Mri in Evaluation of Cesarean Section Scar Niche

Study Overview
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Brief Summary
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To evaluate cesarean section scar and the lower uterine segment in non pregnant woman by MRI to : Assess the clinical symptoms like postmenstrual spotting or prolonged menstrual bleeding, dysmenorrhea, chronic pelvic pain and dyspareunia and its relation to the presence of cesarean scar defects and its characteristics . development of scoring system and correlating it with the symptoms .

Detailed Description
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With increasing cesarean section rate nowadays, the risks of cesarean scar defect (CSD) should increase. CSD is defined by ultrasound imaging as a triangular hypoechoic defect in the myometrium at the site of the previous cesarean section scar. However, patients with CSD are sometimes asymptomatic. Yet, some patients with CSD can have symptoms of abnormal uterine bleeding, pelvic pain, infertility, uterine rupture, and potential risks of adverse pregnancy outcome .There is an association between the size of a niche and postmenstrual spotting. women with a history of CS, the depth and shape of the niche were not significant factors, while a larger niche volume was described in women with postmenstrual spotting. in women with gynecological symptoms, the niches were significantly wider in women with postmenstrual spotting, dysmenorrhea or chronic pelvic pain, and the prevalence of postmenstrual spotting or prolonged menstrual bleeding was higher with a larger diameter of the niche .Magnetic resonance imaging (MRI) has recently shown a promise tool for evaluation of uterine scar thickness. As opposed to ultrasonography (USG), which is the current gold standard for this purpose, MRI reduces observer dependence and has a superior multiplanar capability. MRI can be used for assessment of lower uterine segment. It provides accurate tissue characterization, independent of patient body mass index .

Official Title
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Role of Magnetic Resonance Imaging in Evaluation of Uterine Cesarean Section Scar Niche

Conditions
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Cesarean Section; Dehiscence

Intervention / Treatment
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* Device: MRI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: previous lower uterine segment cesarean section before . At least 6 months after the last cesarean section . still regularly menstruating . Absence of other gynecological disease or intrauterine lesions like endometriosis , uterine fibroid . Exclusion Criteria: Post menopausal women . hysterectomy . Presence of other gynecological disease like endometriosis , uterine fibroids . any general contraindication to MRI as presence of any paramagnetic substance as pacemakers or in severely ill patients or those with claustrophobia, arrhythmic patients . intrauterine devices . bleeding tendency.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: MRI|medical device that is used as an imaging tool for soft tissues|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MRI pelvis examination (sagittal T2WI ) using 1.5 tesla system Torso phased-array body coil with the patient in the supine position and a moderately full urinary bladder | Pre-designated standard protocols were followed consisting of T1-weighted (T1W) and T2-weighted (T2W) imaging sequences in axial and sagittal planes remaining perpendicular to the long axis of the scar The scar site will be identified as the thinnest portion of LUS and having the lowest signal intensity on T2W imaging. | baseline | 
| MRI pelvis examination (sagittal T2WI ) using 1.5 tesla system Torso phased-array body coil with the patient in the supine position and a moderately full urinary bladder | - Scar position will be evaluated using relative distance in mm from inferior boundary of scar to external cervix os, which will be measured by curve distance in mm along the endometrium and cervical inner surface. | baseline | 
| MRI pelvis examination (sagittal T2WI ) using 1.5 tesla system Torso phased-array body coil with the patient in the supine position and a moderately full urinary bladder | Scar thickness in mm will be calculated at the site of the scar . | baseline | 
| MRI pelvis examination (sagittal T2WI ) using 1.5 tesla system Torso phased-array body coil with the patient in the supine position and a moderately full urinary bladder | Presence of endometrium adjacent to scar will be recorded | baseline | 
| MRI pelvis examination (sagittal T2WI ) using 1.5 tesla system Torso phased-array body coil with the patient in the supine position and a moderately full urinary bladder | Scar shape were classified as U shape, V shape and mixed shape, judging from the transitional region from scar to normal uterine or cervical wal | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| clinical evaluation | asking patients about clinical symptoms like postmenstrual spotting , secondary infertility and chronic pelvic pain in order to correlate them with the scar criteria collected by MRI | baseline | 
| transabdominal and transvaginal ultrasound examination | measuring scar depth in mm . | baseline | 
| transabdominal and transvaginal ultrasound examination | position in relation to external cervical os and remaining adjacent lower uterine segment | baseline | 
| transabdominal and transvaginal ultrasound examination | width in mm | baseline |