Ultrasonographic measurement of uterine lower segment scar thickness in cases of previous one caesarean section and obstetric outcome

Trupthi Ganapathi, Hemangi K. Chaudhari


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 lower segment caesarean section willing for trial of labour. Secondly, authors aimed to ascertain the best cut off values for predicting uterine rupture.

Results: Present study found that as duration between previous LSCS and next pregnancy increased there was better chance of VBAC. As the baby weight increased VBAC rate reduced. Study also showed that scar thickness of 2.55mm and above measured by transabdominal method in the third trimester can be safely given trial of VBAC.

Conclusions: Authors thus conclude that measurement of lower uterine segment/ scar thickness can help obstetrician decide whether VBAC is safe or not in patients with previous one LSCS willing for VBAC. Scar thickness of more than 2.55mm can be given safe trial of labour in women with previous one lower segment caesarean section.


Obstetric outcome, Previous one caesarean section, Ultrasonographic measurement of uterine lower segment scar thickness

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Lavin JP, Stephens RJ, Miodovnik M, Barden TP. Vaginal delivery in patients with a prior caesarean section. Obstet Gynecol. 1982;59:135-48.

Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labour after prior caesarean delivery. N Engl J Med. 2004;351:2581-9.

Guise JM, Berlin M, McDonagh M, Osterweil P, Chan B, Helfand M. Safety of vaginal birth after caesarean: a systematic review. Obstet Gynecol. 2004;103:420-9.

Chauhan SP, Martin JN, Henrichs CE, Morrison JC, Magann EF. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after caesarean delivery: a review of the literature. Am J Obstet Gynecol. 2003;189:408-17.

Cunningham, Levono, Bloom, Spong, Dashe, Hoffman, Casey, Sheffield. Prior caesarean delivery: William’s textbook of obstetrics. 24th ed. United States: Mcgraw Hill Education; 2014:25.

Guise JM, Hashima J, Osterweil P. Evidence–based vaginal birth after Caesarean section. Best Prac Res Clin Obstet Gynaecol. 2005;19:117-30.

Turner MJ. Uterine rupture. Best Prac Res Clin Obstet Gynaecol. 2002;16:69-79.

Seracchioli R, Manuzzi L, Vianello F, Gualerzi B, Savelli L, Paradisi R, et al. Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy. Fertil Steril. 2006;86:159-65.

Dubuisson JB, Fauconnier A, Babaki–Fard K, Chapron C. Laparoscopic myomectomy: a current view. Human Reprod Update. 2000;6:588-94.

Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Human Reprod Update. 2000;15:2663-8.

Singh N, Tripathi R, Mala YM. Maternal and foetal outcomes in patients with previous caesarean section undergoing trial of vaginal birth at a tertiary care centre in North India. J Preg Child Health. 2014:1:102.

Wadhawan S, Narone JN. Outcome of labor following previous cesarean section. Int J Gynecol Obstet. 1983;21(1):7-10.

Goel SS, Tiwari M, Hariharan C, Shrivastava DS. Outcome of post caesarean pregnancy and comparison of maternal and foetal outcome following vaginal birth versus repeat caesarean section in a rural hospital. Int J Reprod Contraception Obstet Gynecol. 2013;2(1):16-22.

Shipp TD, Zelop CM, Repke JT, Cohen A, Lieberman E. Inter delivery interval and risk of symptomatic uterine rupture. Obstet Gynecol. 2001;97:175-80.

Bangal VB, Giri PA, Shinde KK, Gavhane SP. Vaginal birth after cesarean section. N Am J Med Sci. 2013;5(2):140-4.

Doshi HU, Jain RK, Vazirani AA. Prognostic factors for successful vaginal birth after cesarean section-Analysis of 162 cases. J Obstet Gynecol India. 2010;60(6):498-502.

Jani RS, Munshi DS. Management of pregnancy with previous lower segment caesarean section in Modern obstetric practice. NHL J Med Sci. 2013;2(2):59-63.

Balachandran L, Vaswani PR, Mogotlane R. Pregnancy outcome in women with previous one cesarean section. J Clinic Diagnos Res: JCDR. 2014;8(2):99-102.

Nikhil A. Analysis of trends in LSCS rate and indications of LSCS-a study in a Medical College Hospital GMERS, Sola, Ahmedabad. Int J Pharm Bio-Sci. 2015;2(1).

Mohammed A, Al-Moghazi D, Hamdy M, Mohammed E. Ultrasonographic evaluation of lower uterine segment thickness in pregnant women with previous cesarean section. Middle East Fertil Soc J. 2010;15(3):188-93.

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

Cheung VY, Constantinescu OC, Ahluwalia BS. Sonographic evaluation of the lower uterine segment in patients with previous caesarean delivery. J Ultrasound Med. 2004;23(11):1441.

Flamm BL, Goings JR, Fuelbirth N, Fischermann E, Jones C, Hewson SA. Oxytocin during labor after previous Caesarean section: results of a multicenter study. Obstet Gynecol. 1987;70:709-12.

Goetzl L, Shipp TA, Cohen A, Zelop CM, Repke JT, Lieberman E. Oxytocin dose and the risk of uterine rupture in trial of labour after Caesarean. Obstet Gynecol. 2001;97:381-4.

Delaney T, Young DC. Spontaneous versus induced labor after a previous Caesarean delivery. Obstet Gynecol. 2003;102:39-44.