Abstract
Objectives: Cesarean section rates are increasing with a decrease in the rate of trial of labor after first cesarean section. Proper assessment of uterus especially scar of the previous lower segment cesarean sections (LSCS) in pregnant females is the key stone for the successful vaginal birth after cesarean section. The objective of this pilot study was to evaluate LSCS scar thickness using transvaginal sonography (TVS) and to determine the correlation between TVS and intraoperatively measured lower uterine segment cesarean scar thickness. Methods: This prospective observational analytic pilot study was carried out jointly by the Departments of Obstetrics and Gynaecology and Radiodiagnosis, Government Medical College and Rajindra Hospital, Patiala after due ethical and research committee approval. 100 women at term with history of previous LSCS and who were scheduled for elective LSCS were recruited for the study after taking the informed consent. Pre-operative scar measurement as on TVS was compared with and analyzed with intraoperative (I/o) scar measurements taken by Calipers. Results: The cutoff value for TVS readings was found to be ≤2.5 mm using receiver operating characteristic analysis. It has significant correlation with I/o scar measurements. It also has a significant relationship with age, pre-pregnancy overweight, number of the previous LSCS, and gestational age. Conclusion: Assessment of the scar integrity and quality by TVS will be helpful in selecting candidates for trial of labor with an optimally informed decision but still a number of studies have to be done to develop a robust scoring system.
Highlights
The old dictum “Once a caesarean section, always a caesarean section” has been subjected to critical analysis by the obstetric world
Studies indicate that the danger of uterine rupture is related with the level of thinning of the Lower uterine segment (LUS) cesarean scar which can be determined by the LUS scar thickness estimation [2]
This prospective, observational, and analytic pilot study was carried out in the Departments of Obstetrics and Gynaecology and Radiodiagnosis, Government Medical College and Rajindra Hospital, Patiala after ethical and research committee approval. 100 women at term with history of previous lower segment caesarean section (LSCS) and who were scheduled for elective LSCS were recruited for the study after taking informed consent. 30 randomly selected full term pregnant females with second or more gravida without the previous LSCS were taken as sample, for determining the baseline measurements
Summary
The old dictum “Once a caesarean section, always a caesarean section” has been subjected to critical analysis by the obstetric world. Studies indicate that the danger of uterine rupture is related with the level of thinning of the Lower uterine segment (LUS) cesarean scar which can be determined by the LUS scar thickness estimation [2]. Various modalities have been utilized to assess the LUS after the lower segment caesarean section (LSCS) such as hysterography of uterine scar, per vaginum investigation of LUS Uterine scar, and amniography but none of them was demonstrated to be valuable in evaluating the risk of uterine rupture. Ultrasonography (USG) gives a genuinely straightforward and non-invasive method, which has been most widely utilized for assessment of the LUS to evaluate the critical thickness above which safe vaginal birth after cesarian is predictable and safe. TVS assessment is an exceptionally precise technique for the recognition of cesarean scar defects, for instance, in relationship with anomalous bleeding or thinning of myometrium, which may expand the risk of uterine rupture [3]
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