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Caesarean Scar Defect Essay

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Sonographic evaluation of caesarean scar defects in speculation of obstetric and gynaecologic sequelae
In the recent decade, there was a significant increase in the rate of caesarean section delivery, either because of closer fetal monitoring during labour or because of availing the technology to anticipate antepartum and intrapartum complications. The most common cause of elective caesarean section is a previous caesarean section (CS). As the number of women with the caesarean section is on the increase, the implications of caesarean section scar defects (CSD) are looked into as cause for various clinical symptoms both in obstetrics and gynaecology. Many studies were conducted on the sonographic evaluation of scar defects, and only a few
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The studies were conducted both on pregnant and nonpregnant women. The scar defects were evaluated based on shape, size, and thickness of residual myometrium. In an unscarred, the lower uterine segment (LUS) is viewed as three-layered structure. The inner layer includes chorioamniotic membrane and endometrial layer. Middle layer includes myometrium, and outer layer includes peritoneal reflection and bladder wall (Cheung 2004). As the pregnancy progress, the LUS develops and the layers changes in sonographic resolution. Myometrium becomes thinner gradually and less distinguished later on in the pregnancy. Whereas in as scarred uterus different layers are not well demarcated, the LUS is comparatively thin. It is considered as scar defect if there is a window or defect in the myometrium. The CS scar was measured in two planes, transverse and sagittal. In the sagittal plane, scar depth, width and residual myometrial thickness (RMT, between hypoechoic indentation at the bottom of the scar to the hyperechoic line of the uterovesical fold) measured and the length of the scar measured in the transverse plane (Naji 2012).
Gotoh H et al. (2000) have assessed the changes in LUS thickness from 19weeks to 39 weeks in women with previous caesarean delivery (caesarean group) and compared with the LUS thickness in nulliparous and multiparous women (control group). Serial measurements of the thickness of LUS showed a steady
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