Scar Tenderness Research Articles

De Quervain's Tenosynovitis Release With Excision of the First Dorsal Compartment: Novel Surgical Technique and a Case Series.

Incision of the dorsal side of the tendon sheath in release of De Quervain's tenosynovitis has traditionally been advocated to prevent the risk of volar tendon subluxation. We describe a novel technique of complete excision, rather than simple incision, of the first dorsal compartment tendon sheath. Over a 10-year period, 147 patients (154 wrists) underwent first dorsal compartment release using this technique of complete excision of the sheath. No postoperative immobilization is used. Patients were followed for a mean of 7.0 months. Records were assessed for any complications including reoperation, tendon subluxation, recurrence, wound complications, scar tenderness, and superficial radial sensory nerve paresthesias. There were no cases of recurrence, reoperation, or tendon subluxation after release with this technique. Postoperatively, 7 (4.5%) patients had scar tenderness and 5 (3.2%) of these patients also had superficial radial sensory nerve parasthesias, which all resolved at the time of final follow-up. Mean range of motion was 73±11 degrees of flexion and 69±10 degrees of extension. In contrast to simple incision, we propose that this technique provides a more complete release of the compartment without risk of symptomatic subluxation or bowstringing and provides a complete release of a separate extensor pollicis brevis subsheath or any concomitant retinacular cysts associated with the tendonitis. There is an immediate removal of the symptomatic swelling and visible, painful bump associated with the thickened retinaculum with this technique. Furthermore, no immobilization is required after surgery.

Metacarpal Small Incision for Carpal Tunnel Syndrome.

Endoscopic carpal tunnel release (ECTR) techniques have been established as a successful treatment for carpal tunnel syndrome and have proven equally effective as traditional open carpal tunnel release (OCTR) techniques in relieving pain and numbness. However, patients who undergo OCTR are more likely to experience scar tenderness and pillar pain and take longer to return to work. We present here a method of metacarpal small incision for carpal tunnel release (MSICTR) as a safe, reliable, cost-effective alternative surgical decompression of the median nerve of the wrist. This technique utilizes a metacarpal small incision and direct visualization of the median nerve and carpal tunnel contents, reducing the risk of permanent injury and neurasthenia when compared to traditional OCTR. MSICTR is also suitable for the examination of the median nerve, surrounding tendon sheath, or space-occupying lesions. MSICTR is associated with shorter operation times, less postoperative pain, faster recovery, and improved cosmetic results when compared to traditional OCTR. Therefore, MSICTR is an effective surgical decompression of the median nerve for the treatment of carpal tunnel syndrome.

State of the art review. Complications after carpal tunnel release.

Carpal tunnel release (CTR) is the most performed surgery of the upper extremity. It is effective but not without complications. This state-of-the-art review covers most common intra- and postoperative complications after CTR. As endoscopic carpal tunnel release (ECTR) has developed over time, severe complications, such as nerve lesions, have diminished. ECTR still has a higher risk on transient nerve lesions. Open CTR on the other hand has a higher incidence of wound-related problems, including scar tenderness, irrespective of incision used. Most complications, such as pillar pain and infection, are ill-defined in the literature, leaving the exact incidence unknown and proposing challenges in treatment. The same is true for failure of treatment. Optimizing the length and location of incisions has played a vital role in reducing intra- and postoperative complications in CTR. It is expected that technical advances, such as ultrasound-guided percutaneous carpal tunnel release, will continue to play a role in the future.Level of evidence: V.

Endoscopy Assisted Carpal Tunnel Syndrome Release Surgery: Case Series

Objective: Endoscopy-assisted surgical procedures for CTS has become increasingly prevalent since 1990s. In endoscopy-assisted carpal tunnel release surgery (EACTRS), it has been proposed that nerve damage likelihood is similar to other procedures. It has also been proposed that EACTRS is especially associated with smaller scar size, painless and faster recovery period. We aimed to determine our clinical and functional results in patients with EACTRS and compare them with the literature Method: We evaluated 25 (39 hands ) patients who underwent endoscopy-assisted carpal tunnel release surgery between 2012 and 2017. In all patients, demographic characteristics, preoperative- postoperative functional scores, patient satisfaction levels and time required to return-to-work were recorded; Results: The endoscopy-assisted carpal tunnel release surgery had positive significant effect on patient satisfaction scores(p<0.05). A statistically significant difference was found between those with and without Double Crush syndrome (DCS) in favor of those without DCS in terms of pre- and postoperative BTCQ symptom severity score (p<0.05). We found only two scar tenderness and two revision Carpal Tunnel release . Conclusion: The EACTRS is an effective method in the treatment of carpal tunnel syndrome. Clinical outcomes are comparable to other methods. Those with DCS, those with comorbidities, and female gender were evaluated as negative prognostic factors in patients who underwent EACTRS.

