Position and Integrity of Uterine Scar Are Determined by Degree of Cervical Dilatation at Time of Cesarean Section

Kamel, Rasha; Eissa, Tamer S.; Sharaf, M.; Negm, Sherif; Thilaganathan, B.

doi:10.1097/01.ogx.0000791684.08887.ef

Cited by 5 publications

(6 citation statements)

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“…A recent cohort study has found that elective and early labour CD at cervix dilatation < 2cm is associated with an increased prevalence of a scar above the internal cervical os as well as a scar niche. 31 In the present study, we found a significantly (P<0.001) higher incidence of a uterine niche in women who had an elective compared to those who had an emergent CD. When the CD was performed at a cervical dilatation < 4 cm there was a significantly (P=0.027) higher incidence of a uterine niche located above the vesicovaginal fold and a significantly (P=0.0002) lower proportion of cesarean scar below the vesicovaginal fold compared to those who had their CD at active stage of labour.…”

Section: Discussionsupporting

confidence: 49%

Prospective Evaluation of the Ultrasound Signs Proposed for the Description of Uterine Niche in Nonpregnant Women

Feldman

Maymon

Jauniaux

et al. 2022

Obstetrical &Amp; Gynecological Survey

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(Abstracted from J Ultrasound Med 2022;41:917–923)As cesarean delivery (CD) rates have exponentially increased worldwide during the last 2 decades, the development of a “niche,” or a CD scar defect (also called isthmocele), has arisen as a key factor associated with secondary gynecological and obstetrical complications. In terms of subsequent pregnancies, these defects have been indirectly associated with increased rates of placenta accreta, iatrogenic obstetric complications, and preterm birth.

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Section: Discussionsupporting

confidence: 49%

Prospective Evaluation of the Ultrasound Signs Proposed for the Description of Uterine Niche in Nonpregnant Women

Feldman

Maymon

Jauniaux

et al. 2022

Obstetrical &Amp; Gynecological Survey

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“…In addition, taking large doses of oxytocin can also cause side effects such as hypotension and arrhythmia. Our study showed that carbetocin has a good hemostatic effect, and the effect is rapid and long-lasting [8][9][10]. is method has been well applied in the cesarean section of pregnancy with a uterine scar.…”

Section: Discussionmentioning

confidence: 99%

Carbetocin Controls Intraoperative Blood Loss and Thickness of Myometrium in Scar Uterus Cases

Sun

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To study the effect of carbetocin on intraoperative blood loss and thickness of myometrium during cesarean section with the scarred uterus at term pregnancy. Methods. Pregnant women with full-term gestational scar uterus who underwent cesarean section from March 1, 2021, to April 30, 2022, were retrospectively collected and divided into a reference group (using oxytocin) or a study group (using carbetocin). The clinical data of the two groups were retrospectively analyzed, and the operation time, intraoperative blood loss, hospital stay, uterine contraction effect, changes in the myometrium, and complications were compared between the two groups. Results. A total of 103 pregnant women were retrieved. There were 44 cases in the reference group and 59 cases in the study group. There were significant differences in operation time, intraoperative bleeding, hospital stay, postoperative adverse events, uterine fundus wall thickness, anterior wall thickness, posterior wall thickness, and uterine contraction effect between the two groups ( p = 0.0001 , 0.005, 0.006, 0.001, 0.0004, 0.003, 0.001, and 0.005, respectively). There were no significant differences in estradiol (E2), luteinizing hormone (LH), or follicle-stimulating hormone (FSH) between the two groups before the surgery ( p = 0.596 , 0.840, and 0.940, respectively), but there were significant differences after the surgery ( p = 0.011 , 0.001, and 0.005, respectively). Conclusion. The use of carbetocin in the cesarean section of a full-term scar uterus is significantly effective in shortening the operation time, reducing the amount of intraoperative blood loss, and promoting the recovery of the uterus.

