Srdjan Saso

Publications (37) View all

• Article: Does the presence of a Caesarean section scar affect implantation site and early pregnancy outcome in women attending an early pregnancy assessment unit?

  O Naji, L Wynants, A Smith, Y Abdallah, S Saso, C Stalder, S Van Huffel, S Ghaem-Maghami, B Van Calster, D Timmerman, T Bourne
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  ABSTRACT: STUDY QUESTION: Are there any differences in the location and distance to the internal cervical ostium of the implantation site of the intrauterine gestation sacs, early pregnancy symptoms and pregnancy outcome at 12 weeks gestation between women with and without a previous Caesarean section (CS)? SUMMARY ANSWER: The presence of a CS scar affects the site of implantation, and the distance between implantation site and the scar is related to the risk of spontaneous abortion. WHAT IS KNOWN ALREADY?: Little is known about the impact of a CS scar on implantation other than the risk of Caesarean scar pregnancy (CSP). Furthermore, there is a paucity of information on how the proximity of implantation to the scar impacts on pregnancy outcome in the first trimester. STUDY DESIGN, SIZE, AND DURATION: A prospective cohort study conducted over 15 months in the early pregnancy unit of a London Teaching Hospital. Three hundred and eighty women underwent a transvaginal scan at 6-11 weeks of gestation. A total of 170 women had undergone ≥1 CS, and 210 women had no history of CS. PARTICIPANTS/MATERIALS, SETTING, METHODS: The 380 women were recruited as consecutive non-selected cases. The relationship between the implanted sac and the CS scar was assessed by quantifiable measures and by subjective impression. Logistic regression analysis was used to determine the influence of the presence of a CS scar on pregnancy outcome. The final outcome of the study was the viability of the pregnancy at 12 weeks. MAIN RESULTS AND THE ROLE OF CHANCE: Implantation was most frequently posterior (53%) in the CS group and fundal in the non-CS group (42%). Gestation sac implantation was 8.7 mm lower in the CS group (95% confidence interval (CI) 6.7-10.7, P < 0.0001). Presenting complaints differed in women with and without a previous CS (P = 0.0009). More frequent vaginal bleeding [73 versus 55%, difference -18, 95% CI (-27 to -8%] yet no clearly increased spontaneous abortion rates were noted in the CS group compared with the non-CS group (adjusted odds ratio = 1.1, 95% CI 0.6-1.9, P = 0.74). Subjective impression showed that in eight cases the implantation site crossed the scar, seven of which resulted in spontaneous abortion, while the remaining case survived to term complicated by placenta praevia and post-partum haemorrhage. The subjective impression of the examiner was supported by the measurements of distance between implantation site and CS scar. LIMITATIONS, REASONS FOR CAUTION: A weakness of the study is the lack of a reference technique to verify the location of implantation. WIDER IMPLICATIONS OF THE FINDINGS: This study adds further support to the hypothesis that the presence of a CS on the uterus impacts on the implantation site of a future pregnancy. The possibility that the CS scar has an impact on the risk of spontaneous abortion should be further studied. Caution must be exercised when implantation occurs near to, and crosses, a CS scar as this is not always associated with the diagnosis of CSP. A potential limitation of the study is that we did not examine scar dimensions and morphology. STUDY FUNDING/COMPETING INTEREST(S): The authors have no competing interests to declare. The study was not supported by an external grant.
  Human Reproduction 04/2013; · 4.47 Impact Factor
• Article: Uterine transplantation: What else needs to be done before it can become a reality?

  S Saso, S Ghaem-Maghami, L S Louis, L Ungar, G Del Priore, J R Smith
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  ABSTRACT: Uterine transplantation may be a possible treatment option in the future for absolute uterine infertility. We describe three important areas of research that we feel are important in order to move closer to a successful and, crucially, safe transplant in the human setting. With closer collaboration among the various international teams working on this project, the first human uterine transplant should be possible in the next few years.
  Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology 04/2013; 33(3):232-8. · 0.43 Impact Factor
• Article: Changes in Cesarean section scar dimensions during pregnancy: a prospective longitudinal study.

