Objective Abnormal placental invasion is more common after an elective Cesarean delivery, suggesting that prelabor Cesarean section (CS) increases the likelihood of the CS scar being above the internal cervical os and predisposing to a scar pregnancy in the future. The aim of this study was to assess the location and integrity of the CS scar in postpartum women delivered by CS at different stages of labor. Methods This was a prospective cohort study of women at term who underwent a CS for the first time. In all women, cervical dilatation was determined by digital examination at the time of the CS. All patients had a transvaginal ultrasound examination to assess the location of the CS scar in relation to the internal cervical os, as well as the presence of a scar niche. Results A total of 407 pregnant women were recruited into the study: 103 with cervical dilatation ≤ 2 cm, 261 with cervical dilatation 3–7 cm and 43 with cervical dilatation ≥ 8 cm at the time of the CS. A statistically significant correlation was observed between cervical dilatation at the time of the CS and the position of the CS scar. The scar was positioned in the uterus above the internal cervical os in 97.1% (100/103) of women delivered at a cervical dilatation of 0–2 cm, whereas the scar was located at or below the internal cervical os in 97.7% (42/43) of cases delivered at a cervical dilatation of 8–10 cm (P < 0.001). A uterine‐scar defect (niche) was observed in 38.1% (64/168) of women with the scar located above, compared with 18.0% (43/239) of those with the scar situated at or below, the internal cervical os (P < 0.001). Conclusions Prelabor and early‐labor Cesarean delivery are associated with an increased prevalence of a scar in the uterine cavity as well as a scar niche. CS in late labor is associated with the uterine scar being situated in the endocervical canal and with a lower incidence of a niche. The position and integrity of the CS scar after prelabor and early‐labor Cesarean delivery explain the predisposition to abnormal placental invasion in subsequent pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

BackgroundHypertensive disorders of pregnancy can cause severe maternal and fetal acute morbidity and mortality. Women with pre-eclampsia have been found to have alterations in calcium and vitamin D metabolism. There are conflicting results regarding the role of vitamin D deficiency in the development of pre-eclampsia. The aim was to compare 25 (OH) D level in patients with pre-eclampsia, eclampsia and normotensive pregnant women as well as to study the prevalence of Vitamin D deficiency among the 3 groups.Patients and methodsTwo hundred patients with pre-eclampsia, 100 with eclampsia and 200 normotensive pregnant controls were compared as regards vitamin D level.ResultsMean 25(OH)D level was lower in the pre-eclampsia (14.8 ± 5.4 ng/mL) and in the eclampsia group (10.5 ± 1.6 ng/mL) than in the pregnant controls (19.5 ± 6.5 ng/mL) (P = 0.002). This difference was only significant between the eclampsia group and the pregnant controls (P = 0.02). All eclampsia cases had vitamin D insufficiency as compared to 17.5% in the pre-eclampsia group and 39.5% in the control group. Deficiency of vitamin D (<12 ng/mL) was 47.5% in the pre-eclampsia group, 80% in the eclampsia group and only 10.5% in the control group (P = 0.035).ConclusionVitamin D deficiency is highly prevalent among Egyptian pregnant females. Our study supports the hypothesis that low vitamin D level can play a role in the development of pre-eclampsia and eclampsia. Thus, supplementation might prevent or delay the development of pre-eclampsia and eclampsia especially in patients at a high risk.

Analyses of treatment covariate interactions found no clear evidence that the relative effects of vaginal progesterone or 17-OPHC differed based on cervix length, or by history of a prior preterm birth. However, because the underlying risk of preterm birth is greater at shorter cervical lengths, the absolute risk reductions were greater for women with a shorter cervix. There was no apparent benefit of treatment in the women with a prior preterm birth and cervical length greater than 30 mm.So, what are the clinical conclusions to be drawn from this study? Certainly, it supports use of vaginal progesterone for women with a short cervix.