Study of intraoperative findings in patients with scar tenderness and comparison with sociodemographic parameters

Abstract

Background: An increasing trend is noted in the trial of labor in cases of previous lower segment caesarian section (LSCS) during the past few years. A vigilant approach is required identification of different signs and symptoms of giving way to the last scar. Aims and objective: To study the intraoperative findings in patients with scar tenderness and compare with sociodemographic parameters. Materials and methods: A hundred women were studied in the Department of Obstetrics and Gynaecology N.S.C.B. Medical College, Jabalpur, from September 2013 to October 2014. Maternal parameters including scar rupture, scar dehiscence, thin scar (<4mm) but intact, normal scar, and adhesions were observed compared to sociodemographic parameters. The odds ratio was calculated to obtain association. Results: Thin scar more likely to occur older age (OR 3.12; 95% CI 0.96-10.10; P=0.045), illiterate cases (OR 1.87; 95% CI 0.54-6.44; P=0.312), patients undergoing emergency CS (OR 3.73; 95% CI 0.76-18.44; P=0.082) and in patients with inter-delivery interval of <18 months (OR 2.75; 95% CI 0.91-8.28; P=0.061). Scar rupture more likely to occur older age (OR 3.60; 95% CI 0.34-37.88; p=0.254), low socio-economic status groups (OR 2.50; 95% CI 0.24-26.00; P=0.427), patients with significant medical/surgical history (OR 5.17; 95% CI 0.41-65.11; P=0.156), in multipara groups (OR 3.13; 95% CI 0.39-24.85; P=0.256), patients undergoing emergency CS (OR 1.40; 95% CI 0.13-14.53; p=0.777), in patients with more than one prior incisions (OR 1.50; 95% CI 0.14-16.00; P=0.736), in patients with inter-delivery interval of <18 months (OR 1.75; 95% CI 0.23-13.49; p=0.586) and in patients with no prior vaginal delivery (OR 21.67; 95% CI 0.88-532.43; P=0.007). Scar dehiscence was more likely to occur in un-booked cases OR 3.05; 95% CI 0.60-15.55; P=0.158), illiterate cases (OR 1.60; 95% CI 0.39-6.60; p=0.508), patients with significant medical/surgical history (OR 3.10; 95% CI 0.48-19.82; p=0.208), multipara groups (OR 1.56; 95% CI 0.41-5.96; p=0.510) and in patients with inter-delivery interval of <18 months (OR 1.75; 95% CI 0.50-6.12; P=0.375). Conclusion: Age, booking status, educational status, socio-economic status, parity, past medical or surgical history, type of C-section (elective or emergency), number of prior uterine incisions, or the inter-delivery interval has no association with scar complications.