الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Incomplete healing of the scar is a recognized sequel of cesarean section (CS) and may be associated with complications in later pregnancies. Different methods of classifying CS scars have been applied, based on the dimensions of the scar and its relation to the internal cervical os and the uterine fundus. In all the studies cited, a scar ‘defect’ or ‘niche’ was defined by the presence of a hypoechogenic area within the myometrium of the lower uterine segment, at the site of a previous CS. Myometrial scar tissue takes at least 3 months to form, and that complete involution and recovery of the zonal anatomy is not achieved until 6 months later. In general, the normal lower uterine segment can be seen, using ultrasound, as a two-layer structure that consists of a hyperechoic layer representing the bladder wall and a less echogenic layer representing the myometrium. In cases of previous elective CS, the scar will appear halfway between the uterovesical fold and the internal cervical os. Transvaginal ultrasounds offer a further tool for observing the uterine scar after CS. Described as a wedge-shaped hypoechoic area at the cesarean wound site that was easily distinguishable from the neighboring part of the lower uterine segment. Therefore, this study was designed to determine how accurately CS scars defects can be detected by transvaginal ultrasound imaging, also how to integrate these images on subsequent patient management. This study was carried out on 60 patients divided into three groups. Each group includes 20 patients. group I: women underwent previous one cesarean section. group II: women underwent previous more than one cesarean section. Control group: women underwent non-instrumental vaginal delivery. All patients were subjected to history talking, clinical examination including general, abdominal, and vaginal examination and ultrasound examination through 2D transvaginal ultrasound.
Summary of our Results:
• Age was significantly lower in group I and control group than group II (P value <0.001 and =0.02 respectively) and significantly lower in group I than control group (P value =0.02). • Number of CS was significantly lower in group I than group II (P value <0.001). • Duration from last CS and position of the uterus were insignificantly different between group I and II. • The visibility of scar and characteristics of the scar including intact scar, scar defect, shape and location were insignificantly different between group I and II. • Size of scar defect showed that depth, width and length and the volume of scar defect were insignificantly different between group I and II. • Myometrial thickness with intact scar, residual myometrium thickness (RMT), myometrial thickness adjacent to defect and ratio between RMT 79 and myometrial thickness adjacent to defect were insignificantly different between group I and II. • The myometrial thickness of the control group ranged from 5 to 14 mm with a mean ± SD of 9.4 ± 2.64 mm.