Factors Associated With Lower Uterine Segment Thickness Near Term in Women With Previous Caesarean Section (original) (raw)
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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.
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).
Sonographic assessment of lower uterine segment at term in women with previous cesarean delivery
Archives of Gynecology and Obstetrics, 2010
Objective To correlate lower uterine segment (LUS) thickness measured by abdominal sonography at term pregnancy with that measured manually using caliper at cesarean delivery and to Wnd out minimum LUS thickness indicative of its integrity in women with previous cesarean. Methods In 106 women with previous cesarean delivery and 68 with unscarred uterus, abdominal sonographic assessment of LUS was carried out within a week of delivery. Sonographic measurements were correlated with manual measurement of lower Xap of LUS using Vernier calipers in 96 of these women (64 with previous cesarean and 32 of unscarred uterus) who had elective cesarean delivery. Results Sonographically determined LUS was thinner among women with previous cesarean delivery than in those without (4.58 SD 1.05 vs. 4.8 SD 0.8; t = 1.986; p = 0.04). Women with vaginal birth after cesarean had thicker LUS than women with repeat cesarean delivery (4.4 SD 0.97 vs. 4.48 SD 1.0). The Wndings were not inXuenced by engaged fetal head status or amount of bladder fullness. Directly measured LUS thickness using Vernier calipers before delivery of the baby conWrmed ultrasound measurements, but showed smaller diVerences between them. There were eight cases with defective uterine scar at cesarean. LUS thickness at term of 3 mm provided 87.5% sensitivity and speciWcity, and was found to have negative predictive value of 98%. But in two of seven cases the actual LUS was not measurable despite sonographic measurement of 3 mm, and there were two records of scar dehiscence in those with 3 and 4 mm of LUS thickness. Conclusion LUS thickness of 3 mm measured by abdominal ultrasonography prior to delivery at term in women with previous cesarean is suggestive of stronger LUS but is not a reliable safeguard for trial of labor.
International journal of clinical obstetrics and gynaecology, 2024
Background: Ultrasound is used to evaluate the Lower Uterine Segment, (LUS) especially if there is a previous scar, and it is more beneficial to predict the possibility of the occurrence of any complication during labour such as repeat caesarean section or during trial for vaginal delivery. Aim: This study aimed to compare the lower uterine segment (LUS) thickness measured by both transvaginal (TVS) and transabdominal ultrasonography (TAS) after completion of 37 weeks of pregnancy with that measured manually using a calliper at the time of caesarean delivery and to determine minimum LUS thickness indicative of its integrity in women who have undergone a previous caesarean section. Material and Methods: This was a single-centre, hospital-based, cross-sectional study conducted over a period of 18 months by enrolling a total of 120 pregnant women with previous one C-section. All patients were examined by both TAS and TVS to evaluate the thickness of the LUS and the thickness was reme asured using a vernier calliper intraoperatively. Results: Of the 120 participants enrolled in the present study-64 (53.3%) underwent elective LSCS and 56 (46.7%) underwent emergency LSCS. The mean thickness of the LUS as measured by TAS, TVS, and VC was 2.69 mm, 2.25 mm, and 2.22 mm, respectively. As the inter pregnancy interval increased, the thickness of the LUS increased. There were 3 cases of scar dehiscence, all cases were noted among women with scar thickness of < 2 mm on VC. Conclusion: Transvaginal ultrasonographic measurement of the lower uterine segment in previous LSCS patient is better predictor of LUS thickness in comparison to transabdominal sonography.
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.
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.
American Journal of Obstetrics and Gynecology, 2016
BACKGROUND: Choice of delivery route after previous cesarean delivery can be difficult because both trial of labor after cesarean delivery and elective repeat cesarean delivery are associated with risks. The major risk that is associated with trial of labor after cesarean delivery is uterine rupture that requires emergency laparotomy. OBJECTIVE: This study aimed to estimate the occurrence of uterine rupture during trial of labor after cesarean delivery when lower uterine segment thickness measurement is included in the decision-making process about the route of delivery. STUDY DESIGN: In 4 tertiary-care centers, we prospectively recruited women between 34 and 38 weeks of gestation who were contemplating a vaginal birth after a previous single low-transverse cesarean delivery. Lower uterine segment thickness was measured by ultrasound imaging and integrated in the decision of delivery route. According to lower uterine segment thickness, women were classified in 3 risk categories for uterine rupture: high risk (less than 2.0 mm), intermediate risk (2.0e2.4 mm), and low risk (!2.5 mm). Our primary outcome was symptomatic uterine rupture, which was defined as requiring urgent laparotomy. We calculated that 942 women who were undergoing a trial of labor after cesarean delivery should be included to be able to show a risk of uterine rupture <0.8%. RESULTS: We recruited 1856 women, of whom 1849 (99%) had a complete follow-up data. Lower uterine segment thickness was <2.0 mm in 194 women (11%), 2.0e2.4 mm in 217 women (12%), and !2.5 mm in 1438 women (78%). Rate of trial of labor was 9%, 42%, and 61% in the 3 categories, respectively (P<.0001). Of 984 trials of labor, there were no symptomatic uterine ruptures, which is a rate that was lower than the 0.8% expected rate (P¼.0001). CONCLUSION: The inclusion of lower uterine segment thickness measurement in the decision of the route of delivery allows a low risk of uterine rupture during trial of labor after cesarean delivery.
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...