Scoping review of the evaluation of lower uterine segment thickness and trial of labour after caesarean section

Callistus O. Elegbua; Angela A. Elegbua; Harold Y. Doneh; Emmanuel A. Adekanye; Vincent C. Ani; Oiseremen S. Ovbiagele; Uchenna Nwagha

doi:10.18203/2320-1770.ijrcog20242103

Authors

Callistus O. Elegbua Department of Obstetrics and Gynaecology, David Umahi Federal University Teaching Hospital, Uburu, Ebonyi State, Nigeria
Angela A. Elegbua Department of Obstetrics and Gynaecology, David Umahi Federal University Teaching Hospital, Uburu, Ebonyi State, Nigeria
Harold Y. Doneh Department of Obstetrics and Gynaecology, Nigerian Navy Reference Hospital, Calabar, Cross River State, Nigeria
Emmanuel A. Adekanye Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Ido Ekiti, Ekiti, Nigeria
Vincent C. Ani Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
Oiseremen S. Ovbiagele Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital Ituku Ozalla, Enugu State, Nigeria
Uchenna Nwagha Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital Ituku Ozalla, Enugu State, Nigeria

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242103

Keywords:

Evaluation, Lower uterine segment thickness, Trial of labour after caesarean section, Review

Abstract

The fact that the integrity of the lower uterine segment (LUS) has not been routinely evaluated sonographically before deciding on the mode of delivery after caesarean section has deemed it fit that the lower uterine segment thickness (LUST) should be assessed. The authors carried out a scoping review in October 2023. Four databases were searched for peer reviewed articles that discussed evaluation of LUST and TOLAC. The year of publication, primary author’s country of origin, sample size, study design, gestational age at ultrasonographic assessment, scanning route and key findings were extracted from the included articles. The articles identified were 625 while 250 were screened after removing duplicates and finally 30 articles were included in the review. The first authors of the included articles originated from 10 different countries and 30% of them were Indians. The most frequently used study designs in the articles were prospective cohort studies (63.3%). Majority of the key findings were as follow: Ultrasonography is the best modality for LUS assessment, LUST measurement is more reliable through vaginal scan; maternal age, body mass index and pregnancy related factors affect LUST and LUST of ≥3.5 mm at term is safe for TOLAC. Maternal socio-demographic characteristics and past obstetric history affect the LUST and success of TOLAC. Ultrasonographic evaluation of the LUST at term is safe, needed before TOLAC and more reliable when conducted through vaginal route. The LUST influences the pregnancy outcome during TOLAC and a LUST cut-off value of ≥3.5 mm is safe for TOLAC.

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