الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cesarean delivery is the most commonly per¬formed major abdominal operation in women. Women delivered by cesarean section are prone to some complications.
Assessment of cesarean scar integrity and prediction of subsequent scar complications is feasible using ultrasound. It provides a non-invasive way to scan uterus and scar.
This study aimed to assess the ability of ultrasound in evaluation of uterine wall cesarean section scar.
In present study, the total number was 500 female patients who had positive previous history of conception were referred from obs/gyn clinic to the Diagnostic Imaging and Intervention Department of Alexandria Main and El-Shatby University Hospitals, faculty of medicine, Alexandria University ,for pelvic US assessment. Out of these 500 women, 276 (55.2%) were excluded due to absence of definite CS delivery (subjected to normal vaginal delivery); the remaining 224 women (44.8%) fulfilled the inclusion criteria of the study and were enrolled.
Among the 224 female patients forming the study group; 172 were diagnosed as having normal CS scar (forming normal group) while the remaining 52 females showed imaging abnormalities at the region of CS scar and considered as (pathology group). With the age of last CS scar ranged from 3-72 months).
According to clinical symptoms and signs in all females of study group, there were highly statistically significant differences as regards vaginal bleeding, secondary infertility, and pelvic pain (P-value <0.0001*, = 0.0005*,<0.0001*, respectively).
Using TAUS, The majority of females in both groups had AVF uterus 154 females (89.5%) in normal group and 38 females (73.1%) in pathology group. There was a high statistically significant difference between both groups as regards uterine position (P = 0.006*).
All females in normal group showed homogenous, well-delineated shadow of scar borders at anterior wall of LUS between vesicouterine fold and internal os, clear surrounding fat planes, normal vasculature and no scar defects noted. They also showed a scar thickness ranged from 3.5 up to 11 mm with a median (IQR) of 6.0.
Based upon data of TVUS, color Doppler study; further imaging modalities as well as clinical and imaging follow up and surgical reports revised in some cases. The most frequent diagnosed complication in the pathology group was a niche in 44 female patients (84.6%), abnormally implanted gestational sac at previous CS scar in two cases (3.8%), diplaced IUCD at previous scar in two cases (3.8%) placenta previa accreta in two pregnant cases (3.8%), thinning of previous CS scar in one pregnant female (1.9%) and finally, vesicouterine fistula in one female (1.9%).
Regarding radiological measurement of diagnosed niches, depth ranged from 2.3 – 9.0 mm with a mean of 4.602 mm, while niche width ranged from 2.0 – 8.0 mm with a mean of 3.97 mm and RMT ranged from 2.5 – 11.0 mm with a mean of 5.05 mm