Evaluation of the efficacy of vacuum sealing drainage in combination with silver-containing dressings for the improvement of chronic refractory wounds.

The aim of this study was to explore the clinical efficacy of vacuum sealing drainage in combination with silver-containing dressings for the treatment of chronic refractory wounds. In this retrospective study, 80 patients with chronic refractory wounds who were treated in the hospital were retrospectively selected as the study objects. Based on the treatment modalities, the patients were divided into the study group (SG; n = 40, receiving vacuum sealing drainage combined with silver-containing dressings) and the control group (CG; n = 40, receiving vacuum sealing drainage alone). The total effective rate of the SG was 92.5%, significantly higher than the 75% in the CG. After treatment, the SG exhibited lower positive rates in bacterial culture, as well as decreased levels of C-reactive protein and erythrocyte sedimentation rate compared to the CG. Starting from the sixth day of treatment, the SG reported statistically significant lower pain intensity scores than the CG. Additionally, the SG exhibited significantly lower dimension scores in terms of scar thickness, color, tenderness, and vascular distribution compared to the CG. The combined application of vacuum sealing drainage and silver-containing dressings demonstrated a positive treatment efficacy for patients with chronic refractory wounds.

To Identify Common Risk Factors Associated with IUFD in Rangpur Medical College Hospital, Rangpur, Bangladesh

Introduction: Intra uterine fetal death is always an unacceptable event not only by the expecting mother and family but also by the obstetrician. Both the woman & the obstetrician become desperate to know the cause of IUFD & its prevention in future pregnancy. In more than 50% cases causes of fetal death cannot be determined. Objective: To identify common risk factors associated with IUFD. Methods: It was a cross sectional study was conducted in the department of Obstetrics & Gynaecology, Rangpur Medical College Hospital, Rangpur over the period of 6 months dated from July 2017 to December 2017. Sample size: 50 cases. All pregnant woman after 28 weeks of gestational age who were admitted in antenatal ward of the Gynae & Obstetric department of Rangpur Medical College Hospital, Rangpur. During the study period all the patients with IUFD & Fetuses who does not show any signs of births were the study population of this study. Result: Total 50 patients included in your study. Table-I shows that most of the women with IUFD cases fall in the age group of 20-30years 76% and 72% of women had primary level of education. Most of the patient 70%were from middle class. All were housewife. Majority (88%) were from rural area. Majority 52% were primigravida, 50% were>36weeks of gestational age, history of abortion were in 14% cases & IUFD in 04% cases. None of the patient took regular antenatal care, most of the Patient (72%) took irregular ANC, and 28% of patient did not take any ANC. Hypertensive disorder was the major risk factors 34% which include chr. HTN. 08%, preeclampsia 10% & eclampsia 16%, Other risk factors were PROM 16%, Prolong labor and obstructed labour 12%, GDM 06%, Rupture uterus with previous C/S 10%, Placental factor 08%, Cord prolapse 06%, Severe IUGR 04%, no risk factors found in 04% cases. 72% of the cases had mild anaemia, 60% were normotensive & 40% had high blood pressure, Scar tenderness were found in 20% cases who had H/O C/S. the patient 58% had Hb% 08-10gm/dl, all were Rh+ve mother, PPBS raised in 06% cases. In USG liquor volume normal 20%, mild to moderate oligohydramnios in 44%, moderate to severe oligohydramnios in 20% & severe oligohydramnios in 16% cases. Shows vaginal delivery had occurred in 86% cases. 14% need operative intervention among which 10% laparotomy were due to rupture uterus & 04% LSCS were due to scar tenderness. Maternal outcome in 84% cases were uneventful. Wound infection occured in 12% cases & Puerperial sepsis occurred in 04% cases. Conclusions: PIH, PROM were leading causes of IUFD. Majority of women who had IUFD were emergency admission who had not received adequate antenatal care. A significant proportion of IUFD is preventable by health education to patients and community for regular antenatal care, about warning signs during antenatal period, hospital delivery and early referral.

