Ultrasonographic measurement of uterine lower segment scar thickness in cases of previous one caesarean section and obstetric outcome

Background: Vaginal birth after caesarean section (VBAC) has become an integral part of modern obstetrics with more than 1lakh VBACs achieved each year nationwide. Several studies have reported perinatal risks associated with failed trial of labour and uterine rupture in women attempting VBAC, due to concerns about these complications, the rate of VBAC deliveries has continued to fall in developed countries, with an inverse increase in Caesarean Sections (CS). To better assess the risk of uterine rupture, many authors have proposed sonographic measurement of scar or lower uterine segment (LUS) thickness near term, assuming that there is an inverse correlation between LUS thickness and the risk of uterine scar defect. Therefore, this assessment for the management of women with prior CS has increased safety by selecting women with the lowest risk of uterine rupture.Methods: Present study was a prospective observational study which assessed the obstetric outcome in women with previous lower segment caesarean section willing for trial of labour. Secondly, authors aimed to ascertain the best cut off values for predicting uterine rupture.Results: Present study found that as duration between previous LSCS and next pregnancy increased there was better chance of VBAC. As the baby weight increased VBAC rate reduced. Study also showed that scar thickness of 2.55mm and above measured by transabdominal method in the third trimester can be safely given trial of VBAC.Conclusions: Authors thus conclude that measurement of lower uterine segment/ scar thickness can help obstetrician decide whether VBAC is safe or not in patients with previous one LSCS willing for VBAC. Scar thickness of more than 2.55mm can be given safe trial of labour in women with previous one lower segment caesarean section

Heterotopic pregnancy with molar changes

Trophoblastic disease of pregnancy is also called as gestational trophoblastic disease (GTD), a rare group of tumors that involves abnormal proliferation of the trophoblastic cells. GTD is generally benign but sometimes can be malignant due to its marked penetration into and destruction of myometrium as well as its ability to metastasize hence the groups of tumors are referred to as gestational trophoblastic neoplasm (GTN). These are among the rare tumors that can be cured even in the presence of widespread dissemination. Present study is a case of intrauterine partial mole with ectopic pregnancy in the right adnexa with vesicular changes, a rare entity in obstetrics

A case of Takayasu‘s aortoarteritis with severe dilated cardiomyopathy in pregnancy

Takayasu’s aortoarteritis (TA) is a idiopathic, rare, chronic, giant-cell inflammatory disease of the arteries which primarily involves the aorta, its main branches and coronary and pulmonary arteries Women are affected in 80–90% of cases with a mean age of presentation in the second and third decade of life, reflected in a synonym for TA as ‘‘young female arteritis’’. Also known as pulse less disease that causes progressive damage including inflammation, scarring, narrowing and abnormal ballooning inside the wall of aorta and major arteries. A pregnancy in such cases is often associated with severe life-threatening complications and is hazardous to the life of the mother and therefore requires contraception counseling. Our case is a coexistence of Takayasu’s aortoarteritis and dilated cardiomyopathy which is an uncommon complication of TA and hence required termination of pregnancy

Heterotopic pregnancy with molar changes

Trophoblastic disease of pregnancy is also called as gestational trophoblastic disease (GTD), a rare group of tumors that involves abnormal proliferation of the trophoblastic cells. GTD is generally benign but sometimes can be malignant due to its marked penetration into and destruction of myometrium as well as its ability to metastasize hence the groups of tumors are referred to as gestational trophoblastic neoplasm (GTN). These are among the rare tumors that can be cured even in the presence of widespread dissemination. Present study is a case of intrauterine partial mole with ectopic pregnancy in the right adnexa with vesicular changes, a rare entity in obstetrics