ABSTRACT
Background: The objective of this study was to compare the thickness of the scar and relative thinning of the uterinewall following conventional LSCS closing technique versus new closing technique (modified mattress Suture) and any additional surgical procedure in each group.Methods: A total of sixty patients undergoing primary caesarean for obstetric indications and who were willing for the study were included. In 30 patients uterus was closed by conventional double layer technique (the first layer is suturing with absorbable suture in a continuous running fashion. After first layer is complete, a second continuous stitch is used to invert the first layer, inverting stitch may be horizontal or vertical using same suturing material) and in 30 patient uterus was closed by new modified mattress technique. In both groups same suture material (vicryl 1-0) was used. Measurement of the thickness of scar site and corresponding posterior wall thickness was done following 6 months of caesarean section.Results: The possible parameters of better technique i.e., the mean scar thickness is more and relative as well as percentage thinning is less with this new technique of uterine closure although statistically not significant. Conclusions: Modified mattress suture technique is a single step procedure and gives the feel of double layer uterine closure. Hence the time taken, material. Used and the cost involved will be less along with excellent hemostasis.
ABSTRACT
Background: In a well-equipped hospital, trial of vaginal delivery is done in selected cases of previous C-section (CS). Epidural analgesia administration has been proved to be good adjunct in trial of labor after caesarean (TOLAC).Methods: This study is a prospective observational study done in a tertiary care institution in Tamil Nadu from May 2019 to July 2019. 50 cases with previous history of one CS were selected. Single ton pregnancy, previous transverse lower segment cesarean section admitted cases with adequate pelvis with no other co-morbidities were selected. Epidural analgesia was administered once mother was in established labor. TOLAC was continued till satisfactory progress and emergency repeat caesarean was taken in case of Suspected scar dehiscence (SSD) or abnormal fetal heart rate tracings. Quantitative data was expressed in mean and standard deviation. For qualitative data percentage was used.Results: In 50 cases observed the mean age of the cases was 26±3.64 years. TOLAC was successful in 41 (82%) mothers out of 50. The mode of delivery in 41 TOLAC mothers was found to be forceps in 18 cases (36%) and ventouse delivery 18 cases (36%). Only 9 cases had needed emergency CS (18%). The major indication for CS in TOLAC was found to be fetal distress in 4 number of cases (8%). 43 babies delivered were healthy, 6 babies (12%) admitted in NICU.Conclusions: With the application of epidural analgesia on attempted vaginal delivery in previous cesarean, vaginal delivery was 82% cases.
ABSTRACT
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.