Evaluation Of Lower Uterine Segment Research Articles

Two dimension versus three dimension ultrasound assessment of caesarean section scars

Background: Ultrasound (US) is now used as an imaging modality for the evaluation of lower uterine segment (LUS). A number of reports of sonographic evaluation of LUS have appeared in literature. It has been speculated that thickness of the LUS is related to the quality of wound healing. There is strong correlation between the anatomic status of scarred LUS as assessed by USG and its functional status which is tested during labour. Objective: The aim of this work was to investigate the accuracy of two-dimensional and three-dimensional ultrasound in measurement of Caesarean section scar thickness. Patients and methods: This study was cross sectional study, conducted in Aswan University Hospital. The ultrasound examinations were conducted in the Obstetrics and Gynecology department between June 2017 and September 2021. The study included 150 pregnant females with previous one or two cesarean sections (CS) (aged 20-41y; mean 32.5y), underwent TA 2D and 3D US for assessment of the LUS thickness at 37-39 gestational weeks, before planning.

Ultrasonographic assessment of lower uterine segment thickness and perinatal Outcomes in patients with a previous cesarean history

Objective: The purpose of the study was to establish the validity of the abdominal evaluation of lower uterine segment (LUS) thickness in patients having a previous cesarean section (CS) in predicting uterine rupture, and to evaluate if there is any effect of the number of a previous surgeries on adverse maternal and perinatal outcomes.
 Materials and methods: A prospective case-control study was carried out between December 2017 and June 2018 in Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital. 555 patients were classified into three groups; Group 1: patients having one previous CS, Group 2: patients having two previous CS, Group 3: patients having more than the two previous CS). Ultrasonographic measurements of the LUS, intraoperative findings and, adverse pregnancy outcomes were assessed.
 Results: LUS thickness of group 2 was significantly less than the LUS thickness of the other groups (p=0.022). The feeling of pain was significantly more in the patients of group 2, when compared with the other groups (p=0.019). Pregnancy interval was the only parameter that had significant predictivity for adverse pregnancy outcomes for group 1(#CS=2) and group 3 (#CS≥4) (p=0.042, and p=0.021, respectively). In group 2 (#CS=3), age, the thickness of LUS, and thickness of subcutaneous adipose tissue were found to have significantly high predictivity for adverse pregnancy outcomes (p=0.012, p≤0.001, and p=0.007, respectively).
 Conclusion: Measurement of LUS, in the patients who had previous CS, can be used for risk assessment and management. It is a non-invasive, reliable and, easily applicable method. Standardization of the measurement technique is a necessity.

Ultrasound Evaluation of Lower Uterine Segment in Pregnant Patient with History of Hysterotomy

Background: ultrasonography has been widely used in the field of obstetrics & gynecology. Development of more sophisticated technology in ultrasonography & the huge amount of studies & education by physicians makes ultrasonographic examination one of the most useful diagnostic techniques in obstetrics & gynecology. Objective: In this study we aimed to evaluate the gravid uterus in women with a history of previous, 1 or more hysterotomy, in all 3 trimesters by Trans-vaginal ultrasound (TVUS). Patients and Methods: This is a prospective, case-control, observational study. The study was carried out in a private Obstetrics & Gynaecology center Wally center in Fayoum city. The study was carried out in the period from December 2017 to December 2018. Initially, 100 patients were enrolled, but at the end of the study only 67 patients were involved in the study. Results: The distance between the leading edge of the placenta to the internal OS is the diagnostic accretion. This difference between the 5 groups regarding this distance was found to be highly significant (p-value= 0.001) across all 3 trimesters, which proves that repeated CS deliveries is a major risk factor for placenta praevia. There were 1 case, 3 cases & 2 cases of low-lying placenta found in groups 3, 4 & 5, respectively. Conclusion: Cesarean section scar pregnancy and rupture uterus are both rare events and were not found in the sample of this prospective study. However, they are both very important to diagnose as early as possible to prevent serious morbidity and even mortality.

Ultrasound Evaluation of Lower Uterine Segment in Pregnant Patient with History of Hysterotomy

Ultrasound Evaluation of Lower Uterine Segment in Pregnant Patient with History of Hysterotomy

Sonographic assessment of lower uterine segment thickness at term in women with previous cesarean delivery.

The purpose of this study was to establish the validity of abdominal sonographic evaluation of lower uterine segment (LUS) thickness in full-term pregnancies with a single previous cesarean section, and to assess the usefulness of measuring LUS thickness in predicting the risk of uterine dehiscence. Three hundred and thirty-six women with a single previous cesarean section who had an ultrasound measurement of the LUS thickness in pregnancy were enrolled. Abdominal sonographic assessment of LUS was carried out within 2 weeks of delivery. Sonographic measurements were correlated visual finding of a uterine scar at the time of the iterative cesarean section. Receiver operating curve analyses has been used to determine the detection rate and the risk of each actual value of LUS thickness vs. a thin uterine scar. In our present study, 2.5 mm was considered the critical cut-off value of the LUS thickness. This critical cut-off value was derived from the ROC curve with sensitivity, specificity, PPV, and NPV of 90.9, 84, 71.4, and 95.5 %, respectively (using transabdominal ultrasound). The linear regression model analysis revealed that full LUS thickness of <2.5 mm was the only factor to be correlated with translucent lower uterine segment (C3) (8.8 vs. 0 %; P = 0.02). Full LUS thickness of <2.5 mm is associated with a higher risk of uterine dehiscence.

