EP10.12: Usefulness of elastography in assessment of the post‐Caesarean uterine wall scare in women with abnormal uterine bleeding

Abstract

The purpose of this study was to establish the validity of transvaginal elastographic assessment of the post-Caesarean uterine wall scare in women with abnormal uterine bleeding. We performed ultrasound examinations in 265 premenopausal women with a history of at least one Caesarean section. The region of the uterine isthmus was visualised by transvaginal ultrasonography. A Caesarean scar defects (CSD) is defined on ultrasound as a triangular hypoechoic defect in the myometrium at the site of the previous hysterotomy. Finally the elastography option was activated. Elastographic evaluation of the uterine post-Caesarean scar was performed using an Accuvix V20 Prestige equipped with ElastoScan TM software. A four colour scale was used to estimate the myometrial tissue stiffness: purple (hard), blue (medium-hard), yellow (medium-soft) and red (soft). 55 women had a history of 2 to 10 days of postmenstrual spotting. In 39 patients the uterine Caesarean scar was evaluated as CSD. Twenty five cases with CSD was evaluated as soft (64.1%). In patients with normal appearance of uterine aesarean scar (226 cases) sixteen women had postmenstrual spotting and thirteen of them the uterine Caesarean scar was evaluated by elastography as soft (81.25%). Elastography may be useful in identifying patients with a history of Caesarean section who may suffer from postmenstrual spotting.