Segment Scar Research Articles

Comparative study between Transabdominal and Transvaginal sonography in the Assessment of Lower Uterine Segment Scar at Term in recurrent Caesarian Sections

Comparative study between Transabdominal and Transvaginal sonography in the Assessment of Lower Uterine Segment Scar at Term in recurrent Caesarian Sections

Spontaneous Rupture of the Gravid Uterus in a Multigravida Women with a Previous History of Caesarean Section: A Case Report

Spontaneous uterine rupture is a rare obstetric complication that has catastrophic effects on both the mother and foetus, resulting in significant morbidity and 80 to 90% foetal mortality. Rupture of the uterus through a previous lower uterine segment scar is the most common cause in developing nations. However, factors such as lack of antenatal care, inappropriate obstetric interventions, obstructed labour, grand multiparity, unbooked status, limited access to emergency obstetric care, and low socioeconomic status play a crucial role in uterine rupture in developing countries like India. Hereby, the authors present a case report of a 31-year-old pregnant patient at 19 weeks of gestation with sudden severe lower abdominal pain. An ultrasound revealed the absence of foetal cardiac activity, placenta located outside the uterus, an empty endometrial cavity, and minimal free fluid in the pelvis. Further, an Magnetic Resonance Imaging (MRI) of the pelvis showed a rupture of the anterior and right lateral uterine wall, through which the foetus and most of the placental tissue had passed into the peritoneal cavity. After confirming the diagnosis, the patient underwent emergency laparotomy, during which the uterine wall defect was closed with appropriate haemostasis. The patient recovered without any untoward complications.

Comparison of Clinical and Radiological Findings for the Prediction of Scar Integrity in Women With Previous Lower Segment Cesarean Sections.

We aimed to compare the clinical and radiological findings to predict scar integrity in term antenatal mothers with a previous lower segment cesarean section (LSCS). This prospective study was conducted in the obstetrics and gynecology department of LN Medical College, Bhopal, India, from August 2020 to August 2021. We included all pregnant women with term gestation (37+0 to 42+0 weeks) who were admitted either for elective repeat LSCS or for emergency LSCS and had a history of a previous LSCS. A detailed history and clinical examinations were performed. We noted the presence of scar tenderness and conducted transabdominal ultrasound (USG) to assess the integrity of the uterine scar in all women. During surgery, the surgeon identified the lower uterine segment scar and graded it as normal, thinned-out, dehiscent, or ruptured. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for both clinical findings (scar tenderness) and ultrasound findings as predictors of scar integrity. A total of 60 pregnant women were included in the study. During a repeat cesarean section, we found a thinned-out scar in 26 women out of 60 (43.3%). Out of 60 women, 13 had scar tenderness, and among these 13 women, 12 had thinned-out scars intraoperatively. Forty-seven women had no scar tenderness; 14 had thinned-out scars intraoperatively. The sensitivity of scar tenderness as a predictor of a thinned-out scar was 46.2%, specificity was 97.1%, PPV was 92.3%, and NPV was 70.2%. Whereas the sensitivity of ultrasound scar thickness as a predictor of a thinned-out scar was only 19.2%, with a specificity of 94.1%, a PPV of 71.4%, and an NPVof 60.4%. Thus, we documented a significant correlation between intraoperative and clinical findings (κ = 0.46; p<0.05), but no agreement could be found between ultrasound and intraoperative findings (p>0.05). Clinically evident scar tenderness continues to be a useful parameter to predict intraoperative scar status.

Revised Storegga Slide reconstruction reveals two major submarine landslides 12,000 years apart

The Storegga Slide is the largest known exposed submarine landslide in the world, which triggered a tsunami that inundated the coasts of northern Europe ~8,150 years ago. Previous studies suggested the removal of 50–70 m of sediment from the northern slide scar segment, contributing half of the total slide volume of up to 3200 km³. However, new sediment echosounder profiles and sedimentological constraints show that most material within the northern Storegga slide scar had already failed ~20,000 years ago, at the end of the Last Glacial Maximum. We refer to this previously undetected slope failure as the Nyegga Slide. In our revised slope failure reconstruction, the Nyegga Slide removed more than 35 m of sediments that were previously attributed to the tsunamigenic Storegga Slide. This implies that large slope failures at the mid-Norwegian margin occur more frequently than previously thought, indicating a higher tsunami hazard for the North Atlantic.

