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  • Title: Prediction of Delivery Complications by First-Trimester Ultrasound Measurement of the Gestational Sac's Distance From a Previous Cesarean Section Scar.
    Author: Li C, Yang P, Luo H.
    Journal: J Ultrasound Med; 2020 Aug; 39(8):1563-1571. PubMed ID: 32073684.
    Abstract:
    OBJECTIVES: This study was designed to investigate the clinical relationship between labor complications in the second and third trimesters and the distance from the gestational sac to a previous cesarean section (CS) scar. METHODS: We conducted a retrospective review of the electronic medical records and included all 7- to 9-week transvaginal ultrasound examination reports from pregnancies with a history of a single cesarean delivery in our hospital between January 2015 and December 2017. Women were divided into 6 groups according to the distance of the gestational sac to the CS scar (groups A-F). A composite of pregnancy outcomes (gestational age at birth, delivery mode, placental abnormality, blood loss, uterine rupture, and hysterectomy) and other maternal and neonatal outcomes were assessed. RESULTS: A total of 699 cases were included in our study. The median gestational age was 39.0 (range, 38.1-39.9) weeks. The median intrapartum blood loss volume was 400 (range, 300-500) mL. The results showed no statistically significant difference in blood loss (P = .297) or birth weight of the neonate (P = .318) among the distance subgroups. Overall, the fetuses were stillborn in 9 of 699 cases (1.29%). There was a statistically significant difference in a morbidly adherent placenta, placenta previa, and preterm labor, and their incidence increased with decreasing distance (P < .001; P for trend < .05). There was no statistically significant difference in uterine rupture (P = .597) or the delivery mode (P = .187) among the subgroups. CONCLUSIONS: The relative positions of a CS scar and the gestational sac in the first trimester are associated with the incidence of placental abnormalities. As the distance decreases, the extent of a morbidly adherent placenta increases.
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