Assessment of Cesarean Section Scar Strength: Still A Challenge.

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.