Cesarean section scar measurements in non-pregnant women using three-dimensional ultrasound: a repeatability study.

OBJECTIVE: To evaluate intra- and inter-observer agreement in measurements of the cesarean scar niche and the residual myometrial thickness (RMT) using 3-dimensional (3D) transvaginal ultrasonography. STUDY DESIGN: Fifty-eight uterine 3D volumes from women with deep cesarean scar niches were evaluated. 3D volumes were obtained six to fifteen months after a primary cesarean section. Evaluation of the 3D volume was performed in a standardized multiplanar view. Two observers independently obtained RMT, cesarean scar niche depth (D), length (L), width (W), and myometrium adjacent to the scar (M). Differences within and between observers were expressed in mm and were evaluated according to the Bland-Altman method including the calculation of limits of agreement (LOAs). RESULTS: The intra-observer LOAs in mm were as follows: RMT: -3.7 to 4.0; D: -2.2 to 2.6; L: -3.6 to 4.2; W: -4.0 to 3.7; and M: -3.4 to 4.5. The inter-observer LOAs in mm were as follows: RMT: -3.2 to 4.1; D: -3.3 to 2.2; L: -3.4 to 4.2; W: -3.2 to 4.1; and M: -4.1 to 3.2. CONCLUSIONS: In non-pregnant women, we found rather wide limits of agreement measuring the cesarean section scar niche and myometrium using 3D volumes. Whether 3D transvaginal ultrasonography provides clinical advantages compared to 2D TVU needs clarification.

Do pregnant women prefer timing of elective cesarean section prior to versus after 39 weeks of gestation? Secondary analyses from a randomized controlled trial.

OBJECTIVE: To evaluate women's preferences for timing of elective cesarean section (ECS) scheduled prior to versus after 39 completed weeks. METHODS: Secondary analyses from a randomized controlled open-label trial were conducted at seven Danish tertiary hospitals from March 2009 to June 2011 with inclusion of singleton pregnant women with a healthy fetus. The women were allocated by a computerized telephone system to ECS scheduled at 38(+3) weeks or 39(+3) weeks of gestation. Dissatisfaction with timing of ECS and preferred timing of the procedure in a proposed future ECS delivery were evaluated. Data analyses were done by intention-to-treat, using logistic regression. RESULTS: A total of 1196 women (94%) completed an online questionnaire at follow-up eight weeks postpartum. In the 38 weeks group, 61 (10%) women 601 were dissatisfied with the timing of their ECS, whereas in the 39 weeks group 157 (26%) of 595 were dissatisfied (adjOR 3.18, 95% CI 2.30; 4.40). The proportion of women who preferred the same timing in a future ECS were 272 (45%) in the 38 weeks group compared to 232 (39%) in the 39(+3) weeks group (adjOR 0.75, 95% CI 0.60; 0.95). CONCLUSIONS: The women in this trial preferred ECS scheduled prior to 39 weeks of gestation.

Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial.

OBJECTIVES: To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes. DESIGN: Randomised controlled multicentre open-label trial. SETTING: Seven Danish tertiary hospitals from March 2009 to June 2011. POPULATION: Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section. METHODS: Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days). MAIN OUTCOME MEASURES: The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events. RESULTS: Among women scheduled for elective caesarean section at 38⁺³ weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39⁺³ weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups. CONCLUSIONS: This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.

Ultrasound evaluation of Cesarean scar after single- and double-layer uterotomy closure: a cohort study.

OBJECTIVES: To compare residual myometrial thickness (RMT) and size of the Cesarean scar defect after single- and double-layer uterotomy closure following first elective Cesarean section. METHODS: A retrospective cohort study was conducted in 149 women at least 6 months after an uncomplicated, elective Cesarean delivery. Two-dimensional transvaginal ultrasonographic measures of RMT, scar defect depth, width and length and myometrial thickness adjacent to the scar were compared in 68 women with single-layer and 81 women with double-layer closure delivered before and after, respectively, a change in the surgical procedure. Outcomes between the two groups were compared. RESULTS: Median RMT was 5.8 (interquartile range (IQR), 4.1-7.8) mm in women with double-layer closure vs 4.6 (IQR, 3.4-6.5) mm in those with single-layer closure (P = 0.04). Scar defect length was greater in women with single-layer closure (median, 6.8 (IQR, 4.4-8.5) mm) than in those with double-layer closure (median, 5.6 (IQR, 3.9-6.8) mm) (P = 0.01). Measurements of defect depth and width, and the proportion of scars with RMT < 2.3 mm were similar in the two groups. CONCLUSIONS: RMT was greater and defect length, but not defect depth and width, was smaller following double-layer compared with single-layer closure, which may indicate some limited benefit of double-layer closure following first elective Cesarean section.

Peroxide formation, vitamin E and myocardial damage in the rat.

Rats were fed diets containing 10% cod liver oil with or without dietary tocopherol for 16 or 32 weeks. Adipose tissue, skeletal muscle and myocardium were isolated. They were examined histologically and analyzed for autoxidation products and a number of energy metabolites. After 16 weeks small amounts of peroxides were present in adipose tissue as determined by the thiocyanate method. Ceroid pigment and slightly defective striation were observed in myocardium and to a lesser extent in skeletal muscle of the tocopherol deficient group. The ATP content was also significantly lower in this group. After 32 weeks, adipose tissue of the tocopherol deficient group contained large amounts of ceroid and had a high content of peroxides and other autoxidation products. More ceroid and a significantly higher peroxide estimate in lipid extracts were found in myocardium of the tocopherol deficient group as compared to the controls. Similar but weaker signs of peroxide occurrence and ceroid formation were obtained in skeletal muscle. The significance of the findings for myocardial function is discussed.

Lipoperoxides in organs of vitamin E deficient rats fed large amounts of highly unsaturated fats.

Rats were fed diets containing 10% cod liver oil with and without a supplement of tocopherol acetate for 32 weeks. The determination of peroxides in lipid extracts of adipose tissue, liver, heart and skeletal muscle by different methods was attempted. High amounts of peroxides were found only in adipose tissue of vitamin E deficient animals. Small values were found in other tissues of both groups. The problem whether the organs contain true lipoperoxides, or some other substances are responsible for the peroxide estimates, is discussed.

Carcinogenicity in mice of some fatty acid methyl esters. 2. Peroral and subcutaneous application.

Two fatty acid methyl esters, methyl oleate and methyl 12-oxo-trans-10-octadecenoate, have been tested for carcinogenicty by oral and subcutaneous administration in ST/a mice of both sexes. A positive effect of methyl oleate could not be assessed, while the results pointed to a promoter effect of methyl oxo-octadecenoate. Given in the diet, this compound increased the incidence and number of forestomach papillomas within 83 weeks after initiation by 4-nitroguinoline 1-oxide. Repeated injections of methyl oxo-octadecenoate in the inguinal area resulted in 2 local sarcomas in a group of 20 females which had previously received skin initiation by 7, 12-dimethylbenz [alpha] anthracene in the neck. In no other animal group did sarcomas appear at this location within the observation period of 2 years. An influence by the injected methyl esters on the initiated skin carcinogenesis was possibly, but weakly, present. The need for more extensive experiments is stressed, especially with a view to the possible carcinogenic hazards involved in dietary intake of oxygen-containing derivatives of oleic acid.