DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20181335

Ultrasonographic assessment of strength of previous cesarean scar during pregnancy

Neeti Nisha S. Jha, Sunita Maheshwari, Shivani Barala

Abstract


Background: Management of a woman who has undergone a previous cesarean section, has always been a controversial topic, with the inability to precisely confirm the integrity of the scarred lower uterine segment (LUS) being the indication of repeat cesarean section. The objective of this study is to evaluate the accuracy of ultrasonography (USG) in determining the 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.

Methods: A prospective study was conducted on 100 women between 37 to 40 weeks of gestation with a previous CS and 100 primigravidae women serving as control. Thickness of LUS was measured by transabdominal USG. The decision for mode of delivery was based purely on obstetric ground. Patients undergoing CS were considered for analysis.

Results: Mean LUS thickness was higher in the control group. Seventy-one patients of control group underwent repeat CS, in which 47 (66.1%) had normal intraoperative finding. 24 (33.7%) had abnormal LUS intraoperatively (LUS thinning). Of these, 20 (28.6%) showed abnormal LUS on USG (<5mm), but 4(5.6%) had normal ultrasonographic finding. Sensitivity, specificity, positive and negative predictive value of ultrasonographic evaluation were found to be 100%, 83.3%, 92% and 100% respectively.

Conclusions: Prenatal scar assessment by USG is useful in evaluation of previous cesarean scar and in most cases a near accurate evaluation was possible.

 


Keywords


Caesarean section, LUS, Lower uterine segment, Pregnancy, Ultrasonography, Uterine rupture

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References


Thomas A, Rebekah G, Vijayaselvi R, Jose R. Transvaginal Ultrasonographic Measurement of Lower Uterine Segment in Term Pregnant Patients with Previous Cesarean Section. Open J Obstet Gynecol. 2015;5:646-53.

Verma U, Chandra M, Nagrath A, Singh S, Agrawal R. Assessment of Cesarean Section Scar Strength: Still A Challenge. 2014;24(10).

Bujold E, Jastrow N, Simoneau J, Brunet S, Gauthier RJ. Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment. Am J Obstet Gynecol. 2009 Sep 1;201(3):320-e1.

Sen S, Malik S, Salhan S. Ultrasonographic evaluation of lower uterine segment thickness in patients of previous cesarean section. Int J Obstet Gynecol. 2004 Dec 1;87(3):215-9.

Birth After Previous Caesarean Birth, RCOG Green-top Guideline 45 October 2015. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf.

National Institute for Health and Clinical Excellence. Caesarean section. NICE clinical guideline 2011. Available at: https://www.nice.org.uk/guidance/cg132.

Asakura H, Nakai A, Ishikawa G, Suzuki S, Araki T. Prediction of Uterine Dehiscence by Measuring Lower Uterine Segment Thickness Prior to the Onset of Labor. J Nippon Med Sch. 2000;67(5):352-6.

Rozenberg P, Goffinet F, Philippe HJ, Nisand I. Ultrasonographic measurement of lower uterine segment to assess risk of defects of scarred uterus. Lancet. 1996;347:281-4.

Michaels WH, Thompson HO, Boutt A, Schreiber FR, Michaels SL, Karo JA. Ultrasound diagnosis of defects in the scarred lower uterine segment during pregnancy. Obstet Gynacol. 1988 Jan;71(1):112-20.

Cowan RK, Kinch RA, Ellis B, Anderson R. Trial of labor following cesarean delivery. Obstet Gynacol. 1994 Jun;83(6):933-6.

Grobman WA. Rates and prediction of successful vaginal birth after cesarean. In Seminars in perinatology. 2010;34(4):244-248.

Rosen MG, Dickinson JC. Vaginal birth after cesarean: a meta-analysis of indicators for success. Obstet Gynacol. 1990;77:465-70.

Macones GA, Cahill AG, Stamilio DM, Odibo A, Peipert J, Stevens EJ. Can uterine rupture in patients attempting vaginal birth after cesarean delivery be predicted?. Am J Obstet Gynacol. 2006;195(4):1148-52.

Fukuda M, Fukuda K, Mochizuki M. Examination of previous caesarean section scars by ultrasound. Archives Gynecol Obstet. 1988 Dec 1;243(4):221-4.

Sen S, Malik S, Salhan S. Ultrasonographic evaluation of lower uterine segment thickness in patients of previous caesarean section. Int J Gynecol Obstet. 2004;87:215-9.

Cheung VYT, Constantinescu OC, Ahluwalia BS. Sonographic evaluation of lower uterine segment in patients with previous caesarean delivery. J Ultrasound Med. 2004;23:1441-7.

Gotoh H, Masuzaki H, Yoshida A, Yoshimura S, Miyamura T, shimaru T. Predicting incomplete uterine rupture with vaginal sonography during the late second trimester in women with prior cesarean. Obstet Gynecol. 2000;95:596-600.

Qureshi B, Inafuku K, Oshima K, Masamoto H, Kanazawa. Ultrasonographic evaluation of lower uterine segment to predict the integrity and quality of caesarean scar during pregnancy: A prospective study. Tohuku J Exp Med. 1997;183:55-65.

Cheung Y. Sonographic measurement of the lower uterine segment thickness: Is it truly predictive of uterine rupture? J Obstet Gynaecol. 2009;113:520.