DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190279

Retrospective study to find predictive factors of scar dehiscence in previous caesarean section to prevent maternal and perinatal morbidity and mortality

Natasha Tyagi, Manju Prabhakar, Smita Tyagi

Abstract


Background: Uterine scar dehiscence is a complication in which scar tissue remaining from previous C-section is disrupted and separated. Its incidence ranges between 0.2%-4.3% of all pregnancies with previous caesarean. It is asymptomatic in 48% of patients and thus is a serious complication because if not predicted it can lead to uterine rupture.

Methods: Patients included in the study were of previous caesarean who were taken for repeat caesarean and scar dehiscence was not predicted preoperatively but seen intra-operatively. History, symptoms, signs and radiological investigations were interpreted to find out single or multiple factors responsible for scar dehiscence.

Results: Incidence of scar dehiscence was found to be 8.3% .Scar dehiscence was detected in 55% of cases who were gravida 3 and above, all patients with intraoperative scar tenderness, 35% of patients with scar thickness ˂2mm, 70% cases with POG 37-40 weeks, 65% of patients with interpregnancy interval˂18 months,86.6% of patients with scar dehiscence had baby birth weight ˃3kg.

Conclusions: Authors concluded that a single factor which has maximum predictive value for scar dehiscence is scar tenderness.


Keywords


Previous caesarean, Scar dehiscence, Scar tenderness

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References


Baron J, Weintraub AY, Eshkoli T, Hershkovitz R, Sheiner E. The consequences of previous uterine scar dehiscence and cesarean delivery on subsequent births. Int J Gynaecol Obstet. 2014;126(2):120-2.

Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean birth. Green-top guideline. 2007(45).

Health and Social Care Information Centre. NHS Maternity Statistics - England, April 2012 to March 2013: Provider level analysis. [Leeds]: HSCIC; 2013 Available at: http://www.hscic. gov.uk/catalogue/PUB12744.

Welsh Government. Maternity Statistics, Wales: Method of Delivery, 2004-2014. SDR 210/2014. Cardiff: Welsh Government;2014 Available at: http://gov.wales/docs/statistics/2014/141202-maternity-method-delivery-2014-en. pdf.

Macones GA, Cahill AG, Stamilio DM, Odibo A, Peipert J, Stevens EJ. Can uterine rupture in patients attempting vaginal birth after cesarean delivery Be predicted? Am J Obstet Gynecol. 2006;195(4):1148-52.

Singh N, Tripathi R, Mala YM, Dixit R. Scar thickness measurement by transvaginal sonography in late second trimester and third trimester in pregnant patients with previous cesarean section: does sequential change in scar thickness with gestational age correlate with mode of delivery? J Ultrasound. 2015;18(2):173-8.

Basic E, Basic-Cetkovic V, Kozaric H, Rama A. Ultrasound evaluation of uterine scar after caesarean section. Acta Informat Medica. 2012;20(3):149-53.

Sen S, Malik S, Salhan S. Ultrasonographic evaluation of lower uterine segment thickness in patients of previous cesarean section. Int J Gynaecol Obstet. 2004;87(3):215-9.

Fukuda M, Fukuda K, Shimizu T, Bujold E. Ultrasound Assessment of Lower Uterine Segment Thickness During Pregnancy, Labour, and the Postpartum Period. J Obstet Gynaecol Can. 2016;38(2):134-40.

Ram M, Hiersch L, Ashwal E, Nassie D, Lavie A, Yogev Y, et al. Trial of labor following one previous cesarean delivery: the effect of gestational age. Arch Gynecol Obstet. 2018;297(4):907-913.

Valentin L. Prediction of scar integrity and vaginal birth after caesarean delivery. Best Pract Res Clin Obstet Gynaecol. 2013;27(2):285-95.

Jastrow N, Roberge S, Gauthier RJ, Laroche L, Duperron L, et al. Effect of birth weight on adverse obstetric outcomes in vaginal birth after cesarean delivery. Obstet Gynecol. 2010;115.