Search

Background: The aim of the study was to assess the clinical outcomes of surgical repair of uterine cesarean scar defects with sonography (US)., Methods: Seven nonpregnant women with history of cesarean section and a large uterine scar defect were enrolled. The surgical repair was performed by minilaparotomy. The US assessment of the uterine scar was performed using a standardized approach at baseline, then at a first visit 2-3 days following the surgical intervention (V1) and at a follow-up visit 3 months later (V2). Residual myometrial thickness (RMT), width, and depth of the scar defect were measured., Results: The mean RMT increased significantly from 1.9 mm at baseline to 8.8 mm at V1 and 8.0 mm at V2. No intraoperative complications were observed. Postmenstrual spotting and abdominal pain reported preoperatively resolved after the operation., Conclusions: A surgical repair procedure for an incompletely healed uterine cesarean scar is effective in increasing RMT thickness, decreasing the depth of the scar, and reducing symptoms related to the cesarean section scar defect. Further studies on post-repair pregnancy outcomes are required to evaluate whether the procedure affects the rate of cesarean scar pregnancy, morbidly adherent placenta, and/or uterine scar dehiscence and rupture. The repair of a cesarean scar defect is recommended only for symptomatic women. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:455-460, 2017., (© 2017 Wiley Periodicals, Inc.)

Objectives: A growing number of studies suggest that the incomplete healing of the CS scar in the uterus increase the risk of uterine dehiscence or rupture during subsequent pregnancies. Thus, the factors that affect wound healing should be evaluated. We aimed to determine whether the morphology of the CS scar in non-pregnant women after one elective CS was affected by the site of the uterine incision, uterine flexion, maternal age, and fetal birth weight., Material and Methods: 208 non-pregnant women were invited for participation in the study, but only 101 of them met inclusion criteria. Standardized scar parameters (residual myometrial thickness (RMT), depth (D) and width (W) of the hypoechoic niche) were measured using ultrasonography at least 6 weeks after the CS., Results: Scar defect was detected in 26 of 101 subjects. Women without scar defect had significantly higher RMT values (1.87 vs. 0.87), lower newborn birth weight (3127 g vs. 3295 g), and higher scar location above the internal cervical os (62% vs. 16%), than those with scar defect. Maternal age was significantly correlated with D value (R = 0.40). Uterine retroflexion was significantly correlated with a larger D value (R = 0.63) and a larger D/RMT ratio (R = 0.24)., Conclusions: In low-risk women who have undergone one elective CS, several risk factors are associated with development of the scar defect, but only scar location can be modified during surgery. Future research is needed to determine whether a relatively higher incision location in the uterus can ensure optimal healing of the CS scar.

Objective: To identify factors related to the healing of a Cesarean uterine incision using the standardized ultrasonographic approach of scar assessment in the non-pregnant uterus., Study Design: Measurements of the uterine scar were taken from 409 women with a history of at least one low transverse cesarean section (CS) with a single layer uterine closure. Residual myometrial thickness (RMT), width (W) and depth (D) of the triangular hypoechoic scar niche, D/RMT ratio and clinical characteristics were analyzed. For statistical analysis, the Mann-Whitney U test, chi-square test, Spearman's rank correlation coefficient, ANOVA test, and logistic regression were used., Results: 268 women presented with a scar defect. RMT values were significantly correlated with the number of CSs (R=-0.17) and uterus retroflection (R=-0.15). The presence of a scar defect was significantly associated with lower RMT values (R=-0.33), greater gestational age (R=0.10), and younger maternal age (R=-0.11). The mean RMT value was significantly smaller in women with CSs performed in the second stage of labor (0.62) when compared to women with CSs in the first stage of labor (0.97) or without cervical dilatation (0.91)., Conclusion: A standardized approach of CS scar assessment in the non-pregnant uterus helps to identify women at risk of long-term complications of CS., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Every year 1.5 million cesarean section procedures are performed worldwide. As many women decide to get pregnant again, the population of pregnant women with a history of cesarean section is growing rapidly. For these women prediction of cesarean section scar performance is still a serious clinical problem., Methods: Starting in 2005, the study included 308 nonpregnant women with a history of low transverse cesarean section. The following ultrasonographic parameters of the cesarean section scar in the nonpregnant uterus were assessed: the residual myometrial thickness (RMT) and the width (W) and the depth (D) of the triangular hypoechoic scar niche. During 8 years of follow-up, 41 of these women were referred to our department for delivery. In all cases, a repeat cesarean section was performed and the lower uterine segment was assessed. Two independent statistical methods namely the logit model and Decision Tree analysis were used to determine the relation between the appearance of the cesarean section scar in the nonpregnat state and the performance of the scar in the next pregnancy., Results: The logit model revealed that the D/RMT ratio showed significant correlation with cesarean section scar dehiscence (P-value of 0.007). Specifically, a D/RMT ratio value greater than 1.3035 indicated that the likelihood of dehiscence was greater than 50%. The Decision Tree analysis revealed that a diagnosis of dehiscence versus non-dehiscence could be based solely on one criterion, a D/RMT ratio of at least 0.785. The sensitivity of this method was 71%, and the specificity was 94%., Conclusions: Assessment of the cesarean section scar in the nonpregant uterus can be used to predict the occurrence of scar dehiscence in the next pregnancy.

