A sonographic assessment of previous caesarean section scar: is a reliable safeguard for trial of labour?

Authors

  • Vandana Dhama Department of Obstetrics and Gynecology, Lala Lajpat Rai Medical College, Meerut, Uttar Pradesh, India
  • Sonam Gupta Department of Obstetrics and Gynecology, Lala Lajpat Rai Medical College, Meerut, Uttar Pradesh, India
  • Rachna Chaudhary Department of Obstetrics and Gynecology, Lala Lajpat Rai Medical College, Meerut, Uttar Pradesh, India
  • Shakun Singh Department of Obstetrics and Gynecology, Lala Lajpat Rai Medical College, Meerut, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20201216

Keywords:

Previous one lower segment cesarean section, Scar thickness, Vaginal birth after cesarean

Abstract

Background: Over the time the caesarean delivery rate has significantly increase worldwide from 18.2% in 2002 to 30.3% in 2012. In parous women, previous caesarean section has been found to be the most common indication for caesarean delivery in as high as 67% cases. Unsecure prediction of the integrity of the scarred LUS during labor appears to be one of the reasons for high repeat caesarean rates. The purpose of this study was to assess the usefulness of sonographic measurement of the lower uterine segment scar before labour for deciding whether it is a reliable safeguard for trial of labour or not in a woman having previous one caesarean delivery.

Methods: This study was a prospective observational study, carried out on 108 pregnant women having previous one CS, gestational age >37, singleton pregnancy, cephalic presentation. Trans-abdominal USG was done to measure scar thickness. Trial of labour was given to each patient irrespective of scar thickness. Pregnancy outcome were noted in terms of successful VBAC or emergency LSCS and compared with scar thickness. Correlation between sonographic and intra-operative finding of scar were noted.

Results: Result shows strong correlation between scar thickness and successful trial of labour. Scar thickness increases chances of successful vaginal deliveries.

Conclusions: Sonographic assessment of previous scar has a practical application to predict the thickness and thinness of previous scar and can be taken as a reliable safeguard for trial of labour after previous cesarean but cut off value above which vaginal delivery could be considered safe is yet to be identified.

References

Al Rifai R. Rising cesarean deliveries among apparently low-risk mothers at university teaching hospitals in Jordan: analysis of population survey data, 2002-2012. Glob Health Sci Pract. 2014;13(2):195-209.

American College of Obstetricians and Gynecologists (ACOG): ACOG Practice Bulletin: vaginal birth after previous cesarean 92 delivery: clinical management guidelines. Int J Gynecol Obstet. 2004;54:197-204.

Lydon-Rochelle M, Holt VL, Easterling R, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med. 2001;345:3-8.

Jha NNS, Maheshwari S, Barala S. Ultrasonographic assessment of strength of previous cesarean scar during pregnancy. Int J Reprod Contracept Obstet Gynecol. 2018;7:1458-63.

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.

Fonda J. Ultrasound specialist trainer ultrasound diagnosis of caesarean scar defects Aust J Ultrasound Med. 2011;14(3):22-30.

Cunningham FG, Levono KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Prior caesarean delivery. Williams Obstetrics. 24th ed, New York, McGraw Hill; 2014:609-619.

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;201:320.e1-6.

Brill Y, Kingdom J, Thomas J. The management of VBAC atterm: a survey of Canadian obstetricians. J Obstet Gynaecol Can. 2003;25:300-10.

Cheung VY. Sonographic measurement of the lower uterine segment thickness in women with previous caesarean section. J Obstet Gynaecol Can. 2005;27(7):674-81.

Rozenberg P, GoYnet F, Philippe HJ, Nisand I. Thickness of the lower uterine segment: its influence in the management ofpatients with previous cesarean sections. Eur J Obstet Gynecol Reprod Biol. 1999;87:39-45.

Leung AS, Leung EK, Paul RH. Uterine rupture after previous cesarean delivery: maternal and fetal consequences. Am J Obstet Gynecol. 1993;169:945-50.

Michaels WH, Thompson HO, Bout A, Schreiber FR, Michaels SL, Karo J. Ultrasound diagnosis of defects in the scarred lower uterine segment during pregnancy. Obstet Gynecol. 1988;71:112-0.

Cheung VY. Sonographic measurement of the lower uterine segment thickness: is it truly predictive of uterine rupture? J Obstet Gynaecol Can. 2008;30:148-51.

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.

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

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

Fukuda M, Fukuda K, Mochizuki M. Ultrasound assessment of lower segment thickness during pregnancy, labour, and the postpartum period. J Obstet Gynecol Can. 2016;38:134-40.

Gotoh H, Masuzaki H, Yoshida A, Yoshimura S, Miyamura T, Ishimaru T. Predicting incomplete uterine rupture with vaginalsonography during the late second trimester in women with priorcesarean. J Obstet Gynecol. 2000;95:596-600.

Farmer RM. Uterine ruptures during trial of labour after previous caesarean section. Am J Obstet Gynecol. 1991;165:996-1001.

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Published

2020-03-25

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Original Research Articles