Document Type : Original Article
Authors
1
Department of Obstetrics and Gynecology, Faculty of Medicine, MUST University
2
Department of Obstetrics and Gynecology, Faculty of Medicine Ain Shams University, Egypt
3
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Egypt
4
Department of Obstetrics and Gynecology, Faculty of Medicine, MUST University,
Abstract
Background: CS Scar defect is associated with increased risk of uterine rupture, abnormal placental implantation, uterine scar dehiscence in subsequent pregnancies and scar ectopic pregnancy, also CS defects are reported to be associated with abnormal uterine bleeding and post menstrual spotting. Uterine wound healing is of great importance to achieve healthy future pregnancy and allow for vaginal birth after caesarean section, hence minimizing the rate of repeated caesarean sections.
Objective: To assess the healing of caesarean section scar defect by sonohystrography after primary CS.
Patients and Methods: The current study investigated the uterine wound healing after primary CS assessed by saline infusion sonography. The calculated surface area of the defect was done after considering the shape of CSD approximates to an isosceles triangle and used the formula (width x depth)/ 2, to calculate the surface area. Additionally, scoring CSD according to surface area with 3 defined grades: Grade 1 when the surface area was less or equal to 15mm2, grade 2 when the surface area was between 16 and 25mm2, and grade 3 when the surface area was larger than 25mm2.most of the defects.
Results: There is no significant correlation between the surface area of cesarean scar defect and age, BMI, GA, Parity, or Hb level. In the present study, the incidence of primary caesarean section in multigravida was 64.2.on the other and , primigravida cases accounted for 19(35.8%). In the present study the most common indication for CS was pathological CTG 15.1% followed by the occurrence of breech presentation 13.2 %4- The triangular shape accounted for more than half of the detected shapes. In our study, severe niche was detected in two patient with an incidence of 3.8 on the other hand non sever defect was 96.2%. There is moderate agreement between the two scoring system in this study were grade 1 (96.2%), and with using the other score severe defects occurred in 3.8% of participants.
Conclusion: It has demonstrated that both scoring systems are efficient in investigating the myometrial wound healing and CS scar defect in the patients undergoing their first elective cesarean section.
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