Uterine didelphys: A Case report of successful term pregnancies in each endometrial cavity

Background: Uterine didelphys is a rare congenital anomaly that may increase the risk of pregnancy loss and adverse perinatal outcome. There is limited knowledge of specific increased risk related to uterine didelphys. Uterine didelphys occurs in approximately 1 in 3000 women and accounts for 8 -10% of all mullerian duct anomalies (MDAs). Aim: To present this rare congenital clinical condition and offer management modality experience from the Rivers State University Teaching Hospital (RSUTH). Case report: Mrs. MC was a 33 year old booked G3 Para 1+ 1 (alive), previous caesarean section, who presented for antenatal care. Her index pregnancy was complicated by premature uterine contractions and ante – partum haemorrhage at 29 weeks and 30 weeks gestation respectively which were managed successfully. Obstetric ultrasound scan revealed a second uterine cavity with separate endometrial plate in keeping with uterine didelphys. She subsequently had an elective repeat caesarean section at 38 weeks gestation for transverse lie and uterine anomaly. Findings were a gravid left uterus and an empty right uterus with a lower segment scar. The left uterus contained a live male neonate in transverse lie with a birth weight of 3.5 kg and good Apgar scores. The baby was successfully managed for neonatal Jaundice. The mother developed postpartum haemorrhage which was successfully managed. The mother and baby were discharged on the 5th and 12th post-operative day respectively in good clinical state. The mother was given appointment to the family planning clinic. Conclusion: We presented a patient with a rare congenital clinical condition – uterine didelphys who conceived spontaneously. She had a previous successful pregnancy on the right uterus followed by a spontaneous miscarriage and successfully carried the index pregnancy on the left uterus to term and was delivered by an elective repeat caesarean section with good fetal and maternal outcome.

Laser therapy for treating hypertrophic and keloid scars.

Laser therapy for treating hypertrophic and keloid scars.

Diagnosing early scar pregnancy in the lower uterine segment after cesarean section by intracavitary ultrasound.

BACKGROUNDEarly scar pregnancy (CSP) in the lower uterine segment after cesarean section is a type of ectopic pregnancy that can cause major complications if left untreated. Transabdominal ultrasound is a common procedure but is influenced by external factors. Thus, intracavitary ultrasound may have better diagnostic efficiency for CSP.AIMTo assess the value of intracavitary ultrasound for diagnosing CSP in the lower uterine segment after cesarean section. METHODSPatients diagnosed with CSP in our hospital from October 2019 to April 2021 were recruited. Transabdominal and intracavitary ultrasound examinations were performed to compare the diagnostic differences for CSP and its types.RESULTSSixty-three patients were diagnosed during the study period. The diagnostic accuracy for CSP was higher in intracavitary ultrasound (96.83%) than in transabdominal ultrasound (84.13%) (P < 0.05). The missed diagnosis and misdiagnosis rates did not differ among the ultrasound types (intra: 0.00% and 3.17%; trans: 4.76% and 11.11%, respectively; P > 0.05). For the diagnostic rates for the CSP types, the rates for gestational sac (100.00% vs 90.48%), heterogeneous mass (93.75% vs 75.00%), and part of the uterine cavity (80.00% vs 60.00%) were higher in intracavitary ultrasound than in transabdominal ultrasound, but the difference was not statistically significant (P > 0.05). For gestational sac CSP patients, intracavitary ultrasound showed that the gestational sac was located in the lower uterine segment scar with abundant peripheral blood flow; the distance between the gestational sac and the serosal layer was 2.42 ± 0.50 cm. Intracavitary ultrasound for heterogeneous mass CSP patients indicated that the mass mainly occurred in the lower anterior uterine wall, protruding into the bladder, and was surrounded by abundant internal and peripheral blood flow; the distance between the mass and serosal layer was 1.79 ± 0.30 cm. For CSP type partly located in the uterine cavity, the gestational sac was partly located in the lower uterine cavity and partly in the scar with abundant internal and peripheral blood flow; the distance between the gestational sac and the serosal layer was 2.29 ± 0.28 cm. CONCLUSIONIntracavitary ultrasound had a higher diagnostic accuracy and application value for diagnosing CSP than transabdominal ultrasound, with reduced risk of missed diagnoses and misdiagnosis, thereby preventing delayed treatment.

