoscopic cases delivered by c-section and in 21 of open cases (p<0.01). Uterine adhesions were more common after open repair (36% vs. 14%; p<0.01). One neonatal death occurred after an open repair due to extreme preterm birth and sepsis. Fetoscopic repair has a lengthier surgery but similar postoperative complications to open repair, while offering significant benefits including higher gestational age at birth, vaginal delivery and a decreased risk of adhesions and scar dehiscence.

Induction of Labour With Prostaglandin Gel in Grand Multipara with a Previous Caesarean Delivery.

This study sought to evaluate the safety of induction of labour with prostaglandin E2 (PGE2) gel in grand multiparous (GMP) women and to compare the labour outcome of GMP women who have undergone one previous Caesarean section (CS) with that of GMP women who never had a previous CS. This prospective cohort study (Canadian Task Force Classification II-2) evaluated induction of labour with 1 mg of PGE2 gel in 96 GMP women with one previous CS (study group) and in 104 GMP women without previous CS (control group). One uterine rupture occurred in the study group (1%), and another occurred in the control group (0.9%). Additional oxytocin was used in seven patients (7.3%) in the study group and in 28 others (26.9%) in the control group (P = 0.002). Both uterine ruptures occurred with oxytocin augmentation. One case of uterine scar dehiscence was found in the study group. There was no significant difference between the study group and the control group regarding the rate of vaginal delivery (74 [77.1%] vs. 78 [75%]) or the rate of CS (21 [21.9%] vs. 24 [23.1%]), respectively. There was no significant difference between the groups in 5-minute Apgar scores ≤7. There was no neonatal death in either group. A low dose (1.0 mg) of PGE2 gel for induction of labour in GMP women with one previous CS is appropriate and appears to be safe for both mother and baby. Augmentation by oxytocin should be used judiciously.

662 - Minor Complications Post Laparoscopic Surgery

Objective: To determine the impact of short term (up to six weeks post operative) minor complications of laparoscopy, including: scar infection, scar dehiscence, urinary tract infection, ongoing abdominal pain, new vaginal discharge or bloating, abnormal vaginal bleeding, requiring readmission or additional medical follow up.

Effect of Single versus Double Layer Suturing on Healing of Uterine Scar after Cesarean Delivery

Background: Cesarean delivery is the one of the oldest procedures performed in the history of surgery. Nowadays closure of the uterine incision is a key step in CD, particularly given the increasing awareness of future scar dehiscence. Aim: to improve quality of cesarean delivery. Objective: to assess healing after single- and double-layer suturing of uterine scar. Patients and Method: Randomized clinical trial conducted at Obstetrics and Gynecology department, Suez Canal University Hospital. Eighty primigravida women with full term pregnancy undergoing first elective CS were equally randomized to either single-layer or double-layer unlocked suture. Six weeks after the operation, the integrity of the cesarean scar done by 2 operators was assessed by sonohysterography. The thickness of the residual myometrium covering the defect RMT, width of the triangular hypoechoic niche W”, depth of the triangular hypoechoic niche D and healing ratio D/RMT were calculated as markers of uterine scar healing. Results: There were no significant differences between the groups in terms of estimated blood loss, operation time, or additional hemostatic suture. However, frequency of appearance of niche in single layer patients was 65% compared to 30% in the double layer patients. The mean thickness of the residual myometrium covering the defect was significantly higher 9 ± 1.1 mm after double-layer than 7.9 ± 0.92 mm after a single-layer closure (P = 0.002). The mean healing ratio in double-layer was 0.2948 ± 0.05 versus 0.2969 ± 0.04; P =0.922 in the single-layer closure. Conclusions: Double unlocked layer closure was associated with higher residual myometrial thickness than locked single layer and better uterine scar healing

Laparoscopic management of uterine cesarean scar dehiscence during mid-trimester misoprostol-induced termination of pregnancy

Laparoscopic management of uterine cesarean scar dehiscence during mid-trimester misoprostol-induced termination of pregnancy

Incidence and Risk Factors of Uterine Scar Dehiscence Identified at Elective Repeat Cesarean Delivery: A Case-Control Study

Background: The aim of this study was to determine the rate of uterine scar dehiscence among women undergoing elective repeat cesarean delivery and to investigate associated risk factors. Methods: This was a retrospective case-control study of patients with previous one or more lower segment transverse cesarean incisions giving birth by elective repeat cesarean delivery at two tertiary-care centers over a period of 1 year. Demographic data, previous and current obstetric events were recorded and compared among women with or without uterine scar dehiscence. Results: Among 588 patients included in this study, 27 cases of uterine scar dehiscence were identified with an incidence of 4.6%. This rate was not affected by maternal age, parity, co-morbidity, twin gestation, preoperative labor or previous preterm cesarean delivery. Factors significantly associated with uterine scar dehiscence were “preterm delivery” (OR: 2.76, 95% CI: 1.18 - 6.42), “tertiary cesarean delivery or higher” (OR: 2.56, 95% CI: 1.14 - 5.75) and “inter-delivery interval ≤ 24 months” (OR: 2.38, 95% CI: 1.04 - 5.44). No immediate adverse maternal or neonatal complications were noted. Conclusions: Uterine scar dehiscence is not uncommon among women undergoing elective repeat cesarean delivery. Increased risk was associated with preterm delivery, tertiary cesarean delivery or higher and short inter-delivery interval of ≤ 24 months. J Clin Gynecol Obstet. 2018;7(2):37-42 doi: https://doi.org/10.14740/jcgo481w

