Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

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

Nisza w bliźnie macicy po cięciu cesarskim — etiologia, diagnostyka ultrasonograficzna i następstwa kliniczne niecałkowitego zagojenia się rany macicy po cięciu cesarskim

Aktualnie 1 na 5 kobiet na świecie rodzi metodą cięcia cesarskiego. Badania licznych autorów wskazują, że u około 50% pacjentek po przebytym cięciu cesarskim podczas badania ultrasonograficznego w macicy nieciężarnej stwierdza się w obrębie blizny obecność hipoechogennej, zwykle trójkątnej, przestrzeni, określanej mianem niszy. Przestrzeń ta odpowiada niezrośniętej części blizny. Biorąc pod uwagę liczbę przeprowadzanych cięć cesarskich oraz szacowaną częstość niecałkowitego gojenia się blizny po cięciu cesarskim, pacjentki z niszą w bliźnie stanowią dużą i gwałtownie rosnącą populację, także w Polsce. W ciągu ostatnich kilku lat dokonał się duży postęp wiedzy na temat odległych następstw związanych z obecnością blizny w macicy po cięciu cesarskim. Do następstw tych należą u kobiet ciężarnych: rozejście się lub pęknięcie blizny, ciąża w bliźnie po cięciu cesarskim oraz nieprawidłowa placentacja. U kobiet nieciężarnych występują nieprawidłowe krwawienia maciczne, a także prawdopodobnie niepłodność wtórna i dyspareunia. Co najważniejsze, ryzyko występowania tych powikłań wydaje się mieć związek z niecałkowitym zrośnięciem się blizny, czyli obecnoś­cią niszy w bliźnie. W niniejszej pracy przedstawiono aktualną wiedzę na temat etiologii, diagnostyki ultrasonograficznej oraz odległych następstw klinicznych niecałkowitego zagojenia się rany macicy po cięciu cesarskim. Autorzy pracy stoją na stanowisku, że ocena blizny metodą standaryzowaną powinna stanowić element rutynowego badania ultrasono­graficznego narządu płciowego u kobiet po przebytym cięciu cesarskim

The analgesic efficiency of transversus abdominis plane (TAP) block after caesarean delivery

Objectives: The ultrasound-guided transversus abdominis plane (TAP) block is a supporting method of pain relief after different types of surgical and gynecological procedures. The aim of the present study was to evaluate the analgesic effects of the TAP-block in patients undergoing caesarean section. Material and methods: 88 women undergoing elective caesarean section under spinal anaesthesia were prospectively randomized into two groups. In the first group, an ultrasound-guided bilateral TAP block was performed using 40 mL 0.25% bupivacaine, while the second group was treated without a regional nerve block. Both groups received a standard analgesia protocol with intravenous paracetamol administered every 6 hours and intravenous tramadol on-demand, delivered using the Patient Controlled Analgesia (PCA) method. Pain intensity was assessed according to the visual analogue scale (VAS) directly after the TAP block and at 3, 6 and 12 hours postoperatively. Any patient complaints and side-effects during the postoperative period were recorded. Results: The TAP block resulted in a significant reduction of pain intensity using the visual analogue scale after 3, 6 and 12 hours (p < 0.05) and a significant decrease in tramadol administration (p < 0.05) during the first 12 hours postoperatively. No significant differences in the heart rate and blood pressure were noted between groups (p > 0.05). There were no complications related to the TAP block. Conclusions: The TAP block is a safe and effective adjunctive method of pain relief after caesarean delivery

Cesarean section versus vaginal delivery – state-of-the-art paper

Summary Aim of the study: The aim of the study was to perform a comparative analysis of complications after vaginal deliveries and cesarean sections and to introduce emotional status of the mother as an indication for a cesarean section. Material and methods: 406 patients after vaginal deliveries and cesarean sections, that took place in the first quarter of 2009, were enrolled into the study. Results: In the studied group of 406 patients, 200 women (49.2%) had cesarean section and 206 women (50.8%) delivered vaginally. In both groups there were no differences in the clinical state of newborns, which were assessed according to the Apgar score, and in umbilical cord blood pH. Hemoglobin concentration evaluated on the second day of puerperium was statistically significantly higher in the group of patients after cesarean section than after vaginal delivery. Episiotomy and laparotomy wound healing complications were observed in 2 (0.97%) and 3 (1.5%) cases, respectively. Conclusions: Due to lack of differences in complication rates between cesarean section and vaginal delivery patients, the emotional status of a pregnant woman should be considered as an indication for cesarean section

Sonoelastografia szyjki macicy jako nowa metoda diagnostyczna w ocenie stanu szyjki u kobiet ciężarnych – doniesienie wstępne