Lower uterine segment scar assessment at 11-14 weeks' gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery.

To validate prospectively transvaginal ultrasound assessment of the lower uterine segment (LUS) scar at the time of first-trimester screening in women with previous Cesarean section (CS) and to determine its feasibility and accuracy in stratifying women according to the risk for placenta accreta spectrum (PAS) disorder. Women with a history of CS were recruited between 11 + 0 and 13 + 6 weeks' gestation and underwent LUS scar assessment using transvaginal ultrasound. A standardized midsagittal plane, which included the cervicoisthmic canal (CIC), the uterine scar and the placental site, was obtained. The scar was described in terms of its size (narrow or dehiscent) and its location in relation to the CIC (within or above), with each LUS scar classified into one of four groups based on these features. Placental location was assessed and classified as high- or low-lying. Women were stratified according to the risk of PAS, based on the relationship between the scar location and placental site. Women were considered high risk when the scar was above the CIC and the placenta was low-lying (i.e. when the placenta was overlying an exposed scar) and low risk when the scar was within the CIC and/or the placenta was high. High-risk patients were followed up at 20 weeks and 28-30 weeks for the development of PAS. Maternal demographics, detailed obstetric history and obstetric outcome were collected. First-trimester transvaginal ultrasound was offered to 535 women with prior CS during the study period. A LUS scar was visualized in 79.9% (401/502) of those who agreed to undergo the examination. At this scan, the LUS scar was above the CIC in 9.0% (36/401) of women, but only 5.7% (23/401)additionally had a low-lying placenta overlying the scar. Of these 23 high-risk women, two were found to have PAS on the mid-trimester screening scan and one was noted to have placental adherence during evacuation following mid-trimester termination of pregnancy. On the first-trimester scan, 94.3% (378/401) of women were at low risk of PAS. This screening protocol yielded a positive likelihood ratio of 21.33 (95% CI, 13.02-34.96), sensitivity of 100% (95% CI, 29.24-100%), specificity of 95.31% (95% CI, 92.39-97.35%), positive predictive value of 16.7% (95% CI, 5.8-39.2%) and negative predictive value of 100% (95% CI, 98.4-100%). On multivariable regression analysis performed to identify confounding variables associated with a LUS scar above the CIC, only maternal body mass index ≥ 30 kg/m2 was significant (odds ratio (OR), 2.42 (95% CI, 1.04-5.39); P = 0.03). Although there was a trend towards an increased risk of a LUS scar above the CIC in women with prior elective prelabor CS (OR, 1.72 (95% CI, 0.80-3.68)), this association did not reach statistical significance. Routine transvaginal ultrasound assessment of the location of the LUS scar and placenta at the time of first-trimester screening between 11 + 0 and 13 + 6 weeks' gestation in women with prior CS is a feasible and effective tool to identify those at risk of subsequent development of PAS disorder. A finding of placental implantation over an exposed LUS scar seems to be cardinal in predicting the risk of PAS disorder in women with prior CS, with an excellent negative predictive value. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Diagnostic Accuracy of Lower Uterine Segment Scar Thickness ≤1.6mm in Prediction of Scar Dehiscence in patients

