EVALUATION OF THE UTERINE SCAR IN PATIENTS WITH PREVIOUS CAESAREAN SECTION IN SMS MEDICAL COLLEGE, JAIPUR

Meena Seema; Mittal Suman; Saini Soniya; Bansal Shikha; Baghotia Priyanka; Meena B.S.

Volume : VI, Issue : IV, April - 2017

EVALUATION OF THE UTERINE SCAR IN PATIENTS WITH PREVIOUS CAESAREAN SECTION IN SMS MEDICAL COLLEGE, JAIPUR

Meena Seema, Mittal Suman, Saini Soniya, Bansal Shikha, Baghotia Priyanka, Meena B. S.

Abstract :

Aims and Objective : To evaluate the safety and integrity of scar in patients with previous caesarean section.

Material and Method : This study was a prospective observational study was done in the Department of Obstetrics and Gynaecology, Zenana Hospital, SMS Medical College and Hospital, Jaipur during a period of August 2015 to August 2016, either in labour or not in labour. Both booked and emergency cases were included in the study group. A total of 320 cases were studied. All pregnant women with previous one caesarean will be selected. History and investigations (USG) will be done. Intraoperatively findings will be noted. Results will be compared and statistically analysed.

Results and Discussion : Uterine dehiscence was present in 2.81% cases. Thinning was present in 25.63% cases intraoperatively. Rupture was not present in study group. 75.82% of cases of thinned out scar and dehiscence had their previous caesarean section at tertiary hospital. The intraoperative findings were statistically significantly associated with complain of scar tenderness at the time of admission (p < 0.05). 18.12% cases complaint of scar tenderness. The sensitivity of scar tenderness for thinning and dehiscence 56%, specificity 96.9%, positive predictivity 87.9%, negative predictivity 84.7%.The intraoperative findings were statistically significantly associated with preoperatively USG scar thickness. When preoperative USG scar thickness was <3mm then intraoperative findings of thinned out scar and dehiscence was increased (p <0.05). With a cut off value of 3 mm the sensitivity of USG scar thickness for evaluation of uterine scar was 87.90%, specificity 98.25%, positive predictivity 95.23%, negative predictivity 95.34%. This shows that preoperative USG is an important tool in measuring lower uterine segment scar thickness. It indicate that preoperative USG scar thickness >3 mm is safe for trial of labour in previous caesarean section. Intraoperative adhesion was seen in 27.82% cases.

Conclusion : The concept of routine repeat caesarean birth should be replaced by a specific indication for a subsequent abdominal delivery and in the absence of contraindication, a woman with one previous caesarean delivery with a low transverse incision should be counslled and encouraged to attempt labour in her current pregnancy