Intrapartum ultrasound measurement of the lower uterine segment thickness in parturients with previous scar in labor: a cross-sectional study (original) (raw)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Background: Vaginal birth after caesarean section (VBAC) has become an integral part of modern obstetrics with more than 1lakh VBACs achieved each year nationwide. Several studies have reported perinatal risks associated with failed trial of labour and uterine rupture in women attempting VBAC, due to concerns about these complications, the rate of VBAC deliveries has continued to fall in developed countries, with an inverse increase in Caesarean Sections (CS). To better assess the risk of uterine rupture, many authors have proposed sonographic measurement of scar or lower uterine segment (LUS) thickness near term, assuming that there is an inverse correlation between LUS thickness and the risk of uterine scar defect. Therefore, this assessment for the management of women with prior CS has increased safety by selecting women with the lowest risk of uterine rupture.Methods: Present study was a prospective observational study which assessed the obstetric outcome in women with previous ...
2017
Background: Risk of scar defect is inversely correlated with lower uterine segment thickness. The study aims to assess the diagnostic accuracy of sonographic measurement of the lower uterine segment thickness near term in predicting uterine scar defect in women with prior Caesarean section and ascertain the best cut-off value for predicting uterine rupture in our country. Methods: This observational case series study was carried out at Department of Gynecology and Obstetrics, Ziauddin University and Hospitals from January 2015 to June 2015. Women carrying singlet on pregnancy of 36-38 weeks with history of previous C-section were included in the study. Lower uterine segment measurement was done by transabdominal ultrasound at 36-38 weeks gestation and these women are followed up to the time of delivery. Results: A total of 180 patients based on inclusion criteria were recruited in the study. Significant association (p=.001) was found between LUS thickness values measured during preg...
Middle East Fertility Society Journal, 2010
Objective: To evaluate the accuracy of prenatal sonography (U/S) in determining the lower uterine segment (LUS) thickness in women with previous cesarean section (CS) and to assess its usefulness in predicting the risk of uterine rupture during a trial of vaginal birth. Design: Prospective controlled study. Setting: Suzan Mubarak University Hospital. Subjects: One hundred and fifty pregnant women with singleton pregnancies, with the gestational age between 37 and 40 weeks were recruited for the study during the period from October 2007 to June 2008. The recruited patients were allocated into three equal groups. Group I included those with previous one low transverse CS and with the history of successful VBAC. Group II included those without the history of successful VBAC. Group III included those without the previous history of CS (control group). Interventions: The recruited patients were subjected to clinical and U/S evaluations. The LUS thickness was evaluated by both transabdominal (TA) and transvaginal (TV) U/S. Women were categorized for the mode of delivery into either trial of VBAC or elective repeated CS (ERCS).
Journal of Health, Medicine and Nursing, 2021
Background: Nowadays it's a big problem of lower uterine thickness in pregnant women that causes a lot of problems. Lower uterine segment thickness is a strong predictor for uterine scar defect in women with prior caesarian section. Lower segment cesarean section (LSCS) rates are raising throughout the world. Women with previous one cesarean can undergo either the trial of vaginal birth or elective repeat cesarean section in their next pregnancy. The study aims to assess the diagnostic accuracy of sonographic measurement of lower uterine segment thickness in pregnant women So there we are going to evaluate lower uterine segment thickness in pregnant women sonographically by using transabdominal and transvaginal approaches as well.