Mechanical induction of labor and ecbolic-less vaginal birth after cesarean section: A cohort study

ObjectiveDuring delivery counseling, some women with previous uncomplicated cesarean section (CS) wish mechanical induction of labor (IOL) but they are not accepting the added risk of using ecbolics to induce and/or augment labor. The objective of the study was to assess the safety and efficacy of the isolated use of transcervical Foley's catheter balloon as a mean of mechanical cervical ripening (CR)/IOL and successful ecbolic-less vaginal birth after cesarean section (VBAC). Materials and methodsA cohort study was conducted in two tertiary care maternity hospitals between October 2013 and July 2016 and recruited women with singleton pregnancy and cephalic presentation who had previous one uncomplicated CS and were scheduled for mechanical CR/IOL at term for routine obstetric indications. No ecbolics were used for induction or augmentation of labor as per patients' request. The primary outcome variable was the rate of successful VBAC. Results108 Women had a completed trial of mechanical CR/IOL without ecbolics till delivery. Active labor started in 94 women (87%), however only 43 women (39.8%) had successful VBAC. No woman in the study cohort had uterine rupture, scar dehiscence, uterine tachysystole, postpartum hemorrhage and/or puerperal sepsis. No cases were admitted to intensive care units and there were no maternal mortalities. Prior successful VBAC and post-expulsion BS were the only independent predictors for successful VBAC and shorter duration of labor after balloon expulsion. ConclusionMechanical IOL with the mere use of transcervical Foley's catheter is a safe and effective method of VBAC in women refusing use of ecbolics.

Aesthetic Improvement of Undeveloped Calves After Treatment of Congenital Clubfoot Deformity.

Even when clubfoot deformity is treated in a timely manner, the consequences observed in adulthood include hypoplasia of the calf muscles, gait impairment, decreases in foot size, and it can also affect the tibial length. These consequences may have negative impacts on the patient's subjective appraisal of long-term outcomes, and can influence the patient's self-esteem in both male and female patients. We present our experience in the treatment of undeveloped calves after surgical treatment of congenital clubfoot. In total, 72 patients underwent corrective surgery in order to improve undeveloped calves resulting from a congenital clubfoot deformity. We used calf silicone implants in combination with fat grafting in multistaged procedures, in order to decrease complication rates and improve aesthetic outcome. Amongst our patients there were 54 (75%) females and 18 (25%) males. All of the patients, except one, had unilateral calf hypoplasia. The procedures were divided into several groups: (1) medial calf augmentation with silicone implants; (2) medial calf augmentation with silicone implants and fat grafting; and (3) medial and lateral calf augmentation with silicone implants and fat grafting. We had one case of a hyperpigmented scar and one case of partial scar dehiscence. There were no cases of compartment syndrome. The average follow-up period was 9.8 months. Calf enhancement surgery in patients with congenital clubfoot deformity is very gratifying. When combining calf implants with fat grafting in multistaged procedures, we can achieve excellent results with low complication rates.

Orifice Preserving Double Opposing Z-Plasty for Partial Split Ear Lobe Repair: A Review of 25 Cases.

Surgeons often come across split earlobe (SEL) deformities in their clinical practice which usually result from wearing heavy earrings for a long duration. It is of utmost importance to achieve a satisfactory repair with increased strength in one go. To describe a strong repair for partial SEL with preservation of the orifice. This study is a retrospective review of 25 patients (36 earlobes), who underwent repair of partial SEL deformity with an orifice preserving double opposing Z-plasty in the hospital, from January 2014 to June 2015. The duration of follow-up was 12 months. Adequate cosmetic results were obtained in all patients with no need for revision surgery due to recurrence or scar dehiscence. Patients did not report any difficulty in wearing earrings and were satisfied with the aesthetic outcome. The orifice preserving double opposing Z-plasty technique seems to offer an efficacious method of repair of partial SEL deformity with an acceptable scar. The technique is simple and reproducible with good aesthetic outcomes and minimal complications.

