Abstract
Purpose: To evaluate the accuracy of sonographic measurements of the lower uterine segment (LUS) thickness at term in predicting uterine scar defects in women with previous Cesarean delivery (CD). Methods: Eighty-nine pregnant women who underwent CD between 37 and 41 weeks of gestation from 2013 to 2015 were enrolled in this study and divided into two groups. Group A consisted of women with previous CD, and Group B consisted of women with previous vaginal deliveries. We performed an ultrasound evaluation of the myometrial and full thickness of LUS (mLUS and fLUS) transvaginally before a CD and evaluated the appearance of LUS during surgery, which was defined as follows: grade I, well-developed; grade II, thin without visible content; grade III, translucent with visible content; and grade IV, either dehiscence or rupture. Results: The median mLUS and fLUS were 1.50 and 4.07 mm in the group A, and 2.75 and 5.37 mm in the group B. We observed significant differences in the median mLUS and fLUS between grades I/II (2.07 and 4.37 mm) and grades III/IV (0.67 and 2.52 mm). Both mLUS and fLUS were predictive factors for grades III/IV and cutoff values were 0.97 mm of mLUS and 3.13 mm of fLUS, having a sensitivity of 87.5% and 75.0%, and a specificity of 87.7% and 91.4% in mLUS and fLUS measurement, respectively. Conclusion: Sonographic measurements of LUS at term may be a feasible and reliable method to predict uterine rupture or uterine dehiscence in women with prior CD.
Highlights
The rates of Cesarean delivery (CD) have increased in recent decades and continue to rise today
CDs are associated with severe obstetric complications in the following pregnancies, such as uterine rupture and placenta previa/ increta [3] [4], which can lead to catastrophic consequences for both mother and child
The most frequent indication for CD is having a history for previous CD, which may weaken the lower uterine segment (LUS), leading to a uterine scar defect during pregnancies, especially during labor
Summary
The rates of Cesarean delivery (CD) have increased in recent decades and continue to rise today. A sharp and persistent decrease in vaginal birth after cesarean has been reported [2]. CDs are associated with severe obstetric complications in the following pregnancies, such as uterine rupture and placenta previa/ increta [3] [4], which can lead to catastrophic consequences for both mother and child. The increase in CDs and resultant escalation of medical costs will have a serious impact on the economy. The most frequent indication for CD is having a history for previous CD, which may weaken the lower uterine segment (LUS), leading to a uterine scar defect during pregnancies, especially during labor
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