PURPOSE: To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS). METHOD: In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I-IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I-IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I-IV). RESULTS: Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS (p = 0.440) and inter-delivery interval (p = 0.062) had no statistically significant correlation with thickness of LUS. CONCLUSIONS: Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.
PURPOSE: To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS). METHOD: In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I-IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I-IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I-IV). RESULTS: Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS (p = 0.440) and inter-delivery interval (p = 0.062) had no statistically significant correlation with thickness of LUS. CONCLUSIONS: Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.
Authors: José Villar; Eliette Valladares; Daniel Wojdyla; Nelly Zavaleta; Guillermo Carroli; Alejandro Velazco; Archana Shah; Liana Campodónico; Vicente Bataglia; Anibal Faundes; Ana Langer; Alberto Narváez; Allan Donner; Mariana Romero; Sofia Reynoso; Karla Simônia de Pádua; Daniel Giordano; Marius Kublickas; Arnaldo Acosta Journal: Lancet Date: 2006-06-03 Impact factor: 79.321
Authors: Sanne I Stegwee; Astrid Beij; Robert A de Leeuw; Lidwine B Mokkink; Lucet F van der Voet; Judith A F Huirne Journal: Qual Life Res Date: 2019-12-16 Impact factor: 4.147
Authors: Anna Sarah Erem; Thomas Okpoti Konney; Adu Appiah-Kubi; Kwasi Ankomah; Adu Tutu Amankwa; John Jude Kweku Annan; Augustine Tawiah; Benjamin Kwame Amoako-Adjei; Kwabena Fosu Lartey; Emma R Lawrence Journal: Am J Case Rep Date: 2020-12-28