THE ROLE OF ULTRASOUND IN PREVENTING THE LIFE-THREATENING EMERGENCIES ASSOCIATED WITH REPEATED CESAREAN SECTION
Ultrasonographic evaluation of the hysterorrhaphy scar is an extremely important element in current obstetrical practice, especially in patients who still want a future pregnancy. The purpose of our study was to evaluate the ultrasound findings of the cesarean scar in the third trimester of pregnancy that can reduce the life-threatening emergencies caused by repeated cesarean section such as uterine rupture of abnormal placental adhesions. We conducted a prospective study that included patients who gave birth by caesarean section and presented at a subsequent pregnancy to be monitored during pregnancy. The study was realized during 2016-2020at the Bucur Maternity Hospital, 'Saint John', Bucharest. A number of 57 patients were included in the analyzed group. A number of 12 pregnant women (21%) monitored both in weeks 30-34 and intraoperatively presented contractions and areas of dehiscence, while 30 (52.6%) pregnant women showed neither contractions nor areas of dehiscence. Women with contractions had an average scar thickness measured in the third trimester of 3.81 mm (SD 1.62, CI: [3.32; 4.30]), and those without contractions a thickness of 4.58 mm (SD 1.25, CI: [3.78; 5.37]. Intraoperatively we identified 3 cases with incomplete uterine rupture. Those cases were previously diagnosed with hysterorraphy scar between 0.15-0.5 cm. The repeated ultrasound evaluation of the cesarean scar is a good predictive factor for the intraoperative quality of the cesarean scar. With the third trimester ultrasound measurement of the uterine scar thickness, the uterine rupture may be avoided.
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