[Ultrasonic diagnosis of scar defects following cesarean section]

The clinical signs and the diagnosis of deficient healing of the scar following caesarean section are reviewed. Maternal mortality following repeated caesarean section is four times higher than by normal vaginal delivery. Uterine rupture is accompanied by a 25-fold increase in perinatal mortality. At the department of obstetrics at Danderyd's Hospital 2542 case histories were reviewed. Caesarean section rate was 11,3%. At reoperation 2,8% of the scars exhibited deficient healing.--Because of this experience the ultrasound method was used to examine the echo-structures between the urinary bladder and the amniotic cavity. A Real time US-apparatur Axiscan 5 B-S was used. Corresponding to the scar-region smooth or pathologically deformed structures were observed. The clinical diagnosis of the scar healing was made at the time of delivery. 68 patients were examined. In 31% of the cases a vaginal delivery was planned and carried through without complications. In an additional 9% vaginal delivery was planned but it was necessary to perform an acute caesarean section. Only in two of these cases the indication for operation was imminent scar-rupture. In the following 41 patients (60%) a planned caesarean section was performed. In no case there was clinical suspicion of defective scar healing.--In the whole material (n = 68) 1,5% fenestrations were found. Ten of the 15 (22%) deficiently healed uterine scars were diagnosed with aid of ultrasound before onset of labor. The ultrasonic risk group comprised 18% of the material. The sensitivity of the ultrasonic method was 67% and the specificity 96%.(ABSTRACT TRUNCATED AT 250 WORDS)