Re: Post Caesarian scar
From: dr. amit sengupta (asengup@tm.net.my)
Sat Jan 16 21:25:47 1999
Nirvi,
I fully agree with James S Smeltzer, it is very important to follow up such
patients clinically and to have all precceding history of the post section
pueperal period, type of operation, place and by whom etc..Dr.A Sengupta,
-----Original Message-----
From: James S Smeltzer MD <gaperina@mindspring.com>
To: Multiple recipients of list <ultrasound@talk.obgyn.net>
Date: Thursday, January 14, 1999 3:15 AM
Subject: Re: Post Caesarian scar
>Nirvi,
>
>We measure everything as perpendicular to the surface, so one must angle
>the transducer such that the beam plane is perpendicular (or orthogonal) to
>the tangent of the surface that is being measured throughout the relevant
>surface area and then measure perpendicular to the apparent surface of the
>object on the image.
>
>If you do this on the sagittal midline you will show the uterine thickness
>from cervix to fundus. Patients with classical cesareans I measure in
>semi-axial, angled to meet the above requirements for measurements
>perpendicular to the uterus. As a practical matter if you are within 15
>degrees, thickness will be overestimated very slightly, as the ratio of
>actual to measured = cos(angle of deviation). This is close to 1 at < 15
>degrees.
>
>Jim S
>
>What is this being used for? The major source of strength of the uterine
>repair is the endopelvic fascia, which can be quite thin. Incisions in the
>muscle of the fundus of vertical incisions can appear thick but are know to
>be weak. To my knowledge there is no good correlation between such results
>and risk for rupture. Patients with prior vertical incisions should be
>offered repeat cesarean section. Patients with prior low transverse need
>to labor in hospital and monitored during labor, to permit emergent
>delivery if indicated, but do not require other special treatment.
>
>The apparent thickness of a lower segment scar would not affect my
>treatment.
>
>At 12:26 PM 1/12/1999 -0600, you wrote:
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>>I have been asked by some gynecologists to measure the scar thickness in
>patients who have undergone earlier caesarian sections.How to do this? and
>how will it have a clinical relevance?
>>Should we measure it on trans abdominal scans? and if so is it the AP
>thickness?
>>I could not find anything in the books i have....would be obliged if
>someone could answer this.
>>Thank you
>>Dr Nirvikar Dahiya DMRD
>>Radiologist
>>India
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