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“…Remodeling of the lower uterine segment after Cesarean delivery (CD) can lead to Cesarean scar defect, which can range from a small defect of the superficial myometrium to a deep defect or niche 4 . The incidence of Cesarean scar defect increases with the number of prior CDs and is influenced by the hysterotomy closure technique used and scar location [4][5][6] . After multiple lower-segment CDs, the anterior uterine wall becomes thinner and largely consists of fibrotic scar tissue [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of impact of post‐Cesarean section uterine scarring in perinatal diagnosis of placenta accreta spectrum disorder

Hussein

Elbarmelgy

et al. 2022

Ultrasound in Obstet & Gyne

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Objective Standardized ultrasound imaging and pathology protocols have recently been developed for the perinatal diagnosis of placenta accreta spectrum (PAS) disorders. The aim of this study was to evaluate prospectively the effectiveness of these standardized protocols in the prenatal diagnosis and postnatal examination of women presenting with a low‐lying placenta or placenta previa and a history of multiple Cesarean deliveries (CDs). Methods This was a prospective cohort study of 84 consecutive women with a history of two or more prior CDs presenting with a singleton pregnancy and low‐lying placenta/placenta previa at 32–37 weeks' gestation, who were referred for perinatal care and management between 15 January 2019 and 15 December 2020. All women were investigated using the standardized description of ultrasound signs of PAS proposed by the European Working Group on abnormally invasive placenta. In all cases, the ultrasound features were compared with intraoperative and histopathological findings. Areas of abnormal placental attachment were identified during the immediate postoperative gross examination and sampled for histological examination. The data of a subgroup of 32 women diagnosed antenatally as non‐PAS who had complete placental separation at birth were compared with those of 39 cases diagnosed antenatally as having PAS disorder that was confirmed by histopathology at delivery. Results Of the 84 women included in the study, 42 (50.0%) were diagnosed prenatally as PAS and the remaining 42 (50.0%) as non‐PAS on ultrasound examination. Intraoperatively, 66 (78.6%) women presented with a large or extended area of dehiscence and 52 (61.9%) with a dense tangled bed of vessels or multiple vessels running laterally and craniocaudally in the uterine serosa. A loss of clear zone was recorded on grayscale ultrasound imaging in all 84 cases, while there was no case with bladder‐wall interruption or with a focal exophytic mass. Myometrial thinning (< 1 mm) in at least one area of the anterior uterine wall was found in 41 (97.6%) of the 42 cases diagnosed as non‐PAS on ultrasound and 37 (88.1%) of the 42 diagnosed antenatally as PAS. Histological samples were available for all 48 hysterectomy specimens with abnormal placental attachment and for the three cases managed conservatively with focal myometrial resection and uterine reconstruction. Villous tissue was found directly attached to the superficial myometrium (placenta creta) in six of these cases and both creta villous tissue and deeply implanted villous tissue within the uterine wall (placenta increta) were found in the remaining 45 cases. There was no evidence of percreta placentation on histology in any of the PAS cases. Comparison of the main antenatal ultrasound signs and perioperative macroscopic findings between the two subgroups correctly diagnosed antenatally (32 non‐PAS and 39 PAS) showed no significant difference with respect to the distribution of myometrial thinning and the presence of a placental bulge on ultrasound and of anterior uter...

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Position and Integrity of Uterine Scar Are Determined by Degree of Cervical Dilatation at Time of Cesarean Section

Cited by 5 publications

References 0 publications

Prospective Evaluation of the Ultrasound Signs Proposed for the Description of Uterine Niche in Nonpregnant Women

Prospective Evaluation of the Ultrasound Signs Proposed for the Description of Uterine Niche in Nonpregnant Women

Carbetocin Controls Intraoperative Blood Loss and Thickness of Myometrium in Scar Uterus Cases

Prospective evaluation of impact of post‐Cesarean section uterine scarring in perinatal diagnosis of placenta accreta spectrum disorder

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