الفهرس 
CESAREAN SECTIONOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
T
he rate of cesarean delivery is increasing worldwide; repeat cesarean sections are associated with an increased risk for uterine rupture, abnormal placental implantation, uterine scar dehiscence in subsequent pregnancies, scar ectopic pregnancy, prolonged postmenstrual spotting, dysmenorrhea and chronic pelvic pain.
So we need methods to improve uterine wound healing to achieve a healthy future pregnancy and allowing for vaginal birth after cesarean section to minimize the rate of repeated cesarean section and reduce the complications associated with repeated cesarean section.
Alpha lipoic acid enhances alpha smooth muscle actin expression and has a triggering effect on fibrogenesis during wound healing. It also increases vascular endothelial growth factor levels regulating the healing of smooth muscle fibers.
Animal models suggested that ALA can be used after cesarean section to improve the healing of the cesarean scar.
Sonohysterography has an overall accuracy of 96% in the diagnosis of scar defect; and 91% in the diagnosis of intrauterine adhesions. In addition, the procedure of SCSH is well-tolerated, cost effective, not time-consuming, and can be performed as an office based gynecological practice so saline sonohystrography can be used to evaluate the healing after cesarean section.
The current study was performed at Ain Shams Maternity Hospital during the period between August 2017 and January 2018.
The aim of this work was to evaluate the efficacy of alpha lipoic acid on uterine scar healing after cesarean section by using saline contrast sonohystrography.
The study included 102 participant attending Ain Shams Maternity Hospital emergency room aged 18-35 years who underwent cesarean section for the first time. They were recruited after obtaining an informed consent. They were randomized into two groups.
group A (Study group): 51 women received alpha lipoic acid drug (thiotacid film coated tablets 600 mg twice daily) for 6 weeks after cesarean section followed by saline sonohystrography performance.
group B (Control group): 51 women received a placebo drug for 6 weeks after cesarean section with subsequent saline sonohystrography.
The following measurements were recorded; the thickness of the myometrium bordering the scar, the depth and length of the niche, intrauterine adhesion related to the scar and the healing ratio (the thickness of residual myometrium covering the defect divided by the sum of the thickness of residual myometrium cover the defect and the height of wedge shaped defect)
In the current study the average age of the participants in both groups was matched 25.1± 5.4 vs. 25.3± 5.1 years. The commonest indications for CS were breech presentation followed by pathological CTG and others indications. The incidence of scar niche was 60.8% in the study group and 80.4% in placebo group.
The healing of scar was better in study group than placebo group. There was an agreement between SCSH and TVUS in measuring the uterine scar healing parameters. In the study group, there was no drug discontinuation. ALA use was associated with minimal complications (only 3 cases experienced persistent GIT upset.
SCSH associated complications in the form of inadequate distension and pain occurred in less than 5% of the participants.
Conclusion
The administration of alpha lipoic acid for 6 weeks after CS improves the healing of the cesarean scar.