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TOPIC: scar thickness in post-LSCS pt.

scar thickness in post-LSCS pt. 5 years 1 month ago #3339

hello dear friends,
i had some queries regarding scar thickness in post LSCS pt.
what is the normal minimum thickness that is needed?
whether only myometrial thickness is given?
does it really need a high freq linear probe to give it ?
&
whats is the exact location to measure it?

i find it difficult to measure in pts with hist of previous LSCS many years before, because scar may not be well visualised in them. i think most important is whether there is any dehiscence or tear is there or not.
what is usufulness at 32 or 34wks ? , as many gynecologist ask for it in that period also rather than in full term pt.
so pls help me out.
thanks in anticipation.
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Re:scar thickness in post-LSCS pt. 5 years 1 month ago #3341

Ouch, you ask a very difficult question.

In third trimester pregnancy,the scar per se is mostly not visible.In fact I remember a study which showed that the site of measurement by ultrasound and actual scar site widely differs (I am not able to locate the study now, may be I will post a link later on). So what every one measures is the thinnest part of anterior uterine wall lower uterine segment.

Also there is almost no consensus on what is the optimum scar thickness. Different studies, different results, 2.5 mm, 3.5 mm, 5.0 mm (transabdominal/ transvaginal), take your pick. Although the obs people I work with are not comfortable about VBAC if I mention scar thickness is < 5mm. Largely empirical..., especially when most obstetricians prefer second LSCS over VBAC any day.

The most concise resource for post LSCS scar thickness I found was this.

ultrasoundchikitsa.com/teachingmodule.htm

Personally, I like to scan in first or second trimester, when scar is certainly visible in larger percentage of patients. I see for bulges, cysts, focal thinning etc. Much more useful than actual measurements.
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Re:scar thickness in post-LSCS pt. 5 years 1 month ago #3354

thanks u given a very usful site link.
i can show it to my gynecologist too.
thanks again.
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Re:scar thickness in post-LSCS pt. 5 years 1 month ago #3357

Thank you Dr.Yogesh Chinnawar for posting an interesting topic on the forum and I am equally thankful to Dr.Alok Varshney for that excellent link provided.

Personally I feel measurement of thickness of lower uterine segment is highly subjective and further compounded by status of the urinary bladder.

If the scar is thick enough it may resemble a small fibroid adding to the confusion .

I always advice my obstetricians not to depend too much on the measurements given and they have to take the decision of VBAC on their own.
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Re:scar thickness in post-LSCS pt. 5 years 1 month ago #3417

Thanks Dr.Varshney for providings such an informative link.
And i agree ,along with the scar thickness ,which is dependant upon the UB status,other parameters like focal irregularity & thinning have to be taken into consideration.
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