Retrospective study to find predictive factors of scar dehiscence in previous caesarean section to prevent maternal and perinatal morbidity and mortality
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20190279Keywords:
Previous caesarean, Scar dehiscence, Scar tendernessAbstract
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.
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.