Background: Cesarean section uterine scar dehiscence (CSD) is a rare but notable complication of Lower segment cesarean section (LSCS) surgery. The cause for a uterine scar dehiscence is based on the etiology behind the uterine scar defect or any event that would predispose the cesarean scar to dehisce. Globally accepted option for assessing the CS scar is transvaginal ultrasonography of the non-pregnant uterus. Objective: To determine the diagnostic accuracy of lower uterine segment scar thickness≤1.6mm in the prediction of scar dehiscence in patients with previous one LSCS who are undergoing repeat LSCS after trial of labour taking intraoperative findings as gold standard. Material and methods: This cross sectional study was conducted in Services Hospital, Lahore for 6 months. The Non probability consecutive sampling technique was used to include women with previous one LSCS at 36-38 weeks were asked to get their TVS done for scar thickness. Women with scar thickness≤1.6mm and scar thickness&gt;1.6mm were identified. Their intraoperative findings of scar dehiscence were confirmed. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients was 29.87±6.07 years. The emergency LSCS was done in 599(49.1%) patients and elective LSCS was done in 621(50.9%) patients. The sensitivity, specificity &amp; diagnostic accuracy of TVS was 98.31%, 99.05% &amp; 98.69% respectively. Conclusion: According to our study results the TVS for uterine scar is a very useful and effective tool in the prediction of scar dehiscence in patients with previous one LSCS taking intraoperative findings as gold standard. Keywords: Transvaginal sonography, TVS, Uterine, Scar, dehiscence, LSCS, Intraoperative

Time-Course Changes of Extracellular Matrix Encoding Genes Expression Level in the Spinal Cord Following Contusion Injury-A Data-Driven Approach.

The involvement of the extracellular matrix (ECM) in lesion evolution and functional outcome is well recognized in spinal cord injury. Most attention has been dedicated to the “core” area of the lesion and scar formation, while only scattered reports consider ECM modification based on the temporal evolution and the segments adjacent to the lesion. In this study, we investigated the expression profile of 100 genes encoding for ECM proteins at 1, 8 and 45 days post-injury, in the spinal cord segments rostral and caudal to the lesion and in the scar segment, in a rat model. During both the active lesion phases and the lesion stabilization, we observed an asymmetric gene expression induced by the injury, with a higher regulation in the rostral segment of genes involved in ECM remodeling, adhesion and cell migration. Using bioinformatic approaches, the metalloproteases inhibitor Timp1 and the hyaluronan receptor Cd44 emerged as the hub genes at all post-lesion times. Results from the bioinformatic gene expression analysis were then confirmed at protein level by tissue analysis and by cell culture using primary astrocytes. These results indicated that ECM regulation also takes place outside of the lesion area in spinal cord injury.

The clinical and ultrasound-based comparison between cesarean scar pregnancy and other lower uterine segment pregnancies with a history of cesarean section

Objective: To compare the clinical and ultrasound characteristics of cesarean scar pregnancy (CSP) and other lower uterine segment pregnancies (LUSPs) to enable differential diagnosis of the two pathologies in the first trimester.Methods: A retrospective analysis of early pregnancies with a gestational sac located in the lower uterine segment with cesarean section history in our hospital from December 2011 to February 2018 was performed. According to the diagnoses, the patients were divided into the CSPs group and the other LUSPs group. The clinical and ultrasound features were compared.Results: A total of 38 patients were enrolled with 16 (42.1%) CSPs and 22 (57.9%) other LUSPs. Compared to the other LUSPs group, the CSPs group had thinner lower uterine myometrium (0.16 ± 0.11 cm versus 0.32 ± 0.14 cm, p = .000), larger maximum diameter of the gestational sac (5.14 ± 2.08 cm versus 3.77 ± 1.24 cm, p = .028); the distribution of the villous chorion sites (p = .001) and the main blood supply sites (p = .000) of the gestational sac were different between the two groups. Surgical bleeding volume during the termination of gestation was higher in the CSPs group than in the other LUSPs group (p = .028).Conclusion: Patients with CSPs and other LUSPs have different imaging characteristics on ultrasound. The prognosis of these patients also differs. Ultrasound feature is very useful in the differential diagnosis of these two clinical-mimicking pathologies.