A Prospective Randomized Controlled Trial Comparing Clinical Equivalence of PD Synth and PDS Polydioxanone Sutures.

Introduction Incisional hernia is a common complication of midline laparotomy that may develop even after several years of surgery. Abdominal fascia closure with ideal suture material reduces the incidence of incisional hernia. This study compared the clinical equivalence of PD Synth (Healthium Medtech Limited) and PDS(Ethicon, Johnson & Johnson) slowly absorbed polydioxanone suture with respect to the occurrence of incisional hernia, following elective/emergency midline laparotomy. Methods Eighty-eight subjects undergoing elective/emergency midline laparotomy were randomized to PD Synth (n=45) and PDS(n=43) groups of this prospective, multicenter, randomized (1:1), single-blind, two-arm, parallel-group study (December 2020-May 2023). Primary endpoint was incidence of incisional hernia, occurring within six and 12 months of surgery. Secondary endpoints included incidence of fascial dehiscence, surgical site infection (SSI), suture sinus, seroma, hematoma, scar tenderness, and re-suturing, and evaluation of operative data, hospital stay, intra-operative suture handling, pain, time to return to normal day-to-day activities and work, overall patient satisfaction score, and adverse events. Results One subject in both PD Synthand PDSgroups (p>0.05) developed incisional hernia at umbilicus 12 months post-laparotomy. In PDSgroup, one subject each had incidences of SSI on day 2, day 7, and one month, two subjects developed seroma on day seven, and one subject had readmission on one month; two subjects in PD Synthgroup developed superficial SSI (one month). Findings of other secondary endpoints were comparable between the groups. Conclusion Primary and secondary outcomes manifested that PD Synthand PDSslowly absorbed polydioxanone sutures are clinically equivalent, and can be used for abdominal fascial closure following midline laparotomy.

Vaginal Birth after Caesarean Section: A Study of 60 Patients with Spontaneous Onset of Labor Pain

Background: Most women with a singleton pregnancy of cephalic presentation at 37+ weeks or later who have had a single prior lower segment cesarean delivery, with or without a history of prior vaginal birth, are candidates for planned VBAC and may be offered it for a trial of VBAC. Objective: The objective of this study is to determine the outcome of vaginal birth after caesarean section (VBAC) in a tertiary care hospital in Sylhet. Methods: This prospective study took place between April 2022 and February 2023 and lasted for a total of eleven months. A total of sixty patients were hospitalized in the gynecology and obstetrics department at North East Medical College, all of whom had a history of either one or two previous cesarean sections and were experiencing labor pain. 43 of these patients had their deliveries through the vaginal route. The remainder of the patients had cesarean sections because of fetal distress, scar tenderness, and the patient's wish during 1st stage of labor. Results: The VBAC success rate in this study was 71.67%. Among the 43 patients, the highest number of patients, 51.2%, came from the age range of 28-37 years, followed by 21 patients (48.8%), who were in the age category of 18-27 years. The majority of the patients (24, 55.82%) were in their second pregnancy, with 10 (23.25%) in their third pregnancy and 9 (20.93%) in their more than third pregnancy. Among the 43 patients, 42 (97.7%) had a previous caesarean section, while the remaining 1 patient (2.3%) had two previous caesarean sections. Most patients (58.14%) were admitted to the hospital between 35 and 38 weeks of pregnancy. Among the participants, 97.7% had normal placenta size, 88.4% had average bleeding, 79.1% had clear liquor and 97.7% had no scar rapture. The study shows an extremely low level of complication in VBAC. Conclusion: This study identified that, the success rate of vaginal birth after one caesarean section is very high. An evidence-based systematic review suggested that planned VBAC is a safe and appropriate mode of delivery for the majority of pregnant women with a single previous lower-segment caesarean delivery.

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 > 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.

