Scar Dehiscence Research Articles

Degeneración quística de la cicatriz uterina anterior, riesgo de rotura uterina y revisión de la literatura

ObjectiveTo assess whether thinning of the lower uterine segment may increase the risk of obstetric complications and to determine the most effective method to study its correct measurement. Material and methodLiterature review and case report. Results case reportWe present the case of a pregnant woman with cystic degeneration of a uterine scar during pregnancy. The delivery occurred at term with no obstetric or neonatal complications. Comment, discussion and literature reviewUltrasound is considered an easy-to-use and reproducible technique with a well-defined methodology to assess a prior caesarean scar. Nevertheless, there is still no standardised technique to measure the lower uterine segment. Although most authors and some societies are in agreement, there is a lack of homogeneous studies and a definitive cut-off value. Despite published studies, there are no data to suggest that uterine scar dehiscence requires repair for proper healing. ConclusionsThe most effective diagnostic method is hysterosonography. Measurement of the lower uterine segment in the third trimester could be useful to decide the route of delivery. A cut-off cannot be determined to predict the risk of uterine rupture or uterine scar dehiscence. Further studies are required to establish an adequate technique and a cut-off value to classify patients and aid decision-making on the route of delivery. The most clearly defined cut-off for the lower uterine segment is 3.5-3.2. The most important factor in imaging tests is to evaluate whether they are able to predict the obstetric complications that may occur, the risk of maternal or foetal compromise and the option of vaginal delivery. There are no studies on clinical decision-making according to these results.

Management of secondary infertility following cesarean section: Report from the Subcommittee of the Reproductive Endocrinology Committee of the Japan Society of Obstetrics and Gynecology.

The aim of this study was to examine the current status and management of secondary infertility following cesarean section in Japan. A two-step questionnaire survey was performed in 1092 facilities, including teaching hospitals and artificial reproductive technology clinics, registered with the Japan Society of Obstetrics and Gynecology. In our questionnaires, we obtained data about symptoms, clinical findings, diagnostic methods, and pregnancy outcomes. Treatments were sorted into three groups, namely typical infertility treatment (group A), conservative treatment (group B), and operative treatment (group C). Of the 1092 facilities, 616 (56%) sent back reply forms to the first questionnaire; 56 (32%) of 176 facilities answered the second questionnaire, and 189 cases were able to be analyzed after completion of the two questionnaires. The commonest symptom was abnormal uterine bleeding during the follicular phase (91 cases; 48% of the 189 eligible cases), and the commonest clinical finding was fluid pooling in the area of cesarean scar dehiscence during the ovulatory phase (142 cases; 75%). The most commonly used diagnostic method was transvaginal ultrasound (153 cases, 81%). The pregnancy rate was 33% in group A, 50% in group B, and 60% in group C. In patients with abnormal uterine bleeding, painful symptoms and fluid pooling at the cesarean scar dehiscence, the pregnancy rate was significantly higher in group C (64%) than in group A (16%; P = 0.0063). We recommend operative treatment for secondary infertility following cesarean section with painful symptoms and fluid pooling at the site of cesarean scar dehiscence.

The role of multimodality imaging after cesarean delivery.

There has been a global increase in the rate of cesarean delivery during the last 30 years. As a result, many women of reproductive age now have uterine scars. Well-recognized obstetric and gynecologic consequences include cesarean scar pregnancy, scar dehiscence or rupture, and scar endometriosis. More recently, abnormal menstrual bleeding, pelvic pain, and secondary infertility have been reported as a consequence of cesarean delivery. This article reviews the range of normal imaging findings after cesarean delivery, as well as the imaging manifestations of complications, both acute and chronic.

English

Torsion of gravid uterus is a rare complication in pregnancy. It is often associated with a previous cesarean section. When a patient with a previous history of ceasarean section complains of pain abdomen, apart from scar dehiscence and abruptio placenta, torsion of gravid uterus should be entertained as a differential diagnosis. The case report highlights the presentation of rare case of torsion of gravid uterus.

A prospective observational study of trial of labor after cesarean in rural India

ObjectiveTo determine the success rate of trial of labor after cesarean (TOLAC) in rural India. MethodsThe present prospective observational study enrolled pregnant women attending Dr Rajendra Prasad Government Medical College, Kangra, India, in 2013. Eligible women had a previous low-segment cesarean delivery and had a singleton pregnancy with cephalic presentation. Women in labor were managed as per the institutional protocol. ResultsIn total, 482 women were included. TOLAC led to a vaginal delivery in 383 (79.6%) women. Overall, 2 (0.4%) women had scar rupture, and 4 (0.8%) had scar dehiscence. Fetal death was recorded in one woman with scar rupture, for whom peripartum hysterectomy was necessary. Blood loss was significantly lower among the 316 women with normal vaginal delivery than among the 99 who underwent cesarean (P<0.001). Blood transfusion was required in 2 (0.6%) women with normal vaginal delivery and 2 (2.0%) with cesarean delivery (P=0.05). The proportion of neonates who had to be admitted to intensive care did not differ significantly by mode of delivery (P=0.06). ConclusionUnder strict supervision, TOLAC is a reasonable option even in rural India.

