Degeneración quística de la cicatriz uterina anterior, riesgo de rotura uterina y revisión de la literatura

Abstract

ObjectiveTo assess whether thinning of the lower uterine segment may increase the risk of obstetric complications and to determine the most effective method to study its correct measurement. Material and methodLiterature review and case report. Results case reportWe present the case of a pregnant woman with cystic degeneration of a uterine scar during pregnancy. The delivery occurred at term with no obstetric or neonatal complications. Comment, discussion and literature reviewUltrasound is considered an easy-to-use and reproducible technique with a well-defined methodology to assess a prior caesarean scar. Nevertheless, there is still no standardised technique to measure the lower uterine segment. Although most authors and some societies are in agreement, there is a lack of homogeneous studies and a definitive cut-off value. Despite published studies, there are no data to suggest that uterine scar dehiscence requires repair for proper healing. ConclusionsThe most effective diagnostic method is hysterosonography. Measurement of the lower uterine segment in the third trimester could be useful to decide the route of delivery. A cut-off cannot be determined to predict the risk of uterine rupture or uterine scar dehiscence. Further studies are required to establish an adequate technique and a cut-off value to classify patients and aid decision-making on the route of delivery. The most clearly defined cut-off for the lower uterine segment is 3.5-3.2. The most important factor in imaging tests is to evaluate whether they are able to predict the obstetric complications that may occur, the risk of maternal or foetal compromise and the option of vaginal delivery. There are no studies on clinical decision-making according to these results.