Home Treatment of Scars
The natural history of caesarean scar pregnancy is not fully known. Unlike a cervical pregnancy, a caesarean scar pregnancy may potentially be carried to term, though this is likely to be associated with significant morbidity and possibly mortality. The known association between multiple caesarean sections and an increased risk of abnormally implanted placentae (praevia, accreta and percreta) suggests that if a caesarean scar pregnancy were to continue to term, then it would be associated with such placental pathology. Indeed many cases of abnormal placentation reported in the past may well have been unrecognized caesarean scar pregnancies. It therefore seems likely that this is not a new condition, but the earlier recognition of an old problem. Life-threatening haemorrhage, coagulopathy and hysterectomy at or after delivery are significant risks for such women. There have however been several case reports where women have been managed expectantly. Ben Nagi recently reported a case of...
Most babies who recover from NEC do not have additional problems. Some babies can have scarring and narrowing of the bowel causing a blockage of the bowel. When a large portion of the bowel is removed, the remaining bowel may not be sufficient to absorb all needed nutrients for optimal growth.
The ophthalmologist will examine your baby's eyes for orderly growth of the blood vessels. Babies with stages I and II ROP do not usually need any treatment, and the abnormal growth corrects itself. Close follow-up is needed. Stage III cases may need treatment with laser therapy (destroying the vessels with heat) or cryotherapy (freezing the vessels). Without treatment the abnormal growth of blood vessels can cause scarring and distortion of the retina, even retinal detachment and blindness. Treatment of ROP decreases the chances of blindness but cannot always prevent it. Myopia (nearsightedness), amblyopia ( lazy eye), and strabismus ( crossed eyes) can develop as a result of ROP.
1 Inspection - to note the size and shape of the uterus. The size should correspond with the estimated dates and period of gestation. The normal shape is a longitudinal ovoid. If the baby is lying obliquely or transversely, the unusual shape created will be unmistakable in late pregnancy. The dark line of pigmentation (the linea nigra), the quality of muscle of the abdominal wall, any abdominal scarring and any fetal movements should also be noted.
In 57 women treated with asparaginase and other agents 2 months to 15 years before conception, a total of 83 pregnancies occurred, resulting in 5 spontaneous abortions, 5 elective abortions, 2 stillbirths, and 71 liveborn infants (10,12,13,14 and 15). Among the liveborn infants, 4 were delivered prematurely, 1 was growth retarded, and 7 had congenital defects, 4 minor and 3 major. The minor abnormalities were an epidermal nevus (13), dark hair patch (14), ear tag (14), and congenital hip dysplasia (15). Infants with major defects were the offspring of women who had been treated 15-24 months before conception with asparaginase, chlorambucil, mercaptopurine, methotrexate, procarbazine, thioguanine, vinblastine, vincristine, and prednisone (14). The defects were hydrocephalus, tracheomalacia, and pelvic asymmetry. The authors concluded that the latter defect was most likely a deformation, resulting from the mother's scoliosis or from uterine scarring caused by radiation, rather than a...
Crohn's disease (CD) was identified in 1932 by Dr Burril Crohn. It comprises chronic inflammation, ulceration and scarring anywhere from mouth to rectum, but most commonly the small intestine. It is characterised by patchy inflammation that passes through the wall of the intestine, affecting each layer2. Symptoms include1'2
In the same infant note the hyperex-tensibility of the skin and the mild skin defects. There may be flat scars with paper-thin scar tissue, and hematomas occur after mild trauma in Ehlers-Danlos syndrome. Figure 3.34. In the same infant note the hyperex-tensibility of the skin and the mild skin defects. There may be flat scars with paper-thin scar tissue, and hematomas occur after mild trauma in Ehlers-Danlos syndrome.