The Egyptian Journal of Hospital Medicine, 2019
Introduction: There is a steady increase in the rate of cesarean delivery. In Egypt, Cesarean sections were performed in 38.84% of deliveries in 2008, 37.88% in 2009, 39.08% in 2010, 37.72% in 2011 and 41.17% in 2012, repeated cesarean sections (RCS) was the main indication. In making plans for delivery, physicians and patients should consider a woman's chance of a successful VBAC as well as the risk of complications from a trial of labor. Approximately 60-80% of appropriate candidates who attempt vaginal birth after cesarean (VBAC) will be successful. Aim of the Work: was to determine a cutoff value that can be clinically used to allow a safe vaginal delivery by using abdominal ultrasound to evaluate the thickness of the lower uterine segment in patients with history of previous cesarean section. Patients and Methods: The lower uterine segment thickness was measured by both transabdominal ultrasound in 200 cases, gravidas (37 week-40 week),100 cases with previous CS (study group) undergoing repeated CS, and the other 100 cases without any scar in the uterus (control group), then the grade of the scar was assessed intraoperatively. Results: By TAS the best cutoff value was 2.5 mm and this yielded a sensitivity of 77.3% and a specificity of 73.5%. At this cutoff value, the positive predictive value was 85% while the negative predictive was 62.5% and the accuracy was 76%. Conclusion: Ultrasonographic evaluation permits good assessment of the risk of scar complications intra partum. The lower uterine segment thickness is related to the grade of the scar. The best timing to perform the scan is at late third trimester. A cutoff value of 2.5 mm by TAS can be safely used with high degree of sensitivity and specificity.
International Journal of Gynecology & Obstetrics, 2004
Objective: To evaluate by ultrasonography, the lower uterine segment thickness of women with a previous cesarean delivery and determine a critical thickness above which safe vaginal delivery is predictable. Methods: A prospective observational study of 71 antenatal women with previous cesarean delivery and 50 controls was carried out. Transabdominal and transvaginal ultrasonography were used in both groups to evaluate lower uterine segment thickness. The obstetric outcome in patients with successful vaginal birth and intraoperative findings in women undergoing cesarean delivery were correlated with lower segment thickness. Results: The overall vaginal birth after cesarean section (VBAC) was 46.5% and VBAC success rate was 63.5%, the incidence of dehiscence was 2.82%, and there were no uterine ruptures. There was a 96% correlation between transabdominal ultrasonography with magnification and transvaginal ultrasonography. The critical cutoff value for safe lower segment thickness, derived from the receiver operator characteristic curve, was 2.5 mm. Conclusion: Ultrasonographic evaluation permits better assessment of the risk of scar complication intrapartum, and could allow for safer management of delivery.
Acta Obstetricia et Gynecologica Scandinavica, 2019
Introduction: Cesarean section rates are increasing with a decrease in the rate of trial of labor after cesarean section. The objective of this study was to systematically review the predictive characteristics of sonographic measurement of lower uterine segment thickness for uterine rupture during labor. Material and methods: The review was carried out in agreement with PRISMA and SEDATE guidelines. MEDLINE, EMBASE, ClinicalTrials.gov and Cochrane Library were searched from 1990 until November 2018. Quality of included studies was assessed using the QUADAS-2 tool. Data were extracted to construct 2 × 2 tables from each study comparing ultrasound measurement with uterine defect at time of delivery. The data were plotted as a summary receiver-operating characteristic (SROC) curve using the hierarchical SROC model. Results: Twenty-eight observational cohort studies met the selection criteria for inclusion. Sonographic lower uterine segment thickness was measured at a gestational age of 36-40 weeks in women with a previous cesarean section. The risk of bias and concerns regarding applicability were low among most studies. The sonographic measurement was correlated with either delivery outcome or lower uterine segment thickness at the time of repeat cesarean section. The cutoff value for lower uterine segment thickness ranged from 1.5 to 4.05 mm across all studies. An association between thin lower uterine segment measurement and uterine dehiscence and uterine rupture was shown in 27 and four studies, respectively. Nineteen studies were included in a meta-analysis with a subgroup analysis by ultrasound methodology. In the subgroup using the ultrasound methodology associated with uterine rupture, the cutoff value is more precise (2.0-3.65 mm) among these 12 studies. There were 18 cases (1.0%) of uterine rupture, 120 (6.6%) of uterine dehiscence and 1674 (92.4%) women with no uterine defect. The SROC curve showed a sensitivity of 0.88 (95% CI 0.83-0.92) and specificity of 0.77 (95% CI 0.70-0.83). The negative likelihood ratio was 0.11 (95% CI 0.08-0.16) and the diagnostic odds ratio was 34.0 (95% CI 18.2-63.5). Conclusions: Lower uterine segment thickness >3.65 mm, measured using a standardized ultrasound technique, is associated with a lower likelihood of uterine rupture. | 831 SWIFT eT al.
