No abstract

Background: Cesarean section uterine scar dehiscence (CSD) is a rare but notable complication of Lower segment cesarean section (LSCS) surgery. The cause for a uterine scar dehiscence is based on the etiology behind the uterine scar defect or any event that would predispose the cesarean scar to dehisce. Globally accepted option for assessing the CS scar is transvaginal ultrasonography of the non-pregnant uterus. Objective: To determine the diagnostic accuracy of lower uterine segment scar thickness≤1.6mm in the prediction of scar dehiscence in patients with previous one LSCS who are undergoing repeat LSCS after trial of labour taking intraoperative findings as gold standard. Material and methods: This cross sectional study was conducted in Services Hospital, Lahore for 6 months. The Non probability consecutive sampling technique was used to include women with previous one LSCS at 36-38 weeks were asked to get their TVS done for scar thickness. Women with scar thickness≤1.6mm and scar thickness>1.6mm were identified. Their intraoperative findings of scar dehiscence were confirmed. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients was 29.87±6.07 years. The emergency LSCS was done in 599(49.1%) patients and elective LSCS was done in 621(50.9%) patients. The sensitivity, specificity & diagnostic accuracy of TVS was 98.31%, 99.05% & 98.69% respectively. Conclusion: According to our study results the TVS for uterine scar is a very useful and effective tool in the prediction of scar dehiscence in patients with previous one LSCS taking intraoperative findings as gold standard. Keywords: Transvaginal sonography, TVS, Uterine, Scar, dehiscence, LSCS, Intraoperative

Placenta accreta is an obstetrical emergency associated with significantmaternal morbidity and mortality. Traditionally, hysterectomy at the time of cesarean sectionhas been the mainstay of therapy especially in cases where diagnosis is made antenatally. Inrecent years different conservative treatments for partly or totally adherent placental tissue inthe uterine cavity have been reported in patients willing to preserve fertility. We report a case ofsuccessfully managed placenta accreta with methotrexate in our department. The patient washaemodynamically stable, had desire for future fertility and gave informed consent to all thepossible risks of conservative management including repeated episodes of bleeding, multipleblood transfusions, pain, infection, delayed hysterectomy and prolonged follow up. We useda regimen of two doses of methotrexate given a week apart. Further studies are required tostudy the effectiveness of methotrexate and to establish its dose and schedule in conservativemanagement of placenta accreta.