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Background: Caesarean section (CS) is the most common obstetric surgery performed world-wide. The objective of this study was to correlate the antenatal sonographic lower uterine segment (LUS) scar thickness in women with previous one cesarean section with intra operative LUS scar grading.Methods: A Prospective observational study was conducted from December 2014 to November 2015. In a tertiary care center. 200 pregnant women from ANC clinic with previous one LSCS were recruited. Transabdominal USG done between 36-38 weeks. LUS thickness was measured from bladder wall-myometrium interphase and myometrium-chorioamniotic membrane inter phase. Intraoperative grading of LUS scar was done. Based on grading of scar participants were assigned into scar dehiscence group (grade III and IV LUS scar) and non-dehiscence group (Grade I and II LUS scar).Results: Mean LUS thickness was 3.41±0.623 mm (range: 2-7 mm). Mean LUS thickness in the scar dehiscence group and non-dehiscence group was 2.98±0.55 mm and 3.48±0.60 mm (P value < 0.05) respectively. A cut off value of 3.5 mm was derived from ROC with sensitivity, specificity, positive and negative predictive value of 92.6%, 54.3%, 24.0%, 97.8%, respectively. The present study reported 27 (13.5%) cases of scar dehiscence.Conclusions: Ultra-sonographic evaluation of LUS thickness correlated significantly with intraoperative LUS appearance. USG evaluation of LUS can be used as a screening test to predict the LUS scar integrity. Risk of dehiscence is increased in women with thin LUS i.e. sonographic LUS thickness of < 3.5 mm and needs to be further evaluated. Women with previous one LSCS with thick LUS i.e. sonographic LUS thickness of > 3.5 mm, can be counselled regarding TOLAC if not contraindicated.
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Background: PPH is one of the leading causes of maternal mortality in the world. In India >30% maternal mortality is because of PPH.Methods: 250 females posted for LSCS were randomised into 2 groups. Group A: 5U oxytocin bolus + 40U oxytocin infusion @125 ml/hour in 500 ml saline. Group B: 5 ml Saline bolus + 40 U oxytocin infusionPrimary outcome was to measure blood loss (objective and subjective). Secondary outcomes were time for uterine hardening, additional uterotonic agents, hemodynamic changes, side effects and need for blood transfusion within 24 hours of LSCS.Results: Blood loss was significantly less in Group A in objective as well as subjective assessment (p<0.001). Requirement for additional oxytocin bolus was significantly higher in Group B as compared Group A (p=0.025). Postoperative hematocrit of Group A was higher than that of Group B (p<0.001). Transfusion requirement was significantly higher (p=0.04) in Group B (9.6% versus 3.2%). There was no significant difference in hemodynamics between the groups in the intraoperative period (p>0.05). However, during the postoperative period increase in heart rate was noted in Group B (p<0.05). Vomiting was the only major side effect observed, which was higher in Group A (5.6% versus 3.2%).Conclusions: Combination of 5U oxytocin bolus followed by an infusion of 40 U oxytocin given over 4 hours routinely in ASA grade I and ASA grade II parturient significantly decreases the operative blood loss during LSCS without causing any hemodynamic variability. This regimen provides better uterine contractility, lesser need for additional utero-tonic agents and lesser requirement of blood transfusion.
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The present study was conducted to assess the lower uterine segment with transabdominal sonography (TAS) in women with a previous cesarean section at 36-38 weeks gestation and to study the relationship between various LUS measurements and feto-maternal outcomes. Out of 110 patients enrolled, 10 (9%) with LUS thickness <2 mm were considered as poor healing group and were taken for elective LSCS. Remaining 100 were divided into two groups, 2-3.5 mm group and >3.5 mm group; 92% patients with LUS thickness >3.5 mm and 14% with LUS thickness between 2-3.5 mm delivered vaginally. The fetomaternal outcomes among patients with LUS thickness >3.5 mm were observed to be significant in the form of lower occurrence of puerperal pyrexia (4%), atonic PPH (4%), blood transfusion requirement (2%), less NICU admission (2%), less number of newborns with Apgar score <7 (2%), and with no cases of stillbirth, uterine rupture or uterine dehiscence when compared with LUS thickness 2-3.5 mm. Thus, patients with LUS thickness >3.5 mm had high rate of vaginal deliveries with favourable feto-maternal outcome, resulting in less maternal and perinatal morbidity and mortality. Thus, patients with ultrasonographic LUS thickness >3.5 mm at 36-38 weeks can be selected safely for vaginal birth after cesarean with favourable fetomaternal outcome.