A 20 year old primigravida with a double uterus was admitted with a viable fetus in the right uterus and pus oozing from the left one. Management consisted of a regimen of intravenous antibiotics and intravaginal antibiotic tablets. Tocolysis was used to arrest imminent preterm labor. In the course of pregnancy IUGR was diagnosed. At 38 weeks of pregnancy a SGA baby boy of 2,440 g was delivered by cesarean section. The mother and the baby were discharged from the hospital in good general condition.

Objectives: To define and assess the new ultrasonographic parameters of cesarean hysterotomy scars and to analyze their variation depending on the number of cesarean sections., Material and Methods: Transvaginal ultrasound was carried out among 109 patients after cesarean section in the lower uterine segment with single-layer uterine closure. The following cesarean hysterectomy scar parameters were assessed: angle of the apex (K), basis (P) and height (W) of the anechoic triangle, the thickness of the knit tissue scar segment (G), G/P index and G/W index., Results: Transvaginal ultrasound detected the cesarean hysterectomy scar in 100% of the examined woman. In 5.5% of cases the completely knit hysterectomy scar tissue was identified. All patients from this group underwent a single cesarean section. In the remaining 94.5% of women, the ultrasound detected a presence of the anechoic triangle, defined as scar defect. No difference of statistical importance considering assessed scar parameters was observed between the groups of patients after one and two cesarean sections. The decrease of the thickness of the knit tissue scar segment (G) in the group of patients after three cesarean, sections in comparison to the group of patients after single (1.3 mm vs. 6.7 mm, p = 0.0134) and two (1.3 mm vs. 7.4 mm, p = 0.0366) abdominal deliveries, was found, as well as statistically important decrease in G/P index value in the group of patients after three cesarean sections in comparison to the patients after one (0.3 vs. 1.3, p = 0.0263) and two cesarean sections (0.3 vs. 1.2, p = 0.0138)., Conclusions: The new ultrasonographic parameters to assess the cesarean hysterectomy scar in nonpregnant uterus were introduced. Statistically important decrease in the thickness of the knit tissue scar segment (G) and G/P index value in the group of patients after three cesarean sections in comparison to the group of patients after single and two abdominal deliveries was revealed.

The recommendations represent the current procedure, which may be modified and changed where justified, after a thorough analysis of the given clinical situation, which may be the basis for their modification and updating in the future. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Pelvic organ prolapse is one of the most common pathological conditions in postmenopausal women. There is still a lack of fully effective and safe surgical techniques, especially in the advanced stages of apical defects. The purpose of the video is to present a new technique of laparoscopic treatment in women with an advanced stage of genital prolapse, stage III and IV according to the POP-Q scale. The technique involves uterine fixation for the anterior abdominal wall using overfascial mesh. Methods: We used a live-action surgical demonstration to describe laparoscopic fixation of the uterus to the anterior abdominal wall with the use of overfascial mesh. Results: This video provides a step-by-step approach to laparoscopic fixation of the uterus to the anterior abdominal wall with the use of overfascial mesh. The video can be used to educate and train those performing female pelvic reconstructive surgery. Conclusions: Based on our experience, this technique of laparoscopic suspension of the uterus to the anterior abdominal wall with the use of overfascial mesh is an effective, safe, and easy procedure for the treatment of advanced stages of pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Quantitative Sonoelastography of the Uterine Cervix by Interposition of a Synthetic Reference Material," by L. Hee et al. in the 2013 issue.