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Comparison of preoperative and intraoperative evaluation of lower uterine segment cesarean scar

Author: 
Singla S., Sharma, M., Anand, H.P. and Mittal, P.
Subject Area: 
Health Sciences
Abstract: 

Objectives: To study Lower Uterine Segment cesarean scar using transabdominal ultrasound and clinical parameters in previous cesarean section antenatally at term. To study the physical nature of scar at repeat section and find the association between preoperative and intraoperative evaluation. Methods: This was a cross sectional observational study undertaken in VMMC & SJH, New Delhi. One twenty six women with previous cesarean section were enrolled in the study to evaluate the correlation between clinical and ultrasonographic parameters determined antenatally with the physical nature of scar intraoperatively. Results and Conclusions: In the study, the women with ICP≤2 years, had significantly weaker scar (grade III/IV=55.56%). In women with post operative wound sepsis in previous LSCS, especially the one’s who underwent healing of wound by secondary intention were found to have a higher incidence of weaker scar (grade III/IV=33.4%). A higher percentage of weaker scar,i.e. 34.7% was found in women with maternal tachycardia >100 per minute and 88.89% in women with scar tenderness in peripartum period. Using the ROC curve a cut off of 2.4mm was derived for LUS USG scar thickness. Association of TAS USG LUS scar thickness and per operative grade of scar was found to be significant (p=0.0003). The study revealed a short ICP≤2 years, healing of previous scar by secondary intention, pulse rate>100, scar tenderness, scar thickness<2.4mm, adversely affect the scar, recommending avoidance of TOLAC in such cases. Scar thickness should be measured routinely using TAS USG.

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