Aim: To determine the sonographic measurement of post caesarean scar and its effect on feto- maternal outcome.

Objectives

1. To assess the sonographic measurement of scar thickness near term and to correlate with intraoperative visual assessment of LUS done during caesarean section.

2. To determine the minimum thickness of the lower uterine segment which helps to determine the mode of

delivery,either a vaginal birth after caesarean delivery (VBAC) or an elective or emergency lower segment caesarean section (LSCS).

Material and Methods

Study Area: The study was conducted among patients attending to the Department of obstetrics and gynaecology in Mallareddy Medical College for Women, hospital, Hyderabad.

Study Design: Prospective observational study Study Period

September 2022 to February2024 Study Population Pregnant women with one or more previous caesarean section presenting to the department of obstetrics and gynaecology of Malla Reddy Medical College for Women and hospital, Hyderabad.

Method: For the purpose of the study, the bladder was considered moderately full when the vertical length of the bladder on trans abdominal scan is about 6- 8cm i.e., at 2 hours after ingestion of 500ml water. Every patient was asked to drink 500ml water two hours before scheduled ultrasound was done and not to void urine. Ultrasound equipped with Convex Array with frequency 2- 5 MHz at transducer will be used to measure the thickness of lower uterine segment and to detect defects in the lower uterine segment. -Then the case was posted according to scar thickness, scar tenderness, maternal tachycardia into elective,emergency and vaginal birth after caesarean section. During operation we correlated ultrasonography scar thickness to visual intra- op findings and graded them.

Results: This prospective observational study was conducted in the department of Obstetrics and Gynecology of Malla Reddy Medical College for Women and hospital, Hyderabad with an aim to determine the sonographic measurement of post caesarean scar and its effect on feto- maternal outcome. The results of the study showed, the mean age was 27.3± 2.8 years with majority of them being second gravida, the mean gestational age was 37.2±1.1 weeks and many women were previous one LSCS. The indication of the present LSCS was mostly due to previous LSCS.The preoperative

LUS was 2.4± 0.7 mm and the intraoperative findings showed grade I in 44.8%and grade II, III, IV IN 28.8%,12.8and %13.6%. The indication of the present LSCS was mostly due to previous LSCS.In my study 15 cases were given trial for TOLAC with scar thickness >3mm out of which 5 cases(4%) had successful VBAC.Out of 120 caesarean sections 68 were taken up for emergency LSCS (56.7%) and 52 cases were planned elective LSCS(43.3%). 67.2% the maternal outcome was good and the remaining 32.8% had atonic PPH, traumatic PPH and SSI. The APGAR score was close to being above 8 at all times and 24% babies had transient tachypnoea.

Conclusion:Trial of labour after caesa           rean section should be encouraged in all patients with previous caesarean section provided no other contraindication exits. Highly correlated with intraoperative findings sonographic evaluation of lower uterine segment thickness is accurate,safe procedure and highly recommended in considering trial of labour after caesarean section. Predicting the risk before and carefully selecting patients for trial of labour helps in