Analysis of 82 cases of spinal cord injury treated by ozone [abstract

PURPOSE: To investigate the feasibility and clinical efficacy of ozone in the treatment of spinal cord injury so as to restore the function and sensation of the limbs.&#x0D; &#x0D; METHODS: From May 2007 to July 2016, 82 patients with spinal cord injury were treated, including 24 females and 58 males, with an average age of 32.1 years. &#x0D; Among all the research, 26 cases of cervical spinal cord injury, 12 cases of paraplegia in the thoracic spinal cord, 44 cases of paraplegia in the lumbar spine, all of whom had muscle strength 0 and had incontinence. &#x0D; Frankel classification, grade A is 69 cases, B class is 13 cases. &#x0D; 12 cases of spinous process wire fixation was performed; in 61 cases, internal pedicle screw fixation, and no internal fixation was required in 9 cases. In these patients, we did epidural injection of 2-8 mL of ozone at 35 mcrg/mL with the C arm.&#x0D; In 4 cases we did spinal canal decompression and internal fixation and we used an epidural catheter into the epidural and subarachnoid cavity to directly inject 2-8 mL of ozone at 35 mcrg/mL; after catheter withdrawal, we did ozone injection in the scar segment with the C arm to increase acurracy of the technique. &#x0D; &#x0D; RESULTS: In 10 patients, the treatment produced no neurological improvement; the remaining 72 patients, from the 3rd postoperative day, feeling started to recover. We observed 22 patients during 26 months that could stand up and walk with crutches and 18 patients of them could control defecation and 16 patients could feel the defecation; 14 cases could do slight activities with their lower extremities; 12 patients reached mild forearm movement.&#x0D; &#x0D; CONCLUSION: The key to the repair of the injured spinal cord is provided through the axon growth; ozone can play a worthy role in the release of scar and allow nerve axons to grow and access some function recovery.

A preliminary study of uterine scar tissue following cesarean section.

To compare smooth muscle cells, type I collagen, and apoptosis of the lower uterine segment of women who had/without a prior cesarean delivery. Alpha smooth muscle actin (α-SMA), type I collagen, and nuclear apoptosis were compared between the groups from lower uterine segment. Twenty-eight controls and 82 with one prior cesarean delivery were included. The women with a prior cesarean section were classified by time since the surgery: ≤3 years, >3 and ≤5 years, >5 and ≤7 years, >7 and ≤9 years, and >9 years. Smooth muscle volume density (VD) % was significantly lower in women who had cesarean sections in first three groups than in the controls (all, P<0.01). Type I collagen VD% was similar among all groups and the controls. The number of apoptotic nuclei in the lower uterine segment of the scarred group was greater up to 3 years after surgery and less than in the control at 7-9 years. The number of non-apoptotic nuclei in the scarred group was greater than controls up to 7 years after surgery. The lower uterine segment scar becomes stable at 3 years after cesarean delivery, and by 9 years, the scar is mature.

Speckle-Tracking Layer-Specific Analysis of Myocardial Deformation and Evaluation of Scar Transmurality in Chronic Ischemic Heart Disease

Identification of the extent of scar transmurality in chronic ischemic heart disease is important because it correlates with viability. The aim of this retrospective study was to evaluate whether layer-specific two-dimensional speckle-tracking echocardiography allows distinction of scar presence and transmurality. A total of 70 subjects, 49 with chronic ischemic cardiomyopathy and 21 healthy subjects, underwent two-dimensional speckle-tracking echocardiography and late gadolinium-enhanced cardiac magnetic resonance. Scar extent was determined as the relative amount of hyperenhancement using late gadolinium-enhanced cardiac magnetic resonance in an 18-segment model (0% hyperenhancement=normal; 1%-50%=subendocardial scar; 51%-100%=transmural scar). In the same 18-segment model, peak systolic circumferential strain and longitudinal strain were calculated separately for the endocardial and epicardial layers as well as the full-wall myocardial thickness. All strain parameters showed cutoff values (area under the curve>0.69) that allowed the discrimination of normal versus scar segments but not of transmural versus subendocardial scars. This was true for all strain parameters analyzed, without differences in efficacy between longitudinal and circumferential strain and subendocardial, subepicardial, and full-wall-thickness strain values. Circumferential and longitudinal strain in normal segments showed transmural and basoapical gradients (greatest values at the subendocardial layer and apex). In segments with scar, transmural gradient was maintained, whereas basoapical gradient was lost because the reduction of strain values in the presence of the scar was greater at the apex. The two-dimensional speckle-tracking echocardiographic values distinguish scar presence butnot transmurality; thus, they are not useful predictors of scar segment viability. It remains unclear why thereis a greater strain value reduction in the presence of a scar at the apical level.