Objectives: The study aimed at determining whether there exists a correlation between the cervical cohesion parameters assessed in the elastography and the length of the cervix. Material and methods: Assessment of cervical cohesion parameters with the use of real-time sonoelastography was performed on 59 patients between 28 and 39 weeks of gestation. Results: The analysis showed that there exists a statistically significant (p=0.033) correlation between the cervical length and the elasticity of the front cervical labium (strain ratio A). Correlation coefficient (r) stood at (-) 0.28. Conclusions: 1. There exists a negative correlation between the condition on the front cervical labium in elastographic imaging and the length of the cervical canal in USG imaging. 2. Elastography of the uterine cervix may be helpful in assessing the risk of premature labour or cervical insufficiency. 3. There is a need to perform a study on a larger group of patients in order to determine whether elastography may find its place among routine obstetric diagnostic methods.Cel pracy: Celem pracy było zbadanie czy istnieje korelacja między spoistością szyjki macicy ocenianej metodą elastografii a długością szyjki macicy. Materiał i metody: Badaniu poddano 59 ciężarnych kobiet pomiędzy 28. i 39. tygodniem ciąży, u których oceniono parametry konsystencji szyjki macicy przy użyciu sonoelastografii w czasie rzeczywistym (real-time sonoelastography) . Wyniki: Analiza wykazała, iż istnieje istotna statystycznie (p=0.033) korelacja między długością szyjki macicy a konsystencją przedniej wargi szyjki macicy (strain ratio A). Współczynnik korelacji (r) wyniósł (-) 0.28. Wnioski: 1. Istnieje ujemna korelacja pomiędzy stanem przedniej wargi szyjki macicy ciężarnej ocenianej w badaniu elastograficznym z długością kanału szyjki macicy w obrazie USG. 2. Badanie elastograficzne szyjki macicy może być pomocne w prognozowaniu ryzyka porodu przedwczesnego oraz niewydolności szyjki macicy. 3. Potrzebne są badania na większej grupie pacjentek aby stwierdzić czy elastografia znajdzie miejsce wśród rutynowych położniczych metod diagnostycznych

Ultrasonographic analysis of cesarean scars features in nonpregnant uterus

Abstract 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

Neutron halos in heavy nuclei -- relativistic mean field approach

Assuming a~simple spherical relativistic mean field model of the nucleus, we estimate the width of the antiproton--neutron annihilation ($\Gamma_n$) and the width of antiproton--proton ($\Gamma_p$) annihilation, in an antiprotonic atom system. This allows us to determine the halo factor $f$, which is then discussed in the context of experimental data obtained in measurements recently done on LEAR utility at CERN. Another quantity which characterizes the deviation of the average nuclear densities ratio from the corresponding ratio of the homogeneous densities is introduced too. It was shown that it is also a good indicator of the neutron halo. The results are compared to experimental data as well as to the data of the simple liquid droplet model of the nuclear densities. The single particle structure of the nuclear density tail is discusssed also.Comment: revtex, 12 pages + 6 postscript figure

Perinatal outcome according to chorionicity in twins — a Polish multicenter study

Objectives: The aim of the study was to analyze the perinatal outcome of twin gestations and estimate the influence of chorionicity on the outcome in a large cohort of twin pregnancies in Poland. Material and methods: A retrospective analysis of 465 twin deliveries in 6 Polish centers in 2012 was conducted. Baseline characteristics, the course of pregnancy and labor, as well as the neonatal outcome were analyzed in the study group and according to chorionicity. Results: A total of 356 twin pregnancies were dichorionic (DC group) (76.6%), and 109 were monochorionic (MC group) (23.4%). There were no differences in the occurrence of pregnancy complications according to chorionicity, except for IUGR of at least one fetus (MC 43.1% vs. DC 34.6%; p = 0.003). 66.5% of the women delivered preterm, significantly more in the MC group (78% vs. 62.9%; p = 0.004). Cesarean delivery was performed in 432 patients (92.9%). Mean neonatal birthweight was statistically lower in the MC group (2074 g vs. 2370 g; p < 0.001). Perinatal mortality of at least one twin was 4.3% (2.8% in the DC group vs. 9.2% in the MC group; p = 0.004). Neonatal complications, including NICU admission, respiratory disorders, and infections requiring antibiotic therapy, were significantly more often observed among the MC twins. Conclusions: The overall perinatal outcome in the presented subpopulation of Polish twins and its dependence on cho­rionicity is similar to the reports in the literature. Nevertheless, the rates of preterm and cesarean deliveries remain higher. It seems that proper counselling of pregnant women and education of obstetricians may result in reduction of these rates