Evaluation of Uterine Scar on Repeat Second Cesarean Section in Patients with Previous Cesarean Section

only marginally increased among women undergoing a trial of labor2 than among those undergrant an elective repeat cesarean section (0.4% vs 0.2% OR=2.1), with a significant decrease in need for transfusion (OR=0.57) or hysterectomy (OR=0.39), has led authorities to encourage vaginal birth after cesarean3. A group of investigators concluded4 that among women with a previously scarred uterus, induction of labour is associated with an increased risk of uterine rupture compared with spontaneous labor (2.3% vs 0.7% p=0.001). Current medical evidence indicate that 60-80% of women can achieve a vaginal delivery following a previous lower uterine segment cesarean delivery. When vaginal birth after cesarean Introduction Cesarean Sections (c/s) delivery is a surgical operation to deliver a baby through an incision in the uterus. It is the most common surgical obstetric intervention and its rate varies internationally from 10-25%. The main indication for cesarean section has become repeat cesarean section. During the second half of 20th century, a cesarean section implied that all subsequent pregnancies were very likely to be delivered in the same way. This policy was the result from the fear of catastrophic uterine scar rupture of classical cesarean section, which persisted even after its replacement with lower segment cesarean section (LSCS) without the same basis1. Documentation that the rate of uterine rupture is AKMMC J 2012; 3(1): 16-19 To evaluate the safety and integrity of uterine scar at repeat cesarean section in patients with previous one cesarean section (C/S). A prospective study was Carried out in a tertiary care, obstetric unit over a period of one year, 2010. All pregnant mothers who underwent cesarean section either emergency or elective with history of previous one cesarean sections were included in this study. The variables noted were age, parity, socioeconomic status, residential area, location of previous cesarean section, previous wound infection and associated complaints. Data was analyzed on SPSS 11 Operative findings during cesarean sections were recorded in terms of thinning of scar, dehiscence or rupture. One hundred and twenty cesarean section patients were included in the study. Out of all patients, extreme thinning of scar was noted in 28 (23.33%) patients. Four patients (3.33%) had scar dehiscence,only 3( 2.5%) patients with scar dehiscence had associated complaint of scar tenderness, while 17 (14.16%) of 120 cases of scar thinning were having scar tenderness. All 4 cases of scar dehiscence had their previous c/s at peripheral hospitals. No patient underwent hysterectomy and all patients with scar dehiscence had successful repair. Our findings shows relatively inadequate scar thickness rate but at the same time relatively acceptable scar dehiscence rate. Thus it seems to be a safe approach to make trial of labour after meticulous scrutinization and individualization.