Internal Iliac Artery Ligation as lifesaving Procedure for Spontaneous Posterior Uterine Rupture on Scarred Uterus in Labor Following a Hysterectomy for Managing a Severe Postpartum Hemorrhage

Nowadays, the uterine rupture is a situation world widely encountered especially in low-income countries. Postpartum hemorrhage that the uterine rupture leads to is frequently severe and life threatening. The aim of medical and surgical conservative methods is to preserve the uterus and the fertility. But sometimes, the surgeon has to perform a hysterectomy and even completing with the unilateral or bilateral internal iliac artery ligation to manage the blood loss which may last in some cases after hysterectomy. Here we present a 34 years old pregnant woman with previous cesarean delivery scar for a twin pregnancy, admitted in advanced labor for term pregnancy with a posterior uterine rupture of 12 cm and abdominal expulsion of a dead male fetus with a lesion fusing to the right vaginal angle, with intact lower segment scar. The hemostatic subtotal hysterectomy was performed with the failure of handling the vaginal bleeding. At last, a bilateral internal iliac artery ligation was performed to ensure successful hemostasis and maternal lifesaving.

Clinical study on the relationship between lower uterine segment scar thickness and choices of delivery pattern of women with scarred uterus pregnancy

Objective To explore the accuracy of color doppler ultrasound for detection of lower uterine segment scar thickness and its guiding significance for delivery pattern of women with scarred uterus pregnancy.Methods The thickness of lower uterine segment scar of 112 late pregnancy in our hospital was measured with color doppler ultrasound from January 2011 to August 2011.The results were compared with actual measurement value in operation,and explore the best dehvery time and pattern for pregnant women with history of previous cesarean section.Results There were 5 cases of vaginal delivery and 107 cases of cesarean section in total 112 cases.The measurement results were good consistency between color doppler ultrasound and actual values.The pregnant women had high risk of uterus rupture when their lower uterine segment scar thickness were ＜3 cm and selected cesarean section after 38 weeks of gestation; those with scar thickness ≥ 3 mm had little uterus rupture and can continue to have pregnancy,even with selection of vaginal delivery.Conclusion Sonographic lower uterine segment scar thickness of color doppler ultrasound is a strong predictor for choice of delivery time and pattern of women with scarred uterus pregnancy. Key words: Color doppler ultrasound; Previous cesarean delivery; Lower uterine segment scar; Delivery mode

Diagnosis value of transvaginal ultrasound inspection for the uterine scar after cesarean section with early pregnancy

Objective To explore sonographic features of the lower uterine segment cesarean section scar with early pregnancy,and to evaluate the diagnosis value of transvaginal ultrasound for lower uterine segment scar pregnancy.Methods The transvaginal color Doppler ultrasound was used in 15 cases of uterine scar pregnancy to check the next section to observe the location of the gestational sac,uterine incision site of the echo,the thickness of muscle scars,gestational sac and the uterine incision,and the relationship between blood flow distribution.Results In 15 cases of uterine scar pregnancy,ultrasound correctly diagnosed,14 cases of misdiagnosis,diagnostic coincidence rate was 93.3％.All patients with no intrauterine gestational sac surrounded by the trophoblast echogenic gestational sac audio and video,showed the lower uterine segment scar.We observed the scars were seen in the trophoblast with more abundant blood flow signals,measured by the CDFI RI of low resistance to blood flow,mean RI values less than 0.5.The imaging characteristics of the lower uterine segment scar in early pregnancy were divided into gestational sac integrity embedded in the scar at the embryo sac type,gestational sac to the intrauterine growth of the tomato,three types of abortion harem cavity mixed echo.Conclusions Transvaginal ultrasound in the early lower uterine segment cesarean section scar pregnancy has important diagnostic value. Key words: Transvaginal ultrasound; Cesarean section scar; Early pregnancy