  O Naji, A Daemen, A Smith, Y Abdallah, S Saso, C Stalder, A Sayasneh, A McIndoe, S Ghaem-Maghami, D Timmerman, T Bourne
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  ABSTRACT: Objectives: To describe the changes in cesarean section (CS) scars longitudinally throughout pregnancy, and relate initial scar measurements, demographic and obstetric variables to subsequent changes in scar features and the final pregnancy outcome. Methods: In this prospective observational study we used transvaginal sonography (TVS) to examine the CS scar of 320 consecutive pregnant women at 11-13, 19-21 and 32-34 weeks gestation. Visible scars consisted of hypoechoic shadow and residual myometrial thickness (RMT) segments. The hypoechoic segment was measured in three dimensions. Analyses were carried out using one-way repeated measures ANOVA and mixed modeling tests. The incidence of subsequent scar rupture was recorded. Results: The scar was visible in 284/320 cases (89%). For both scar segments, the larger the initial scar size, the more the scar decreased in size during pregnancy. For the hypoechoic segment, scar width on average increased by 1.8mm per trimester in 98% of cases, while scar depth and scar length decreased by 1.8 and 1.9mm in 97 and 99% of cases respectively (FDR p-value <0.0001>. The mean RMT segment was 3.6mm and on average decreased by 1.1mm in 98% of the cases. Two cases <0.62%> of uterine scar rupture were confirmed, these had a mean RMT of 0.5mm and average decrease in RMT of 2.6mm over the course of pregnancy. Conclusion: Our study establishes reference data and confirms that CS scars change in dimension throughout pregnancy. Scar rupture was associated with a smaller RMT and greater decrease in RMT during pregnancy. The absolute value and changes seen in CS scars have the potential to be tested as predictors of uterine scar rupture and performance in trials of VBAC. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
  Ultrasound in Obstetrics and Gynecology 10/2012; · 3.01 Impact Factor
• Article: A case of pregnancy following a modified Strassman procedure applied to treat a placental site trophoblastic tumour.

  S Saso, J Chatterjee, J Yazbek, Y Thum, Kw Keefe, Y Abdallah, O Naji, I Lindsay, Pm Savage, Mj Seckl, Jr Smith
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  ABSTRACT: Please cite this paper as: Saso S, Chatterjee J, Yazbek J, Thum Y, Keefe K, Abdallah Y, Naji O, Lindsay I, Savage P, Seckl M, Smith J. A case of pregnancy following a modified Strassman procedure applied to treat a placental site trophoblastic tumour. BJOG 2012; DOI: 10.1111/j.1471-0528.2012.03501.x.
  BJOG An International Journal of Obstetrics & Gynaecology 10/2012; · 3.41 Impact Factor
• Article: Do pocket-sized ultrasound machines have the potential to be used as a tool to triage patients in obstetrics and gynecology?

  A Sayasneh, J Preisler, A Smith, S Saso, O Naji, Y Abdallah, C Stalder, A Daemen, D Timmerman, T Bourne
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  ABSTRACT: To evaluate the performance and potential impact on patient management of a pocket-sized ultrasound machine (PUM) in comparison to high-specification ultrasound machines (HSUM). This was an observational cohort study with 204 unselected patients in three categories: 1) women with pain and bleeding in early pregnancy (101 patients); 2) women presenting for routine obstetric ultrasound assessment (53 patients); 3) women with possible gynecological pathology (50 patients). Scans were carried out transabdominally using a PUM. A second operator repeated the examination transvaginally and/or transabdominally, depending on the clinical indication, using an HSUM. The operators were blind to each other's findings. In the early pregnancy group, there was good to very good agreement between the PUM and HSUM for identifying the presence or absence of an embryo, gestational sac, fetal heart motion, pregnancy location and final diagnostic outcome (kappa coefficients, 0.844, 0.843, 0.729, 0.785 and 0.812, respectively; P < 0.0001). In the obstetric ultrasound group there was good to very good agreement for fetal presentation, placental location and placental position (kappa coefficients, 0.924, 0.924 and 0.647, respectively; P < 0.0001). In the gynecological pathology group, there was very good agreement for final diagnosis and type of ovarian mass (low risk or complex) (kappa coefficients, 0.846 and 0.930, respectively; P < 0.0001). For the measured continuous variables, there was close agreement for crown-rump length, mean sac diameter, femur length and mean diameter of an ovarian mass, but not for endometrial thickness. Neither patient demographics (age, body mass index, ethnicity) nor operator experience and familiarity with a PUM had an impact on agreement between the two machines. If a PUM had been the only equipment available for an initial assessment, only two cases would have led to a suboptimal patient management plan. The findings and final diagnosis in the three study groups were similar for both a PUM used transabdominally and an HSUM used transvaginally and/or transabdominally.
  Ultrasound in Obstetrics and Gynecology 05/2012; 40(2):145-50. · 3.01 Impact Factor