Indian Journal of Obstetrics and Gynecology Research, 2015
Objective: To evaluate lower uterine segment thickness by transvaginal ultrasonography (TVS) and its correlation with obstetrical outcome and to derive a critical cut off above which vaginal delivery is safe. Method: A prospective study included 140 antenatal women with history of previous caesarean with gestational age 37-40 weeks in study group and 100 antenatal women without history of any uterine surgery with same profile in control group. Lower uterine segment (LUS) was scanned using TVS. All the women were followed till delivery and further divided into two groups for mode of delivery. Statistical analysis was done by applying chi square test. Results: Overall vaginal birth after caesarean (VBAC) rate and VBAC success rate was observed as 48.57% and 65.38% respectively. The critical cut-off value for safe lower segment thickness derived from receiver operator characteristic curve was 2.5 mm. Conclusion: TVS measured thickness of lower uterine segment allows assessment of scar ...
European Journal of Obstetrics & Gynecology and Reproductive Biology, 1999
Objective: To determine how ultrasound measurement of the lower uterine segment affects the decision about delivery for patients with previous cesarean sections (CS) and what are the consequences on cesarean section rates and uterine rupture or dehiscence. Design: Prospective open study. Patients: 198 patients: all women with a previous CS who gave birth in our department during 1995 and 1996 to an infant with a gestational age of at least 36 weeks and who underwent ultrasound measurement of their lower uterine segment (95-96 study group), compared with a similar population from 1989 to 1994 whose measurements were not provided to the treating obstetrician. Results: Among the patients with one previous CS, the vaginal delivery rate did not differ significantly during the two periods (70.3% for the 89-94 study period vs. 67.9% for the 95-96 study period, P50.53), but the 95-96 study group experienced a significant increase in the rate of elective CS, compensated by a reduction in the rate of emergency CS (6.3% and 23.4%, respectively, for the 89-94 study period vs. 11.9% and 20.1% for the 95-96 study period, P50.01). There was a very significant increase in the rate of vaginal delivery for the 95-96 study period among patients with two previous CS (26.7% vs. 8.0% for the 89-95 study period, P50.01). The lower uterine segment was significantly thicker among women with a trial of labor than among those with an elective CS (4.561.4 mm compared with 3.861.5 mm; P50.006); and the trial of labor group contained significantly fewer women with a lower uterine segment measurement less than 3.5 mm than did the elective CS group (24.0% compared with 56.6%; P,0.001). Two patients (0.8%) were found to have a defect of the uterine scar, a rate significantly lower than that observed in the early group (3.9%, P50.03). Conclusions: Ultrasound measurement of the lower uterine segment can increase the safe use of trial of labor, because it provides an additional element for assessing the risk of uterine rupture.
Sonographic lower uterine segment thickness and risk of uterine scar defect: a systematic review
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2010
To study the diagnostic accuracy of sonographic measurements of the lower uterine segment (LUS) thickness near term in predicting uterine scar defects in women with prior Caesarean section (CS). PubMed, Embase, and Cochrane Library (1965-2009). Studies of populations of women with previous low transverse CS who underwent third-trimester evaluation of LUS thickness were selected. We retrieved articles in which number of patients, sensitivity, and specificity to predict a uterine scar defect were available. Twelve eligible studies including 1834 women were identified. Uterine scar defect was reported in a total of 121 cases (6.6%). Seven studies examined the full LUS thickness only, four examined the myometrial layer specifically, and one examined both measurements. Weighted mean differences in LUS thickness and associated 95% confidence intervals between women with and without uterine scar defect were calculated. Summary receiver operating characteristic (SROC) analysis and summary d...