Endoscopic treatment of glottic stenosis: a report on the safety and efficacy of CO2 laser

Treatment of glottic stenosis is a considerable challenge to the otolaryngologist. Glottic airway patency can be compromised by bilateral vocal fold palsy, anterior webbing or a posterior segment scar, which may be significant enough to impair arytenoid movement. A retrospective analysis of a prospective database of patients (n = 34) treated by a specialist airway surgeon. All patients underwent endoscopic treatment with a CO(2) laser in an attempt to improve airway calibre and, in 12 patients, to decannulate tracheostomy tubes. Twenty-one patients had bilateral vocal fold palsy and 13 had predominantly posterior glottic stenosis. A variety of pathology-directed treatment approaches were used to achieve good functional results. Four patients required a second endoscopic procedure. The overall revision rate was 5 per cent for bilateral fold palsy and 23 per cent for posterior glottic stenosis (p < 0.05). All patients had an adequate functional airway calibre, and all 12 tracheotomised patients were decannulated. Pathology-directed endoscopic laser surgery is safe and effective treatment for glottic stenosis. Rather prescriptive use of unilateral or bilateral cordotomy or combined cordo-arytenoidectomy, clinicians must perform the procedure that will treat the lesion most adequately. Our success rate compared favourably with the best reported results.

OC20.04: Ultrasonographic features of Cesarean scars in non‐pregnant uterus after single and multiple Cesarean sections

Objectives: To assess the association between ultrasonographic parameters of the Cesarean scar in non-pregnant uterus and the number of previously performed Cesarean sections. Methods: The study group included 310 non-pregnant women with a history of low transverse Cesarean section with single-layer uterine closure. The transvaginal ultrasound was performed to assess the following parameters of the Cesarean section scar: the thickness of the knit tissue scar segment (G) and in case of visualization of a triangular shaped anechoic scar defect the basis (P) and height (W) of this triangle. G/P index and G/W index values were also calculated. Results: Transvaginal sonography enabled the visualization of the Cesarean section scar in 308/310 of the examined women (99.4%). In 55/310 cases (17.7%) the completely knit hysterotomy scar tissue was identified. In the remaining group of 255/310 women (82.2%) an anechoic triangle, defined as scar defect, was observed. The mean thickness of the knit tissue scar segment (G) after single, two and three Cesarean sections was: 9.9 mm, 8.0 mm and 4.1 mm, respectively. Statistically important decrease in the G values with the number of previous performed Cesarean sections was observed. The mean G/P index values after single, two and three Cesarean sections were as follows: 1.68, 1.53 and 0.8. The mean G/W index values were: 2.8, 1.9, 0. 9, respectively. No significant difference in the G/P index values was found between patients after one and two Cesarean sections. Statistically important decrease in G/P index values in the group of patients after three Cesarean sections comparing to the patients after one (0.80 vs. 1.68, P < 0.05) and two Cesarean sections (0.8 vs. 1.53, P < 0.05) was observed. Statistically important decrease in the G/W index values was found between the groups of women after one, two and three Cesarean sections. Conclusions: The thickness of the knit tissue scar segment (G) and the G/W index values decrease with the number of previous performed Cesarean sections.

Posterior Uterine Rupture Causing Fetal Expulsion into the Abdominal Cavity: A Rare Case of Neonatal Survival

Introduction. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture. Case Presentation. A multiparous woman underwent prostaglandin induction of labour for postmaturity, after one previous caesarean section. Emergency caesarean section for bradycardia revealed a complete posterior uterine rupture, with fetal and placental expulsion. Upon delivery, the baby required inflation breaths only. The patient required a subtotal hysterectomy but returned home on day 5 postnatally with her healthy baby. Discussion. Vaginal birth after caesarean section constitutes a trial of labour, and the obstetrician must be reactive to labour events. Posterior uterine rupture is extremely rare and may occur without conventional signs. Good maternal and fetal outcome is possible with a prompt, coordinated team response.