Experience of VBAC in A Private Hospital

Background: Vaginal birth after cesarean section (VBAC) for a non-recurring indication has been described by several authors as safe & having a success rate of 60-80%. VBAC increases the possibilities of subsequent vaginal deliveries & reduces the rate of repeat cesarean section with associated postoperative morbidity. Objective: To estimate the success rate & risks of an attempted vaginal birth after one cesarean delivery (VBAC). Materials & Methods: The study was conducted as a private hospital based cross sectional descriptive study from July2021 to December 2021. Total 176 patients were admitted with history of prior CS in this study. Among these cases common indications of primary CS were caesarean delivery on maternal request (CDMR), fetal distress, less fetal movement etc. All cases with previous one cesarean section who delivered vaginally within the study period comprised the study population. Women with 1 previous cesarean section, singleton pregnancy, cephalic presentation & term gestation were included in this study. However, women with history of 2 or more C/S, previous uterine surgery like myomectomy & classical C/S were excluded. Result: Out of 37 cases enrolled in the study, 24 (64.86%) successfully delivered vaginally without any complication. 11(29.73%) cases needed repeat cesarean section and 2 (5.41%) cases had to undergo emergency cesarean section for scar tenderness, those were found to be uterine scar rupture. Conclusion: This study suggested that trial of labour after caesarean section (TOLAC) was effective in decreasing CS in this study population. TOLAC and VBAC can be offered to pregnant women without contraindication. To establish the finding definitively, large multicenter prospective studies are required. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 28-31

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.

Not Just Another Trigger Finger.

Open A1 pulley release for trigger finger has generally been considered a minor procedure with infrequent complications. Most reported complications are minor, including scar pain and tenderness, mild extension lag, and recurrence of triggering. Rates of major complications, such as bowstringing, neurovascular bundle injury, and infection requiring reoperation, are less than 1% to 4%. We aimed to describe the potentially devastating sequelae of these major complications and the subsequent consequences. Three patients underwent open trigger finger release, which were all complicated by severe postoperative surgical site infection requiring multiple subsequent procedures. We review our initial management, subsequent reconstructive options, and outcomes with up to 19 years follow-up. All 3 adult patients who underwent open A1 pulley release for trigger finger developed a surgical site infection, leading to flexor tenosynovitis requiring urgent operative debridement and multiple subsequent procedures. Two patients were poorly controlled diabetics, and the third patient was otherwise healthy. Each patient ultimately developed distinct consequences from their postoperative course-finger stiffness and contracture, disabling bowstringing requiring the use of a pulley ring, and flexor tendon rupture requiring staged tendon reconstruction, respectively. All 3 patients at final follow-up had a permanent functional deficit. Major complications after trigger finger release are infrequent. However, if left untreated, particularly in diabetic patients, there can be disastrous consequences, resulting in permanent loss of function. This case series highlights the importance of accurate diagnosis of postoperative infections and expedient treatment thereafter.

Novel Endoscopic Approach for Carpal Tunnel Syndrome: Functional Outcomes - A Prospective Study

Abstract Introduction: Carpal tunnel syndrome (CTS), a common entrapment neuropathy, can cause debilitating symptoms affecting hand function and sleep. While conservative treatments are initially attempted, surgical intervention becomes necessary for severe cases. The study introduces endoscopic carpal tunnel release (ECTR) as a minimally invasive alternative to open procedures to enhance patient outcomes. Methods: A prospective study from January 2019 to January 2022 investigated arthroscope-assisted carpal tunnel release for CTS. Patients with chronic medical conditions were excluded. The surgical procedure involved local anesthesia, a 1.5 cm incision, flexor retinaculum release under arthroscopic guidance, and postoperative care. Outcomes were assessed using the Global Symptom Scoring Scale (GSS). Results: The affected population (n = 60) had a mean age of 47.58 years, with 42 females and 18 males. Common symptoms included numbness (43.3%), paresthesia (35%), and weakness (13%). Most patients (67.1%) had no comorbidities. Complications were minimal (5.0% paresthesia, 1.7% scar tenderness, and 3.3% infection). The mean preoperative GSS was 38.57, reducing significantly (P &lt; 0.001) to 4.6 at 12 months’ follow-up. Conclusion: The study demonstrates the efficacy and safety of ECTR as a minimally invasive alternative for severe cases of CTS. With a low rate of complications and significant improvement in symptoms, including numbness, paresthesia, weakness, and surgeon expertise remains vital for successful outcomes.