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Objective To study the efficacy and safety of transverse compression suture in the lower uterine segment for the control of postpartum haemorrhage in cesarean section caused by placenta previa. Methods From Jan 2011 to Jan 2013, 21 patients with postpartum haemorrhage in cesarean section due to placenta previa were given transverse compression suture in the lower uterine segment after routine medical treatment. And the hemostatic efficacy and safety were observed. Results 20 cases of the vaginal bleeding were controlled efficient-ly, with an efficiency of 95. 2%. There was no complication occurred, and menstruation were back to normal during the follow-up, and there was nothing abnormal in the uterine double accessories through B ultrasound reexamination. Conclusion Transverse compression suture in the lower uterine segment is an easy, safe and highly effective surgical technique, it is especially suitable for the control of haemorrhage in the lower uterine segment caused by placenta previa.
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Objective To use high frequency ultrasound for scanning the lower uterine segment during the third trimester of scar uterus pregnancy cases were selected. Transabdominal ultrasound scan was done for the fetus between 36th and 40th week of pregnancy, and then the transducer was switched to a high frequency of 7.5-12 MHz to observe the lower uterine segment. The scan results were compared with the obserbations of in complete rupture of lower uterine segment and defective scars in the repeated caesarean section. Results Three types of high frequency ultrasound images were found for the lower uterine segment during the third trimester of scar uterus pregnancy: efficacies of truncation sign (608%,8/118), rat tail sign (44.1%,52/118), and homogeneous echoes (49.1%.58/118). The diagnosis efficacies of truncation sign for incomplete rupture of uterus, rat tail sign for defective scars, and homogeneous echoes for intact cadsarean scars were significantly higher than those of the other two types (X2 valued 20.42, 19.03, and 33.08, respectively, P<0.001). The diagnostic sensitivity, positive predictive value and negative predictive value of the truncation sign were 80.0%, 96.5%, 50.0%, and 99.0%; those of the rat tail sign were 70.0%, 73.8%, 67.3%, and 76.2%; and those of homogeneous echoes were 72.9%, 74.1%, 74.1%, and 73.3%, respectively. Conclusion High frequency ultrasound scan can display the changes of the scars on the lower uterine segment, and may serve as an effective method to diagnose incomplete rupture of uterus, defective and intact scars in the third trimester pregnancy of a caesarean-scarred uterus. To avoid uterine rupture, vaginal trail of labor should be carefully chosen for patients shoeing truncation sign or rat tail sign.
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OBJECTIVE: The aim of this study was to evaluate the role of lower uterine segment thickness in predicting an actual delivery date and to determine the factors affecting the depth of lower uterine segment. METHODS: Sixty patients with singleton gestation were weekly measured for their lower uterine segment (LUS), cervical length, cervical gland thickness and AFI by ultrasonography from 36 weeks. The regression analysis was carried to find out the relevance between LUS and the remaining days to birth and Pearson correlation analysis was performed for relevance between LUS and other factors such as maternal age, parity, cervical length, cervical gland thickness, and AFI. RESULTS: LUS became thin as cervical length decreasing. However, the relevance between LUS and other factors such as age, parity, cervical gland thickness, and AFI was not found. While individual LUS thickness is decreasing as delivery date becomes closer, LUS thickness as a group is found not to be related with the delivery date. CONCLUSION: In term pregnancy, LUS thickness decreases with cervical change but it cannot predict the delivery date.
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Female , Humans , Pregnancy , Maternal Age , Parity , Parturition , UltrasonographyABSTRACT
OBJECTIVE: The aim of this study was to find out the relating factors with the actual delivery day in term singleton pregnancy. METHODS: The 52 patients with singleton gestation were visited weekly and measured for their lower uterine segment (LUS) thickness, cervical length and cervical gland thickness by transvaginal ultrasonography and for amnionic fluid index (AFI) by transabdominal ultrasonography from 36 weeks of gestation until birth. Regression analysis was used to find out the relevance between these factors and remaining days to birth. RESULTS: There was a significant relationship between cervical length and remaining days to birth in term pregnancy, which could be described as a mathematical equation (remaining days for delivery = 6.12 + 0.24 x cervical length (mm) r=0.29, p<0.01). However, no relationship was found between factors such as LUS, AFI, and cervical gland thickness and remaining days to birth. CONCLUSION: Our results suggest that the actual delivery day in term singleton pregnancy might be predicted with cervical length.