Transvaginal Ultrasonographic Measurement of Lower Uterine Segment in Term Pregnant Patients with Previous Cesarean Section

Background: With an aim to reduce the rates of repeat cesarean section in women with a previous scar, prediction of scar rupture or dehiscence is important. If we could predict the risk of rupture by measuring the scar thickness closer to term, we could pursue a trial of scar safely. Aims: To evaluate the use of ultrasound measured thickness of lower uterine segment as one of the predictors of scar rupture or dehiscence in labour and establish a cut off beyond which trial of labour can be attempted safely. Methodology: 187 randomly selected pregnant women with history of one previous cesarean section in the past who satisfied the inclusion criteria, attending the outpatient clinic over a period of six months, at a tertiary level teaching institution in southern India were selected and counseled to undergo a transvaginal measurement of the scar region. These women were then followed up until delivery and the outcome of trial of scar, successful vaginal delivery, rupture or dehiscence of uterus was analysed in relation to the scar thickness and various other contributing factors. Results: 187 women with history of previous cesarean section, attending the outpatient clinic were randomly chosen to undergo trans vaginal scan at term. 52 underwent elective cesarean section and 135 went through trial of scar. The median cut-off of the lower uterine segment in this study population of 135 was 2.4 mm. The sensitivity was 90.9%, specificity was 43.5%, positive predictive value was 12.5%, and negative predictive value was 98.3% at this cut-off for scar rupture or dehiscence. Conclusions: The lower uterine scar thickness could be a useful tool to predict scar rupture. This could aid in making decisions regarding induction of labour with oxytocin in women with previous cesarean section.

The effects of repeated caesarean sections on maternal and fetal outcomes

Objectives : To determine (i) the effects of repeated caesarean sections on maternal and fetal outcomes (ii) whether these outcomes are affected by the timings of caesarean section (elective/emergency). Materials and Methods: This is a retrospective observational study conducted at Al Qassimi Hospital, Sharjah UAE from 1st Jan 2007 to 31st Dec 2008. 224 women who underwent caesarean section (CS) for two or more times were studied with respect to timing of current caesarean section, adhesions, condition of bladder and lower uterine segment, dehiscence of previous scar and any visceral injuries. Total blood loss and postoperative complications were also evaluated. Fetal parameters included gestational age at birth, APGAR scores and breathing difficulties if any. Results: Incidence of dense adhesions increased with increasing number of caesarean sections (22% for prev 2CS, 33% for prev 3 CS, 39% for prev 4 or more CS). Omental adhesions also followed similar pattern. The lower segment was thinned out in 38% of total patients. Scar dehiscence was seen in 50% of previous 4 caesarean section operated in emergency, in comparison to 4% and 6%% in previous 2 and 3 caesarean section. Other complications like bleeding, blood transfusion and postoperative complications were not statistically different in both the groups (elective and emergency). There was no case of caesarean hysterectomy and maternal death. The fetal outcome was similar in all the groups. Conclusions: No definitive upper limit of multiple repeat caesarean sections can be fixed for an individual woman based just on the number of previous Caesarean sections.

Prediction of cesarean section scar dehiscence before delivery using three-dimensional transabdominal ultrasonography

Objective This study aimed to evaluate the efficacy of three-dimensional (3D) ultrasonography in the prediction of cesarean scar dehiscence in pregnant patients at term and to compare the outcome of measurement with the intraoperative visual assessment of the scar. Design This was a prospective study. Patients and methods Seventy pregnant women with a history of a previous cesarean section attending Benha University Hospital were included in this study. All participants underwent a 3D transabdominal scan at third trimester and the data were recorded. We measured the lower segment thickness from the muscularis and mucosa of the bladder on the outer side to the chorioamniotic membrane on the inner side, with the myometrium in between, and hence, depending on a three-layered pattern. This was compared with the pregnancy outcome and the intraoperative scar condition. The data were then statistically analyzed. Results The mean scar thickness as measured by 3D transabdominal sonography in the third trimester was 4.63 ± 0.85 mm. The best cut-off level for predicting uterine scar defects was less than or equal to 2.75 mm (highest diagnostic accuracy) with sensitivity 25%, specificity 100%, positive predictive value 100%, and negative predictive value 95%. Conclusion The current study suggests that prenatal 3D US examination determining the degree of lower uterine segment thinning in patients with previous cesarean delivery provides an additional element for assessing the risk of uterine rupture and may increase safe management of trial of labor.