ASSOCIATION OF SCAR TENDERNESS WITH SCAR INTEGRITY AT REPEAT CAESAREAN SECTION IN A TERTIARY CARE CENTRE: AN OBSERVATIONAL STUDY

BACKGROUND: Caesarean section is an operative process whereby the fetuses after the end of 28 th week are delivered through an incision on the abdominal and uterine wall .This excludes delivery through an abdominal incision where the fetus lying free in the abdominal cavity following uterine rupture or in secondary abdominal pregnancy .The rst operation carried out on a patient is referred to as primary caesarean section .When the operation is carried out in subsequent pregnancies , it is referred to as repeat caesarean section .Caesarean section is used in cases where vaginal delivery is not either feasible or would impose undue risk on mother or baby. AIMS&amp;OBJECTIVE: METHODS: of the study to assess the relationship of scat tenderness with scar integrity at repeat caesarean section. It is a retrospective study, conducted in the admitted patients of Department of Obstetrics and Gynecology, Bundelkhand Medical College, Sagar Madhya Pradesh. The duration of the study from July 2022 to December 2022. During the study pe RESULTS: riod total 130 women were admitted with diagnosis of previous caesarean section with scar tenderness, out of these 88 (66%) had gestational age &lt;37 weeks and on repeat caesarean section scar thinning present in 75(58%) cases. The scar complicat CONCLUSION: ions are highly associated with the intensity of scar tenderness .Hence forth, it can be concluded here that scat tenderness is a vital factor responsible for scar complications

BELL'S PALSY IN PREGNANCY AND PUERPERIUM: A CASE REPORT

Bell's Palsy is an idiopathic facial nerve palsy and also the most common cause of facial nerve palsy. It's incidence is 17/100,000 population per year in women of child bearing age group(WCBA). We, hereby present a case of 26 year old gravida 2, para 1, living 1 with 35 weeks of gestation who presented with gradual onset of facial weakness and few other complaints which after thorough examination were suggestive of Bell's palsy in a case of pre eclampsia. Patient was later posted for C-section at 36 weeks for scar tenderness. In the post operative period patient was on steroids for persistent facial nerve palsy but the patient landed in an unusual complication due to on going steroids as she had failed to follow up. Patient was taken up for exploratory laparotomy, patient tolerated the procedure well and went home on POD-42. Amongst the medications used in this patient for Bell's palsy, we saw that steroids could thus act as a double edged sword and thus close monitoring, follow up and patient compliance is equally important

Successful treatment of scar tenderness using ultrasound guided hydrodissection.

Successful treatment of scar tenderness using ultrasound guided hydrodissection.

The effect of Centella Asiatica cream on scar development in patients who underwent open carpal tunnel release surgery

AimTo evaluate the efficacy of the Centella asiatica extract in a cream preparation for the prevention of scar tenderness formation in patients who underwent conventional open carpal tunnel release (CTR) surgery. Material and MethodsA total of 280 patients with carpal tunnel syndrome who underwent CTR surgery were individually randomized into the intervention (n = 140) and control (n = 140) groups. In the intervention group, a petroleum cream mixture consisting of 1% Centella asiatica extract was applied to the patients’ wrist for 6 months after the sutures were removed. In the control group, no intervention was applied. The Vancouver Scar Scale (VSS), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) functional score, and Visual Analog Scale (VAS) satisfaction scores were assessed preoperatively and postoperatively. Follow-up evaluations were scheduled at 1, 3 and 6 months after CTR surgery. ResultsThe overall VSS score of the intervention group significantly improved at 3-6 months (-1.260, p = .040). At 6 months after surgery, the mean QuickDASH functional score was 18.54 (range 0.00-63.64, SD 17.4) in the intervention group and 28.70 ± 12 (range: 2.27-40.91) in the control group (p < .04). At 6 months after surgery, the mean VAS satisfaction score was 1.46 ± 1.95 (range: 0-4) in the intervention group and 2.48 ± 1.02 (range: 0-4) in the control group (p < .03). ConclusionThe Centella asiatica cream applied to the wrist after CTR surgery was found to be beneficial in preventing scar tenderness in the thenar and hypothenar regions of the hand.

