ABSTRACT
Objective: To assess the integrity (strength) of cesarean scar of uterus during interval period (nonpregnant state) by ultrasonography (USG), hysterography and hysteroscopy and their correlation. Material and methods: The study was conducted in the Dept. of Obstetrics and Gynecology and Dept. of Radiology, SN Medical College, Agra. Three hundred nonpregnant women with cesarean section in past were recruited to undergo USG, hysterography and hysteroscopy along with proper history and other routine examination. The thickness and appearance of anterior uterine wall especially at scar area was noted down during investigations. Results: The mean scar thickness was more (11.59 ± 1.33 mm) in women with only one cesarean section in comparison of women having more than one cesarean section (9.08 ± 9.2 mm). Healthy abdominal scar healed with primary intention correlated with good uterine strength. More breaking on hysterography was associated with thin scar on USG. When scar area was found irregular and wide on hysteroscopy the thickness of scar was less on USG also. Conclusion: A prospective idea of uterine scar strength can be obtained by careful history taking, local examination of abdominal scar as well as p/v findings along with USG, hysterography and hysteroscopy in nonpregnant women. If findings are suggestive of weak scar, a lady can be counsel for planned cesarean section in her future pregnancy in spite of trial for vaginal birth after cesarean. Accordingly, if she can afford further risk and cesarean section, she should become pregnant otherwise should avoid further confinement in future.
ABSTRACT
Objective: The objective of the study was to evaluate the efficacy of bedside test kits (Actim partus kit) based on detection of phosphorylated insulin-like growth factor binding protein-1(PIGFBP-1) in cervical secretions in predicting preterm delivery. Material and methods: Patients presenting with symptoms of preterm labor between 28 and 36 weeks of gestation were recruited. PIGFBP-1 bedside tests (Actim partus test) were performed. Managing obstetricians and patients were blinded to the PIGFBP-1 results. Tocolysis and steroid therapy were administered to all the recruited patients. Outcome data were collected after delivery. Results: Fifty patients were recruited into the study, the median [± standard deviation [SD] gestational age at delivery was 34.12 weeks (± 2.1 weeks) and 37.14 weeks (± 2.8 weeks), patient testing positive and negative for Actim partus test, respectively. A positive result was associated with significantly reduced admission-to-delivery interval. The median admission-to-delivery interval was 3.25 days in the group with positive PIGFBP-1 results while 6.97 days with a PIGFBP-1 result (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value of Actim partus test is 72.22%, 90.6% 81.25% and 85.29%, respectively. Conclusion: Actim partus (IGFBP-1) tests are effective adjuvant bedside test kits for the prediction of preterm delivery in patients presenting with signs or symptoms of preterm labor. High negative predictive values have great value in avoiding unnecessary interventions.