Sonographic Lower Uterine Segment Thickness Measurement and Risk of Uterine Scar Defect in Women with Previous Caesarean Section (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 ...
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...
BMC Pregnancy and Childbirth
Background There is a lack of reliable methods to estimate the risk of uterine rupture or dehiscence during a trial of labor in women with previous cesarean sections. This study aimed to assess the lower uterine segment and myometrial thickness by ultrasonography in women with previous cesarean sections during labor and assess their association with the uterine defect. Methods A cross-sectional study was conducted on 161 women in the active phase of labor having one previous cesarean section. The study was conducted et al.-Azhar University Hospital, Assiut City, Egypt, from March 2018 to March 2019. Ultrasound measurements of lower uterine segment thickness and myometrial thickness were conducted by vaginal and abdominal ultrasound by two observers. The correlation of both thicknesses with the uterine defect was analyzed. Results Uterine defects were reported in 42 women (25.9%), uterine rupture in four women (2.5%), and dehiscence in 38 women (23.5%). The uterine defects were not a...
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).
Ultrasound Predictability Of Lower Uterine Segment Cesarean Section Scar Thickness
Journal of the College of Physicians and Surgeons Pakistan, 2018
OBJECTIVE The objective of this study is to find out association between scar thickness, assessed sonographically, and intraoperative findings (IOF). STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Department of Gynecology and Obstetrics, Sharif Medical and Dental College, Lahore, from June 2016 to April 2017. METHODOLOGY A total of 70 pregnant patients were included in this study. Transabdominal ultrasound was done for scarred uteri. Sonographic findings were co-related with introperative findings. All the given data were entered on SPSS version 23. Age was expressed as mean ± SD. Parity, gestational age, and interval between cesarean sections were expressed as frequencies with percentages. Statistical analysis was done by using Chi-square test for categorical data for association between sonographic scar thickness and intraoperative findings. The statistical significance was set at p-value <0.05. RESULTS The age range of the patients was 20-36 years with a mean of 27.91 ±3.690 years. Gestational age at the time of cesarean section was between 27-40 weeks of gestation with a mean of 37 ±2.126 weeks. The interval from previous cesarean was 10 months at the minimum, and 6 years at the maximum with a mean of 2.29 ±1.0 months. Mean scar thickness was 2.5 mm. Association between scar thickness (<1-3 mm) and intaoperative findings of dehiscence and rupture showed a p-value of <0.001. CONCLUSION Sonographic assessment of a uterine scar has a practical application to determine the thickness of previous scar, and assess its integrity.
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.
Asian Journal of Pharmaceutical and Clinical Research, 2021
Objectives: Cesarean section rates are increasing with a decrease in the rate of trial of labor after first cesarean section. Proper assessment of uterus especially scar of the previous lower segment cesarean sections (LSCS) in pregnant females is the key stone for the successful vaginal birth after cesarean section. The objective of this pilot study was to evaluate LSCS scar thickness using transvaginal sonography (TVS) and to determine the correlation between TVS and intraoperatively measured lower uterine segment cesarean scar thickness. Methods: This prospective observational analytic pilot study was carried out jointly by the Departments of Obstetrics and Gynaecology and Radiodiagnosis, Government Medical College and Rajindra Hospital, Patiala after due ethical and research committee approval. 100 women at term with history of previous LSCS and who were scheduled for elective LSCS were recruited for the study after taking the informed consent. Pre-operative scar measurement as on TVS was compared with and analyzed with intraoperative (I/o) scar measurements taken by Calipers. Results: The cutoff value for TVS readings was found to be ≤2.5 mm using receiver operating characteristic analysis. It has significant correlation with I/o scar measurements. It also has a significant relationship with age, pre-pregnancy overweight, number of the previous LSCS, and gestational age. Conclusion: Assessment of the scar integrity and quality by TVS will be helpful in selecting candidates for trial of labor with an optimally informed decision but still a number of studies have to be done to develop a robust scoring system.
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 Reproduction, Contraception, Obstetrics and Gynecology
Background: Successful conduct of vaginal birth after caesarean section is dependent on a number of foetal and maternal factors including integrity of the previous caesarean section scar. The objective of this study was to determine the average lower uterine segment (LUS) scar thickness for women being planned for VBAC.Methods: This was a prospective cohort study of pregnant women with one previous caesarean section, who were recruited to undergo transvaginal ultrasound scan in preparation for VBAC at the Federal Medical Centre (FMC) Yenagoa. It was conducted between May, 2018 and September 2019. The women were allocated into three groups A (<2.5mm), B (2.5-3.4 mm) and C (≥3.5 mm) according to the thickness of the LUS scar. Data analysis was done using the statistical product and service solutions version 22.0, p<0.05 was taken as statistically significant.Results: The range of lower uterine segment thickness in the study was 1.5 mm to 6.8 mm (mean 3.89±0.95 mm). With cut-off ...
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 ...