Intra-operative uterine scar condition and fetomaternal outcome in patients of previous lower segment caesarean section (LSCS) with scar tenderness

Abstract

Background: During past few years, there is increasing trend in trial of labor in cases of previous lower segment caesarian section (LSCS). It needs vigilant approach in identifying signs and symptoms of giving way of previous scar. This study is to see the intra-operative uterine scar condition and feto-maternal outcome in patients of previous LSCS with scar tenderness.Methods: This is a prospective study done in Safdarjung hospital, New Delhi. It includes 120 patients of previous lower segment caesarian section with scar tenderness operated as emergency cases over a period of one year. It excludes elective repeat LSCS.Results: During this period repeat emergency LSCS was done in 862 cases and scar tenderness was seen in 120 cases (13.92 %). Out of 120 cases enrolled for the study intra-operative scar was intact in 69 cases (57.5%). Scar was thinned out in 27 cases (22.5%). Scar dehiscence was found in 21 cases (17.5%). Rupture occurred in 3 cases (2.5%) out of which 2 were Fresh still births. NICU admission was done in 11 cases (9.17%). 1 neonatal death occurred. No maternal death was recorded. Average hospital stay was 6 days. Blood transfusion was needed in 23 cases (19.2%).Conclusions: Scar tenderness is a very important tool for predicting scar integrity. All cases of previous LSCS should have institutional delivery.

Clinical significance of uterine scar tenderness and third trimester sonographic scar thinning in predicting scar complications

“…Scar tenderness is an easily elicitable sign which appears early, and along with third trimester sonographic scar thickness (both in low resource settings where continuous electronic fetal heart rate monitoring is not available), are more useful in predicting scar complications. Table 1 showed that most common age group in both groups (A&B) was 21-25 years, similar to the findings as seen in the study by Safia Khalil and Gupta N et al [2,16] . In our study mean gestational age was 38 weeks, similar to Safia Khalil's study [2] .…”

“…In the study done by Gupta N et al [16] no maternal death was recorded. Average hospital stay was 6 days.…”

“…In our study mean gestational age was 38 weeks, similar to Safia Khalil's study [2] . In the study done by Gupta N et al [16] , out of 120 cases, intra operative scar was intact in 69 cases (57.7%); scar was thinned out in 27 cases (22.5%); scar dehiscence was found in 21 cases (17.5%) and rupture was found in 3 cases (2.5%).…”

Prevalence and risk factor of postoperative adhesions following repeated cesarean section: A prospective cohort study

“…Other studies reported that blood transfusion was required in 13.5% of their participants despite less blood loss. This was explained by documented preoperative anemia, which made the patients vulnerable to minor blood loss 29 . Adhesiolysis would be the cause of bladder injury.…”

“…This was explained by documented preoperative anemia, which made the patients vulnerable to minor blood loss. 29 Adhesiolysis would be the cause of bladder injury. Also, adhesions lead to difficult access to the abdominal cavity and the lower segment.…”