Variables influencing the integrity of lower uterine segment in post-cesarean pregnancy.

There is significant increase in proportion of cases with previous cesarean delivery requiring obstetric care. The available literature fails to provide uniform opinion on each woman's characteristics to identify risk of uterine rupture while planning trial of labor after cesarean. To study the association of abnormal lower uterine segment with some of the present and previous obstetric variables including patient characteristics and surgical techniques at previous cesarean operation. Consenting consecutive 96 post-cesarean singleton pregnancies admitting after 36 weeks gestation at the same facility from July 2011 to December 2012 for repeat cesarean, were studied. Only the cases with cephalic presentation and vertex as presenting part, having no placenta previa, polyhydramnios, uterine anomaly or fibroid and those who had previous one lower segment cesarean were recruited. Based on the intra-operative finding the lower uterine segment (LUS) was categorized into those having a normal and abnormal (grades 2-4) LUS. Sonographic assessment of LUS thickness and any abnormalities if any were noted. The findings of abnormal LUS (direct observation at surgery and sonographic impression within a week before surgery) were looked for association with some of the present and previous obstetric variables including patient characteristics and surgical techniques at previous cesarean operation using Student t, Chi square or Fisher's exact test for analysis as appropriate. Receiver operating curve analysis was used to determine the optimal cut off value for prediction of LUS integrity by ultrasound. Of the women recruited for the study, 36 were admitted in early labor and ultrasound evaluation of LUS was performed in 48 of the remaining 60 women admitted antenatal for elective cesarean delivery. There were 38 abnormal LUS (39.6%) with 22 of them (57.9%) graded as 'thinned out LUS'. The incidence of scar dehiscence (grade 3, cases 5) was 5.2% of 96 cases and there were no cases of scar rupture. Proportion of cases with abnormal LUS was significantly high when primary cesarean was done in preterm (p = 0.02); it was a single layer uterine closure (p = 0.02), and inter-cesarean interval was 54 months (p = 0.01). Abnormal LUS was also seen to be associated with maternal age beyond 35 years (p = 0.2), when cesarean was performed in labor (p = 0.5), following 18 h of rupture of membranes (p = 0.75), for a baby weight more than 3 kg (p = 0.4), and different suture materials (polyglactin 910 and chromic catgut) were used to close uterus at primary cesarean delivery (p = 0.1), and also if they had post-partum fever (p = 0.3). Ultrasound measurement of LUS by abdominal scan correlated with the intra-operative LUS grading and a thickness of more than 3.2 mm within a week before delivery and was seen to be the safe cut off above which most of the women had a normal LUS (sensitivity 92.3%, specificity 81.1%). Factors at primary cesarean operation significantly influence the state of LUS at term in subsequent pregnancy .

Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment

The purpose of this study was to establish the validity of sonographic evaluation of lower uterine segment (LUS) thickness for complete uterine rupture. A prospective cohort study of women with previous cesarean delivery was conducted. LUS thickness (full thickness and myometrial thickness only) was measured between 35 and 38 weeks gestation, and the thinnest measurement was considered to be the dependent variable. Receiver operating curve analyses and logistic regression were used. Two hundred thirty-six women were included in the study. Nine uterine scar defects (3 cases of complete rupture during a trial of labor and 6 cases of dehiscence) were reported. Receiver operating curve analyses showed that full thickness of <2.3 mm was the optimal cutoff for the prediction of uterine rupture (3/33 vs 0/92; P = .02). Full thickness was also identified as an independent predictor of uterine scar defect (odds ratio, 4.66; 95% confidence interval, 1.04-20.91) Full LUS thickness of <2.3 mm is associated with a higher risk of complete uterine rupture.

Ultrasonographic Evaluation of Lower Uterine Segment to Predict the Integrity and Quality of Cesarean Scar during Pregnancy: A Prospective Study.

A prospective randomized study was conducted to measure the serial thickness of the lower uterine segment (LUS) by transvaginal ultrasonography in a control group of 80 women having no history of uterine surgery and in a study group of 43 women having a history of previous cesarean section (C/S). In the study group, more than 2 mm of thickness of the LUS was considered as good healing and less than 2 mm of thickness as poor healing. After serial sonographic examination, the women with good healing were given trial for labor unless an obstetrical indication for C/S existed. The appearance of the LUS during surgery was compared with antenatal ultrasonographic assessment by direct inspection. Twenty two (79%) of 28 women with a well healed scar had trial labor with the result that 46% had a successful vaginal birth without any uterine rupture of dehiscence. Eight women with poor healing all had elective C/S. Seven women with a 2 mm LUS thickness were individually categorized for delivery mode. Two of those women delivered vaginally. The LUS was found to be thin to translucent in these later two groups. Two mm or less as a criterion for poor healing had the sensitivity and specificity of 86.7% and 100% respectively. The positive predictive value was 100% and the negative predictive value was 86.7%. Ultrasonographic evaluation is effective in predicting the quality of a uterine scar and in differentiating the risk group of probable uterine rupture from the non risk group.