Case 3: Abdominal Distention and Gastrointestinal Bleeding in a Late Preterm Neonate

A late preterm female neonate is born at 34 weeks, 6 days of gestation, with a birthweight of 2.1 kg. The mother is a gravida 2 woman and the infant is delivered via cesarean section in view of scar dehiscence. The infant cries immediately after birth and does not require any resuscitation. She develops respiratory distress in the delivery room, is transferred to the NICU, and given continuous positive airway pressure (CPAP). She is comfortable with CPAP and is gradually weaned to room air 48 hours after birth. On the third day after birth, tube feeding is commenced at 20 mL/kg per day. However, the next day she develops abdominal distention, gastrointestinal bleeding, and melena for which feeding is stopped. There is no history of treatment with steroids or nonsteroidal anti-inflammatory drugs. On the same day, she is transferred to a level IIIB NICU for further management. On admission to the institute, the infant is lethargic and tachypneic. Blood pressure and capillary refilling time are in the normal range. The …

Study on Uterine Scar Dehiscence in in cases having Previous C-Section during trial of labour

Study on Uterine Scar Dehiscence in in cases having Previous C-Section during trial of labour

A Study on the Fetomaternal Outcome in Cases of Previous Three Caesarean Section

Introduction: Caesarean section is the most common obstetrical surgery performed worldwide. Its incidence continuously rising. The rate of caesarean section is 24.4% in urban educated India. In our college LSCS rate of previous 5 years is 25.4%, amongst which 0.2% were previous three LSCS. Methodology: A retrospective observational stu dy of 200 cases of caesarean deliveries from January 2010 to December 2017 in a tertiary care centre. Cases were divided in four groups such as first LSCS, second LSCS, third LSCS and fourth LSCS, each group contained 50 cases. Results: Patients were group ed as per number of caesarean deliveries. There is an increase in maternal morbidity with increase in the number of previous caesarean deliveries. There is increased morbidity in the form of adherent placenta, blood loss, bladder, ureter injury, intra - oper ative adhesions, scar dehiscence, need for ICU admission. Conclusion: Cases of previous 2 and previous 3 LSCS are bound to increase in near future, such cases need proper referral to tertiary care centre for proper management based on the risk of varied co mplications.

Incidence and Risk Factors of Uterine Scar Dehiscence Identified at Elective Repeat Cesarean Delivery: A Case-Control Study

Incidence and Risk Factors of Uterine Scar Dehiscence Identified at Elective Repeat Cesarean Delivery: A Case-Control Study

375: Is Foley catheter use during TOLAC associated with uterine rupture?

Uterine rupture rates are 3 times higher in women who undergo an induction of a trial of labor after cesarean section (TOLAC). As safe pharmacologic cervical ripening agents are limited, mechanical dilation with a Foley catheter is often used in clinical practice, but the association between mechanical ripening and uterine rupture in patients undergoing TOLAC is not clearly delineated. We sought to assess whether use of a Foley catheter in women undergoing a TOLAC is associated with an increased risk of uterine rupture. We performed a secondary analysis of the Maternal-Fetal Medicine Unit’s (MFMU) Cesarean Section (CS) Registry, a prospective observational cohort study. We included women with a history of ≤2 low transverse CS who underwent induction at 324 weeks of gestational age with a live singleton fetus without major anomalies. We excluded those who received prostaglandins or laminaria. We performed multinomial logistic regression, calculating adjusted relative risk (aRR) ratios. Relevant confounders accounted for included prior vaginal delivery, pregnancy-induced hypertension (PIH), chorioamnionitis, and cervical effacement and dilation on admission. 2564 women were eligible. Foley catheter did not increase the risk of uterine rupture in TOLAC (aRR 2.02, p=0.19). Similarly, uterine scar dehiscence was also not associated with Foley catheter use (aRR 1.32, p=0.67). Chorioamnionitis and PIH were significantly associated with increased risk of uterine dehiscence only (aRR 7.40, p<0.01 and aRR 1.89, p=0.02, respectively). Our data suggest that the Foley catheter is a safe tool for mechanical dilation in women undergoing a TOLAC. While we noted a significant association between chorioamnionitis and PIH with uterine dehiscence, this may reflect an earlier decision to proceed with repeat CS in the setting of additional maternal comorbidities. Given the risks of prostaglandin use in TOLAC, our data can assist providers regarding the safety of a Foley catheter in this patient population.

Puerperal Sepsis with Uterine Scar Dehiscence after Cesarean Section: A Rare Complication

Puerperal Sepsis with Uterine Scar Dehiscence after Cesarean Section: A Rare Complication

Endometrial Hyperplasia as a Cause of Secondary Postpartum Hemorrhage in a Post Caesarean Section Patient

There are multiple causes of prolonged and persistent postpartum bleeding. The common etiologies include uterine atony, endometritis and retained products of conception. Uncommon causes described in literature include uterine artery pseudoaneurysm, placental site nodule and uterine scar dehiscence. Endometrial hyperplasia causing persistent per vaginal bleeding postpartum has yet to be reported in literature. The rarity of this condition may be attributed to the underlying pathogenesis. Endometrial hyperplasia is caused by unopposed estrogen and it is well established that pregnancy decreases the risk of endometrial hyperplasia. We present a case report of a 42-year-old lady found to have complex endometrial hyperplasia during evaluation for persistent per vaginal bleeding 3 months post Caesarean section. J Med Cases. 2018;9(6):183-186 doi: https://doi.org/10.14740/jmc3064w