ABSTRACT

Background The ever increasing caesarean delivery rates are at an all-time high and interestingly, the main indication for caesarean section is not a genuine maternal or fetal health issue but the risk of uterine scar rupture. Every primary cesarean leads to greater probability of future repetitions as is evident from the current statistic which dictate a primary caesarean section rate of 16% and a repeated caesarean rate of 67%. Whether the risk of rupture is real or unfounded is worth exploration. Objective To evaluate the integrity of uterine scar in post-cesarean pregnant women presenting for delivery with scar tenderness. Methodology This cross-sectional analysis comprised of a sample of 196 (chosen via non-probability, consecutive sampling) post-cesarean pregnant patients presenting for delivery (from November 05, 2015 to May 04, 2016) to the labor ward of the Dept. of Obstetrics & Gynecology at Liaquat University Hospital, Hyderabad. After taking written consent, information pertaining to basic biodata, socio demographic details, gynecologic and obstetric particulars such as parity, gestational age, booking status and presenting complaints from patients including pain in scar, vaginal bleeding, indication of previous caesarean and details of the trial of labor were recorded onto a pre-structured interview based questionnaire. Inferences obtained from general physical, obstetrical examination (especially sign of cesarean scar tenderness) and ultrasound evaluation of uterine scar integrity were also recorded (scar thickness of more than 5mm was labeled positive for integrity). The data obtained was analyzed through SPSS version 20. RESULTS The mean age of the sample stood at 32.5 (SD ± 6.9) years with a range of 25 to 35 years. The mean parity was 2.9 (SD ± 1.2 and mean gestational age was 38.93 (SD ± 1.66). 73% of the patients were booked cases and 27% were un-booked. Integrity of uterine scar in pregnant women with previous cesarean delivery and scar tenderness was found to be 77%. CONCLUSION Integrity of the uterine scar in pregnant women with previous cesarean delivery with scar tenderness was high. Thus excessive fear of rupture is unfounded and vaginal delivery trials may be commenced (under expert care) among patients with previous cesarean delivery with hope of positive outcome. Keywords: Cesarean Scar, Uterine Integrity, Uterine Scare Tenderness, Vaginal Delivery, Delivery Trial, Serum Iron Level
Publication date: 01/05/2020

https://ijbpas.com/pdf/2020/May/MS_IJBPAS_2020_5068.pdf

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https://doi.org/10.31032/IJBPAS/2020/9.5.5068