The diagnosis of caesarean scar pregnancy is made by transvaginal ultrasonography. The absence of an intrauterine pregnancy and an empty cervical canal are accompanied by the presence of a gestational sac implanted within the lower anterior segment of uterine corpus, with evidence of myometrial dehiscence. If the depth of invasion into the myometrial scar is small, there may be some continuation between the sac and the uterine cavity. Alternatively, if the sac is deeply embedded in the scar, the sac may be seen bulging towards the urinary bladder, with only a very thin myometrial layer visible between the sac and the bladder. Diagnosis may be difficult in the presence of uterine fibroids that can obscure the view. Prominent peritrophoblastic flow may be shown with Doppler ultrasound featuring high velocity and low impedance. Caesarean scar pregnancies have also been described with three-dimensional ultrasound imaging, though the advantages of this method over conventional B-mode...
The folate antagonist methotrexate, either local or systemic, is now the commonest method used to terminate caesarean scar pregnancy. Details of the use of methotrexate are discussed in previous chapters. In his series, Seow described three cases of transvaginal injection of methotrexate into the embryo or sac, four cases of transabdominal injection of methotrexate into the embryo or sac (followed by Transvaginal or transabdominal potassium chloride injection into the sac or embryo has been used successfully, one such case being a heterotopic pregnancy where the remaining intrauterine gestation continued successfully to 36 weeks.36 However, potassium chloride alone, though it usually causes embryonic demise, may be insufficient to prevent further trophoblast proliferation and has therefore generally been used in combination with other techniques, such as methotrexate.16,30 Jurkovic reports another heterotopic pregnancy, and describes the local injection of the scar pregnancy with...
As the available evidence does not favour any one particular mode of treatment for caesarean scar pregnancies, the decision regarding treatment must be made on the basis of gestation, pregnancy viability, myometrial integrity, clinical symptoms and informed discussion with the woman herself.4 Furthermore a lack of clarity in relation to the natural history of this condition renders an evidence-based approach to this condition very difficult. In general, however, because of the risk of massive haemorrhage if the pregnancy progresses to term, most authors strongly recommend termination of the pregnancy in the first trimester for all caesarean scar pregnancies.44 In our unit we have generally used medical management (local or systemic methotrexate) for the haemodynamically stable woman diagnosed with a caesarean scar pregnancy, after careful counselling. Recently, however, we have successfully managed two women (with viable 6 and 8 week caesarean scar pregnancies) with a new strategy,...
Pain management is an important part of hospital care for caesarean sections and is usually managed well. However, I find that I can give additional help using my electroacupuncture machine (Fig. 15.1). In the first 24 hours in particular, four pads either side of the scar can help enormously with the pain.
Ectopic pregnancy can be defined as the implantation of a fertilized ovum anywhere other than in the endometrial cavity. Ninety-five per cent of ectopic pregnancies occur within the fallopian tube (Table 11.1). Non-tubal ectopic pregnancies, including caesarean section scar pregnancy are discussed elsewhere in this book.2,3
Cyproterone acetate is the antiandrogen most commonly used during the reproductive years. It is available in combination with ethinylestradiol. This preparation is frequently prescribed as the pill , especially when acne is also present. The German Institute for Drugs and Medical Products restricted the therapeutic usage of this preparation because it was suspected of causing liver tumors. It may only be prescribed for symptoms of androgenization and acne with scarring.
Chicken pox is uncommon in pregnancy. If it does occur in pregnancy, most women and baby suffer no serious effects. However, in 1-2 out of every 100 cases, the baby may be affected by skin blisters, scarring or even organ damage, especially in the first five months of pregnancy. These abnormalities may not be detected with ultrasound scans during pregnancy. They may only be diagnosed after the baby is delivered. Some pregnant women may also develop serious forms of infection in the chest or brain.
One of the major contributors to the Cesarean section rate is the presence of a previous Cesarean section scar. Two studies have examined the outcome of vaginal birth after Cesarean (VBAC) in women with diabetes. In Coleman et al.49 study, VBAC was offered if the sonographically EFW was
Treatment The lesions disappear without treatment, but most of the time this takes about six months to a year. Sometimes treatment is recommended with chemicals or surgery (by scraping, laser, or cautery), which might leave slight scarring but will remove the lesions and could prevent spreading in some cases. Your child's doctor can help you to determine the best treatment option for your child.
