Blood flow to the scarred gravid uterus at 22–24 weeks of gestation

Flo, Kari; Widnes, Christian; Vårtun, Åse; Acharya, Ganesh

doi:10.1111/1471-0528.12441

Cited by 27 publications

(23 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent study of the uterine circulation in women with a previous CD has shown that the uterine vascular resistance is increased, whilst the volume blood flow is decreased, compared to women with a previous vaginal birth. 29 These data suggest that the blood circulation around the scar is impaired. Poor…”

Section: Scar Implantationmentioning

confidence: 97%

Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging

Jauniaux

Collins

Burton

2018

American Journal of Obstetrics and Gynecology

560

542

View full text Add to dashboard Cite

Placenta accreta spectrum is a complex obstetric complication associated with high maternal morbidity. It is a relatively new disorder of placentation, and is the consequence of damage to the endometrium-myometrial interface of the uterine wall. When first described 80 years ago, it mainly occurred after manual removal of the placenta, uterine curettage, or endometritis. Superficial damage leads primarily to an abnormally adherent placenta, and is diagnosed as the complete or partial absence of the decidua on histology. Today, the main cause of placenta accreta spectrum is uterine surgery and, in particular, uterine scar secondary to cesarean delivery. In the absence of endometrial reepithelialization of the scar area the trophoblast and villous tissue can invade deeply within the myometrium, including its circulation, and reach the surrounding pelvic organs. The cellular changes in the trophoblast observed in placenta accreta spectrum are probably secondary to the unusual myometrial environment in which it develops, and not a primary defect of trophoblast biology leading to excessive invasion of the myometrium. Placenta accreta spectrum was separated by pathologists into 3 categories: placenta creta when the villi simply adhere to the myometrium, placenta increta when the villi invade the myometrium, and placenta percreta where the villi invade the full thickness of the myometrium. Several prenatal ultrasound signs of placenta accreta spectrum were reported over the last 35 years, principally the disappearance of the normal uteroplacental interface (clear zone), extreme thinning of the underlying myometrium, and vascular changes within the placenta (lacunae) and placental bed (hypervascularity). The pathophysiological basis of these signs is due to permanent damage of the uterine wall as far as the serosa, with placental tissue reaching the deep uterine circulation. Adherent and invasive placentation may coexist in the same placental bed and evolve with advancing gestation. This may explain why no single, or set combination of, ultrasound sign(s) was found to be specific for the depth of abnormal placentation, and accurate for the differential diagnosis between adherent and invasive placentation. Correlation of pathological and clinical findings with prenatal imaging is essential to improve screening, diagnosis, and management of placenta accreta spectrum, and standardized protocols need to be developed.

show abstract

Section: Scar Implantationmentioning

confidence: 97%

Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging

Jauniaux

Collins

Burton

2018

American Journal of Obstetrics and Gynecology

560

542

View full text Add to dashboard Cite

show abstract

“…In 2014, a study on uterine arterial circulation showed that in women with a history of cesarean operations, the resistance in uterine artery is increased and the volume of uterine blood flow distributed to utero-placental circulation is lower compared to patients with spontaneous vaginal births in the past. These data would suggest a possible involvement of the factors described above together with a scarce vascularization of the uterine scar, in the process of re-epithelialising of the scar area (34).…”

Section: Discussionmentioning

confidence: 79%

The correlation between histopathological and ultrasound findings regarding Cesarean section scars – A three-year survey study

Balalau¹,

Bacalbaşa²,

Bălălău³

et al. 2019

JMMS

View full text Add to dashboard Cite

The cesarean operation represents a major surgery, with a higher risk of postoperative complications and longer postoperative recovery than vaginal delivery.Due to the increasing frequency of cesarean sections, the ultrasound imaging of the uterine scar has become a particularly useful tool in identifying its potential long-term complications. This should be done pre-conceptively and quarterly or whenever necessary during pregnancy.Currently, there are only few histopathological studies on the uterine scar, trying to assess the myometrial repair and certain factors that influence the quality of the scar.The study was performed on a batch of 123 patients with previous C-sections, with multiple ultrasound exams during pregnancy and post-operative pathologic evaluation of the uterine scar in order to assess the possibility of a new prognostic score by correlating these two factors.Our study found solid evidence related to possible correlations between histopathological and ultrasound data on the cesarean section scar, which could lead to a possible predictive algorithm with implications for both prognostic and therapeutic fields. Keywords ultrasound, histopathological aspects, cesarean scar. Highlights The predictive ultrasound parameters for the risk of rupture/dehiscence of the uterine scar showed varying cut-off values, ranging between 2.0 and 3.5 mm for the lower segment and up to 0.97 mm for the myometrium. This observation of inverse proportionality between the uterine thickness and the risk of rupture/dehiscence of the scar seems to be correlated with the histopathological features of the cesarean section scar.

show abstract

“…In a study conducted by Flo et al, in a total of 68 pregnant women between 22 and 23 + 6 weeks, no significant difference was found between uterine artery PI values of women with and without previous cesarean section history. 10 However, the percentage of maternal cardiac output attributed to the uteroplacental circulation was lower and uterine vascular resistance (not uterine artery PI) was higher in the women with the uterine scarring. Maternal cardiac functions were also evaluated, but no subgroup analysis of the number of previous cesarean sections was performed.…”

Section: Discussionmentioning

confidence: 95%

“…8 Recent studies have investigated the effect of previous cesarean sections on uterine artery Doppler indices in pregnant women, but contradictory results have been revealed. 9,10 To our knowledge, there is no study investigating the relationship between the number of previous cesarean sections and Doppler indices. In this study, we aimed to test the hypothesis that cesarean scarring may increase uterine artery Doppler indices, evaluate the relationship between the uterine artery Doppler indices and the number of previous cesarean sections and analyze its effect on pregnancy complications.…”

Section: Introductionmentioning

confidence: 99%

Effect of previous cesarean sections on second‐trimester uterine artery Doppler

Işıkalan

Yeniçeri

Toprak

et al. 2020

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Aim In this study, we investigated the effects of previous cesarean sections on uterine artery Doppler indices. Methods This prospective cohort study included 153 healthy pregnant women between 18 and 24 weeks of gestation. Seventy‐three pregnant women without previous cesarean sections (control group) and 80 pregnant women with previous cesarean sections (study group) were compared in terms of uterine artery Doppler indices. Results The mean uterine artery pulsatility index (PI) MoM value was 1.18 ± 0.40 in the study group and 1.07 ± 0.35 in the control group (P = 0.046). The number of patients with uterine artery PI values above 95 percentile was 18 (22.5%) in the study group and 5(6.8%) in the control group (P = 0.007). The mean gestational age at birth was significantly lower in the study group (38.2 ± 1.3 vs. 39 ± 1.0, P < 0.001). There was no significant difference between the mean PI, resistance index (RI) and systolic/diastolic (S/D) ratio values of the uterine artery (P = 0.16, 0.11, 0.08, respectively). When the comparison was made with the number of previous cesarean sections, all three index values of the patients who had had more than two cesarean sections were found to be significantly higher. Conclusion The Doppler flow indices of the uterine artery significantly increased in patients with more than two previous cesarean sections. When evaluating uterine artery Doppler indices in pregnant women with a history of previous cesarean sections, these factors should be considered.

show abstract

Blood flow to the scarred gravid uterus at 22–24 weeks of gestation

Cited by 27 publications

References 26 publications

Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging

Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging

The correlation between histopathological and ultrasound findings regarding Cesarean section scars – A three-year survey study

Effect of previous cesarean sections on second‐trimester uterine artery Doppler

Contact Info

Product

Resources

About