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• W2319742826 abstract "Linked Comment: Ultrasound Obstet Gynecol 2016; 47: 506–510 The number of emergency and elective Cesarean sections is increasing continuously and, as a result, more women have subsequent pregnancies with a scar in the uterus. The majority of terminations of pregnancy worldwide are performed using medication to induce miscarriage. The interaction of these two events should be studied, potential negative effects described and possible counteractions to minimize the possibility of these negative effects explored. Cesarean section delivery can have consequences for subsequent pregnancies. Serious complications, such as morbid placental adherence and ectopic Cesarean scar pregnancy, have been described and studied reasonably well. However, less significant complications, such as pelvic pain, prolonged menstrual bleeding, development of pelvic adhesions, episodes of intermenstrual bleeding, and prolonged course of miscarriage and termination of pregnancy in women with previous Cesarean section, have not received adequate attention. None of these complications endangers the woman's life, but each can affect adversely her wellbeing, and medical care can be costly both for the woman herself and for the healthcare system. The suspected mechanism behind these complications is a ‘pouch’ or ‘niche’ in the lower uterine segment, widely referred to in the literature as a defect of the Cesarean scar. It is possible that pathological symptoms are found to be worse when scar defects are more evident on ultrasound examination. In their study of women who had undergone Cesarean section in a previous pregnancy and underwent termination by medical induction in a subsequent pregnancy, Au et al. grouped women into those whose termination was successful (i.e. surgical intervention was avoided) and those in whom termination failed (i.e. for various medical reasons they required dilatation and curettage). They found that women with a failed termination were around twice as likely to have a Cesarean scar defect and that the depth of the defect was significantly larger and the residual myometrium over the defect was significantly smaller than in those with a successful termination. They concluded that detection of a Cesarean scar defect on ultrasound examination is of clinical significance in the management of medical termination of pregnancy. These data are difficult to compare with similar data of other research papers. One may criticize their sonographic method of assessing Cesarean scars, pointing out that the use of saline infusion sonohysterography in the interpregnancy interval would have increased the sensitivity and specificity for detection1 and provided better delineation of the defect2, allowing much more precise measurements to be made. However, that is not all. Clearly there is a need for standardization of measurements and for classification of various changes in the scars, and for determination of the clinical implications of these changes and any requirement for modifications to the clinical management of these patients3, 4. Such standardization of Cesarean scar examination and terminology to describe observed changes would allow us to draw comparisons between different studies and to evaluate long-term outcomes. It is obvious that there is a need for many studies with stricter criteria for recruiting patients with certain pathology and a more unified approach to evaluating Cesarean scar defects. Their clinical significance is still unknown and strategies for effective management of affected women must be established." @default.
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• W2319742826 date "2016-04-01" @default.
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• W2319742826 title "Re: Association between ultrasonographic parameters of Cesarean scar defect and outcome of early termination of pregnancy. H.-K. Au, C.-F. Liu, C.-R. Tzeng, and L.-W. Chien. Ultrasound Obstet Gynecol 2016; 47: 506-510." @default.
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• W2319742826 doi "https://doi.org/10.1002/uog.15907" @default.
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