Unilateral Traumatic Atresia of External Auditory Canal: A Case Report

External Auditory Canal (EAC) atresia, which can be acquired or congenital, is a condition in which the EAC is not present. A blind sac in the external acoustic meatus is the result of intraluminal or extraluminal processes of various aetiologies, which can lead to acquired atresia of the EAC. Acquired EAC atresia is a rare disorder of the EAC, and it is extremely uncommon for it to be brought on by direct trauma. In present investigation, a 31-year-old female patient, leading to onset of right temporal discomfort and impaired hearing in the right ear. On examination, a 10×1 cm tender scar was present extending from right parietal region till right zygomatic arch with stenosis in the right external auditory meatus. Facial nerve examination revealed loss of wrinkling on right side with slight deviation of the angle of mouth to left side. High Resolution Computed Tomography (HRCT) temporal bone showed soft tissue causing complete occlusion of right EAC. Patient underwent right EAC atresiaplasty with canaloplasty and canal reconstruction. Facial nerve weakness persisted postoperatively. Patient is still on follow-up and has improved symptomatically with no restenosis. Surgical management of EAC atresia is very challenging, thus it needs meticulous planning and long term follow-up for good results which was evident in the present case.

A PROSPECTIVE STUDY ON THE MATERNAL OUTCOME IN CASES OF PREVIOUS ONE CESAREAN SECTION

Background and Objectives:Women with previous cesarean sections constitute a high-risk group in obstetrics. The study was conducted to determine the mode of delivery in a previous cesarean section group and maternalcomplications. Method:The study was a prospective observational study conducted in The NSCB Medical College, Jabalpur from January 2020 to June 2021. Cases with previous one cesarean section for outcome in present pregnancy were taken and Cases with gestation before 28 weeks and previous section &gt; 2 were excluded. Result:A total of 384 cases presented with the previous one CS, TOLAC was given to 109 patients (28.38%) and 51.37% achieved VBAC in the TOLAC group. Women who were selected for repeat CS without a trial of labor were 275 (71.61%)and the most common indication being scar tenderness 28%. Post-op maternal complications and infectious morbidity were significantly higher in the repeat cesarean section group. Conclusion: Women given a trial of labor with careful monitoring and taken for emergency LSCS on minimal indication is the best answer to management with an expectant attitude and individualization of labor in patients who had one cesarean section is not only justifiable but represents a sound and conservative obstetrical practice.

EFFECTS OF SHORT INTER-DELIVERY INTERVAL ON MODE OF DELIVERY IN PREVIOUS ONE CAESAREAN SECTION CASES

OBJECTIVE: To determine the effects of short inter delivery interval (IDI) on mode of delivery in patients with immediate previous one caesarean section (C-Section). METHODS: This is a retrospective chart review of 120 patients treated at Khyber Teaching Hospital, Peshawar, Pakistan from December 2017 to December 2019. Patients of previous one C-Section and with gestational age of &gt;37 weeks were included in this study. Outcome variables were mode of delivery whether operative or vaginal delivery, maternal and fetal complications such as scar dehiscence or scar rupture and fetal distress. RESULTS: Mean age of the patients was 28.9±2 years. IDI was &lt;18 months in 35/120 (29.2%) cases, 18-24 months in 54/120(45%) cases and &gt;24 months in 31/120 (25.8%) cases. Out of 120, 102 (85%) patients underwent trial of labour after C-section (TOLAC). TOLAC was successful in 64 (62.7%) cases. Patient who underwent TOLAC with IDI of &lt;18 months, 5/21 (23.8%) patients delivered vaginally and 16/21 (76.2%) patients had emergency C-Section while those with 18-24 months IDI, 38/51 (74.5%) patients delivered and 13/51 (25.4 %) patients had emergency C-Section. Main indications for emergency C-Section were scar tenderness and maternal tachycardia (n=16; 42.10%) and fetal distress (n=11, 28.9%). There were two cases of interauterine deaths. Uterine scar dehiscence was observed in 14.28% and 2.4% in short and normal IDI respectively. CONCLUSION: Patients with short IDI had high C-section and uterine scar dehiscence rate. IDI of &gt;18 months is recommended to avoid the maternal and fetal morbidity and mortality.