CNS abnormalities are thought to result from intracerebral hemorrhages and subsequent scarring, and arc associated with exposure at any time during pregnancy - mostly the second trimester. The sequelae of intracerebral bleeding appear to be more debilitating than those of the coumarin embryopathy intracranial bleeding during delivery is especially to be feared.
When RDS has been severe or there have been other complications, your baby may have injury and scarring of the lungs called bronchopulmonary dysplasia (BPD). BPD is a reaction of the premature lung to its disease and to the oxygen and mechanical ventilation that were needed to treat the infant's lung disease. A baby with BPD needs extra oxygen and medications for the lungs for a few weeks or months, occasionally for up to a year.
(such as the presence of submucosal leiomyomas or uterine scar), abnormal fetal-maternal interaction or early uteroplacental vascular compromise.2 Sometimes, the anomalies of shape can be associated with unprotected membranous fetal vessels (such as vasa previa). The placental weight, which is evaluated after removing cord, membranes and maternal blood clots, is about 450-550 g at term pregnancy. The placen-tal weight is related, other than to gestational age, to the weight of the fetus and to fetal gender. The fetal placental weight ratio should be 6-7 at term. Moreover, placental weight over the 95th or less than the 5th centiles for gestational age is often a sign of chronic insult. Maternal diabetes is a condition that can be associated with large placentas (more than 90 centiles), although the differential diagnosis largely include fetal hydrops, congenital syphilis, villous edema, or Beckwith-Wiedemann syndrome.14 Large placentas, however, should raise the suspicion for a...
There are certain factors that clearly will have led to the increase having had Caesarean at first birth, then it becomes clinically more likely for a subsequent labour due to concerns about the effect of labour on the scar. Many women may therefore opt for a planned Caesarean rather than have the dual difficulties of labour and then a Caesarean. We are delaying the age of first pregnancy, and increasing maternal age makes Caesarean much more likely. As yet it is not clear whether an increased C. section rate is necessarily a bad thing we don't know yet whether maternal and child outcomes are better than with a lower C. rate. After all, what exactly are appropriate clinical reasons If a woman is terrified of labour, possibly following a previous traumatic delivery, then perhaps a Caesarean is the most appropriate course, since intense fear can cause complications in labour.
Caesarean scar pregnancy is considered to be the rarest form of ectopic pregnancy. However the incidence is reported to be as high as 1 in 1800 to 1 in 2216 in some studies.3,4 Seow reports scar pregnancies comprising 6.1 of all ectopic pregnancies in women with a previous caesarean section (overall caesarean rate in their tertiary centre being 30 ) and a rate of caesarean scar pregnancy of 0.15 of all pregnant women who have had a previous caesarean section. However these studies may be open to selection bias, and the real incidence in the general 'post-section' population is not known.
Multiple previous caesarean sections are associated with a higher risk for a caesarean scar pregnancy. Previous dilatation and curettage, placenta praevia, ectopic pregnancy and in vitro fertilization are other reported associations.5,6 Previous caesarean section for breech presentation is more common than might be expected and it is postulated that this may be because the lower segment of the uterus does not develop fully in a breech presentation, thus predisposing to suboptimal healing of the uterine incision after caesarean section and a greater exposed surface area of myometrium for implantation of a scar pregnancy. One case of caesarean scar pregnancy has been reported after the failure of the progesterone only emergency contraceptive.7
Initial misdiagnosis of a scar ectopic pregnancy as intrauterine is common. Thus women may undergo attempted evacuation of retained products of conception (for presumed miscarriage) or suction termination of pregnancy (for presumed intrauterine pregnancy) where the diagnosis of caesarean scar pregnancy has not been suspected. Profuse haemorrhage can result, often as the sac is disrupted by the curettage. These women present as emergencies and need immediate surgical intervention.
Marcus used uterine artery embolization and hysterectomy to manage a case where the pregnancy had ruptured through the scar and was located in the scar tissue between the uterus and bladder.4 Chou employed uterine artery embolization alone, with colour and power Doppler to monitor neovascularization before and after the procedure.37 Hysteroscopic resection of the gestation sac has also been reported47.
