The B-mode sonographic evaluation of the post-caesarean uterine wall and its methodology: A study protocol.

Ammar Al Naimi,Frank Louwen,Marie Hondrich,Niki Mouzakiti,Franz Bahlmann

doi:10.1111/jog.14492

Ammar Al Naimi, Frank Louwen + Show 3 more

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https://doi.org/10.1111/jog.14492

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Abstract

The aim of this study is to utilize the niche measurement guidelines outlined by Jordans et al. in order to establish normal values and accurate description of caesarean section scars in a normal population. After defining the normal distribution, abnormal pregestational scar characteristics will be identified for predicting adverse pregnancy outcomes. This is a prospective observational multicenter clinical study where women with a history of only one caesarean section and yet open family planning are enrolled. The uterine length, cervical length, niche length, niche depth, niche width, residual myometrial thickness, endometrial thickness, scar to internal os distance, anterior myometrial thickness superior and inferior to the scar and the posterior myometrial thickness opposite the scar, superior and inferior to it are measured in a pregestational uterus. The lower uterine segment is measured over a length of 3 cm during subsequent pregnancy and followed up until delivery. Data from 500 patients will yield normal distribution curves for all predefined measurements. Establishing a correlation between deviations from the normal measures and adverse events would be instrumental for counseling women regarding subsequent pregnancy and mode of delivery. This study will demonstrate the changes of the post-caesarean scar from a non-pregnant uterus until delivery and can confirm the importance of the scar characteristics in predicting pregnancy outcome.

Highlights

There is no doubt that caesarean section (CS) is an important surgical intervention which improves both maternal and fetal obstetrical outcomes given the right circumstances
A bar-chart will be established in order to demonstrate the means and the 95% confidence intervals for the measurements collected from the 500 patients
A populationwide screening for all women after a CS is essential in order to define the real prevalence of niches and determine their size and residual myometrial thickness (RMT)

Summary

Introduction

There is no doubt that caesarean section (CS) is an important surgical intervention which improves both maternal and fetal obstetrical outcomes given the right circumstances. A normal lower uterine segment after CS was associated with a sonographic anterior wall thickness of more than 3.2 mm around delivery and assumed to be safe for a trial of labor.[6] Similar results were shown by Basic et al where scar thickness of more than 3.5 mm was regarded as a quality of good healing that can withstand vaginal delivery.[7] Naji et al studied the scar during subsequent pregnancy and considered an anterior myometrial wall thickness of 2.5 mm as a cut-off point for normal thickness. The value of ultrasound in predicting uterine rupture and mode of delivery in a pregnancy following a CS remains controversial, current guidelines do not recommend ultrasound for this purpose.[11]

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