Incomplete cesarean scar rupture

Uterine rupture at the site of a previous cesarean scar is an uncommon but catastrophic complication of pregnancy, which is associated with significant maternal and fetal morbidity and mortality. A 30-year old woman at 24th week of gestation and complaint of pain, contractions and spotting was admitted in Royan Institute in Tehran, Iran. She had a past medical history of an EP and a cesarean section delivery, respectively 4 and 2 years before hospitalization. Herniation of an amniotic membrane into the maternal bladder was found on ultrasound examination. Risk factors of cesarean scar rupture should be considered in women undergoing subsequent pregnancies as they need extra care. Ultrasonography can be used to evaluate women with previous cesarean section to assess the risks of scar rupture during subsequent pregnancies

[Prognosis of delivery on a scar womb: about 123 cases]

During these last two decades, the practitioners are more and more confronted to pregnancies on scar womb. To analyse the behaviour to be held in front of a scar womb and to estimate materno-foetal preview after childbirth [delivery] by vaginal delivery or after a caesarean section at cold. It is about a retrospective study held over 123 cases of patients with a scar womb who gave birth in the department "C" of the CMNT over a period of 2 years. Among the 123 cases of scar womb, 70 patients had a preventive caesarean section. The main indication was a pathological pond. Uterine scar was accepted in 53 women. 25 among them gave birth by vaginal tract and 28 had a casarien section of 2nd intention. There were 4 cases of dehiscence of the scar. 8% of the newborns from vaginal delivery had an apgar < 7 in the 5th mn against [10% in the group of the newborn children stemming from a preventive caesaran-section. Pregnancy on scar womb is a pregnancy at high risk requiring an adapted coverage

Risk factors for cesarean hysterectomy in cesarean delivery.

OBJECTIVE: To identify the risk factors for cesarean hysterectomy. MATERIAL AND METHOD: A case-control study was conducted by reviewing the medical records of pregnant women delivered in King Chulalongkorn Memorial Hospital between January 1994 and December 2004. Cases included pregnant women who underwent hysterectomy immediately or within 24 hours after cesarean delivery, whereas control referred to pregnant women who underwent cesarean section at the same period. RESULTS: Of the 109,005 deliveries, twenty-seven women (0.25/1000-delivery) underwent cesarean hysterectomy. With multivariate analysis, the risk factors significantly associated with peripartum hysterectomy were placenta previa (adjusted OR = 67.96, 95% CI = 15.32, 301.46) and multiparity (adjusted OR = 7.30, 95% CI = 1.24, 43.19). When compared to controls, cases with cesarean hysterectomy had higher incidence of maternal and neonatal morbidities, needed more blood transfusion and required longer hospital stays. Operation performed in daytime found to have less mean blood loss (1,766 ml) compared to operation at nighttime (5,730 ml). CONCLUSIONS: Placenta previa and multiparity were significant risk factors of cesarean hysterectomy. Cesarean section in these cases should be done by experienced obstetricians with good preoperative care and if possible, during the daytime. Before an operation, each patient and her family should be counseled and informed regarding the risk for complications included hysterectomy.

Vaginal birth after caesarean section

To determine the success rate for trial of vaginal birth in women with one prior caesarean delivery. Two hundred and sixty eight pregnant women who had one prior caesarean delivery were given a trial of vaginal birth spontaneously or after induction by oxytocin when indicated. The number of vaginal deliveries, caesarean births, and maternal and perinatal outcomes was recorded. One hundred and ninety two women [70%] had a successful vaginal birth and forty-nine women [30%] had a repeat caesarean delivery. Repeat caesarean deliveries were performed due to failed progress and fetal distress in most of the caesarean births. Our study indicated that vaginal birth after caesarean birth is safe if properly monitored

Acretismo placentario sobre cicatriz de cesárea previa / Placental accretism on cicatrice of previous cesarean section

Se presentan 20 casos consecutivos de acretismo placentario en embarazadas con cesáreas previas ocurridos en el Servicio de Obstetricia del Hospital Materno Infantil de Mar del Plata desde el 1/1/92 al 31/12/93, todos con confirmación anatomopatológica en las piezas de histerectomía. En dicho período hubo 11410 nacimientos y se realizaron 27 por ciento de cesáreas abdominales, de las cuales el 14 por ciento fueron primer cesárea y el 13 por ciento restante iterativas. En los 11410 nacimientos se diagnosticaron 23 acretismos, de los cuales 20 correspondían a pacientes con cesárea anterior y 3 (que no fueron incluídos en este trabajo), no presentaban sección de cesárea previa. Nuestra incidencia de acretismo fue de 1/496 nacimientos. El porcentaje de riesgo de hacer acretismo que tuvieron las embarazadas con placenta previa segmentaria y cicatriz de cesárea anterior fue incrementándose significativamente de acuerdo al número de cesáreas previas, así con 1 ó 2 cicatrices de cesáreas previas el porcentaje de riesgo fue del 5 por ciento, con 3 cesáreas previas fue del 22 por ciento, y con 4 o más el riesgo se elevó al 70 por ciento. El estudio histopatológico de las piezas de histerectomía reveló que el factor predominante fue la ausencia de la decidua. La etiología de esta deficiencia decidual muy posiblemente haya sido la sección de cesárea previa. El objetivo de este trabajo es demostrar dicho aumento en el porcentaje de riesgo de hacer acretismo en estas embarazadas, clasificar a las mismas dentro del grupo de pacientes de "alto riesgo obstétrico", intensificar y normatizar métodos de diagnóstico anteparto, sugerir conductas prequirúrgicas especiales y una vía de abordaje uterino diferente a la habitual