With the increasing incidence of caesarean section and apparent increase in scar pregnancies, all women with previous caesarean section who undergo assessment for early pregnancy pain or bleeding should be carefully examined to exclude a caesarean scar pregnancy. 2. Women with a suspected caesarean scar pregnancy should be referred immediately to a specialist centre for confirmation of the diagnosis and appropriate treatment. 16. Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarian section scar. Fertil Steril 1997 67 398-400. 18. Huang KH, Lee CL, Wang CJ, Soong YK, Lee KF. Pregnancy in a previous cesarean section scar case report. Changgeng Yi Xue Za Zhi 1998 21 323-7. 19. Roberts H, Kohlenber C, Lanzarone V, Murray H. Ectopic pregnancy in lower segment uterine scar. Aust NZ J Obstet Gynecol 1998 38 114-16. 20. Neiger R, Weldon K, Means N. Intramural pregnancy in a cesarean section scar. A case report. J Reprod Med 1998 43(11) 999-1001. 21. Valley MT,...
Non-tubal ectopic pregnancies represent a particular challenge. For cornual pregnancies it seems clear that for the majority, methotrexate will be successful. For cervical and in particular for section scar ectopic pregnancies the situation is less clear. The common thread is that if an embryo is present, it must be terminated. However the problem is what to do next. A consensus seems to be forming that the pregnancy then needs to be removed surgically -the timing of this and whether adjunctive medical treatment should also be given is a matter for debate. The rising rate of caesarean sections in
Although a case of a repeat caesarean scar pregnancy has been reported, many authors have reported normally implanted intrauterine pregnancies after successful treatment of a caesarean scar pregnancy.3,4,53 However, the risk remains of severe complications. In Seow's series of eight cases, one maternal and fetal death occurred due to uterine rupture at 38 weeks in a subsequent pregnancy after prior treatment of a caesarean scar pregnancy with suction curettage and Foley catheter tamponade. He recommends an interval of at least 3 months and preferably 1-2 years after a caesarean scar pregnancy to reduce the chance of further complications. He also suggests early elective caesarean section to minimize the chance of uterine rupture near term.3
Influence later lactation performance (Neifert et al., 1990). Scar tissue from injury should be evaluated for its effect on skin elasticity and the degree to which nerve reactivity may have been affected. The look of the breast does not dictate its ability to function. A case in point may be women who have sustained significant scarring from burns (see Color Plate 25). Second- and third-degree burns rarely extend so deeply into the parenchyma that they destroy the glandular tissue of the breast, even when the burns have occurred in adulthood. Significant scarring of the dermis and epidermis, however, may result in (1) reduced maternal sensation when the infant suckles, (2) minimal tissue elasticity, thus requiring the mother to alter the baby's position at the breast, and (3) reduced milk ejection if a nipple has been surgically reconstructed. Nevertheless, scar tissue on the breast or nipple does not, by itself, preclude breastfeeding.
Generally, if a woman develops chicken pox in the middle part of pregnancy, there is little risk to the fetus. However, infection in the first trimester, and particularly the first 8 weeks of pregnancy, may cause birth defects in a minority of babies. During this time, the fetus is developing rapidly and by the end of the first 8 weeks all the baby's organs are fully formed. Any attack during this period is thus more likely to result in a problem. There is a recognised syndrome, the 'varicella syndrome', which consists of limb shortening, scarring, possible brain development problems and eye defects.
There are a number of risks with ECV. First, it may cause the membranes to rupture. Second, it may cause the placenta to separate. Third, it would not be carried out if the mother's blood group is Rhesus negative, because of the risk of her blood mixing with the baby's and the possibility of the baby's blood group being positive (see Ch. 4). Fourth, there may be problems if the mother has high blood pressure. Finally, if the mother has had a previous caesarean section, the weakness of the scar may cause complications.
How To Reduce Acne Scarring
Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.