A twist in the diagnosis … and the uterus! A case report of third trimester uterine torsion

We report the case of a 26-year-old lady gravida 5, with a previous Caesarean section who presented with 2 episodes of convulsions, shock and evidence of intrauterine foetal death. She was known to have epilepsy since childhood. Anticipating a scar dehiscence or rupture uterus she was posted for emergency laparotomy under spinal anaesthesia. Intra-operatively, 180° uterine torsion was evident. The uterus was untwisted and a lower segment caesarean section was performed to deliver the dead foetus. As the uterus remained flabby and did not retracted after correction of torsion, subtotal hysterectomy was done. She recovered well after surgery. The present case highlights uterine torsions, a rare but potentially dangerous and unexpected obstetric complication and reiterates the need for a timely intervention for better maternal and foetal outcome.

Factors Affecting the Pregnancy Outcome in Patients with Previous One Caesarean Section

This case series study was designed to determine the factors affecting the pregnancy out come in patients with previous one caesarean section. The study was conducted at Marie Stopes Clinic Primium-1 Dhanmondi from July 01, 2012 to January 31, 2013. A total of 150 patients with previous one caesarean section who presented at term were included in the study. The data were collected through proforma and subjected to statistical analysis. Out of 150 patients, 81 (54%) patients had trial of scar and the remaining 69 (46%) patients underwent repeat elective caesarean section. Among those who had trial of scar only 35 (43.2%) patients achieved successful vaginal delivery and remaining 46 (56.8%) had emergency caesarean section. Common indication for repeat emergency caesarean section was non progress of labour (47.8%). It was frequent in women who reported late to hospital after the onset of labour and in women who did not seek antenatal booking in pregnancy. Maternal complications like post partum hemorrhage, scar dehiscence, wound infection and febrile illness were more in those who had emergency caesarean section. There was no maternal mortality in the study. Perinatal outcome was not affected by the mode of delivery. There were two perinatal deaths which occurred in non-booked patients who underwent emergency caesarean section. Most of the women in our study had repeat caesarean section for failed progress. Regular antenatal check up and early report to hospital after the onset of labour can reduce the rate of repeat caesarean section. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21300 Medicine Today 2014 Vol.26(1): 01-03

Clinical diagnosis and therapy of uterine scar defects after caesarean section in non-pregnant women.

Caesarean delivery (c-section) scar dehiscences may cause bleeding abnormalities, e.g. postmenstrual spotting, dysmenorrhea and abdominal pain, secondary sterility and at worst peripartum uterine rupture. The purpose of this study was firstly to identify the correlation of women's complaints after c-section with scar-related clinical symptoms. Secondly, the effects of corrective surgery on preoperatively existing complaints were analysed and assessed in the patient population of our clinic. We present data of a retrospective study of 13 premenopausal, non-pregnant women with symptomatic c-section scars. In 9 out of 13 patients, a microsurgical uterus reconstruction was performed by mini-laparotomy. The postoperative changes of scar-associated symptoms were assessed by a questionnaire as earliest as 4 months after surgery (N = 5). The c-section scar was visualised by transvaginal sonography in 12 out of 13 women by a typical U- or V-shaped hypoechoic or anechoic fluid accumulation in the region of former uterotomy and in all 13 patients by hysteroscopy. Bleeding disorders were often accompanied by dysmenorrhea/abdominal pain (38.5%, N = 5) and secondary sterility (46.2%, N = 6). Blood residues in the scar pouch and bleeding disorders/postmenstrual spotting were found in 30.8% of patients (N = 4) and combined with secondary sterility in 38.5% of patients (N = 5). Reconstructive surgeries resulted in discontinuation of bleeding disorders in all women and a pregnancy in three out of five patients (60%) with secondary sterility. Clinical symptoms, e.g. "bleeding disorders" like postmenstrual spotting, "pain/dysmenorrhea" and "secondary sterility" could be specific indicators for the diagnosis of uterine dehiscence after c-section. Scar dehiscences can be diagnosed by obtaining the patients medical history and asking for typical symptoms followed by vaginal sonography and diagnostic hysteroscopy. If a c-section scar defect is confirmed, microsurgical uterus reconstruction can stop postmenstrual spotting, reduce abdominal pain/dysmenorrhea and improve fertility.

Sonographic prediction of scar dehiscence in women with previous cesarean section.

To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS). In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I-IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I-IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I-IV). Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value=0.000 each). However, the number of previous CS (p=0.440) and inter-delivery interval (p=0.062) had no statistically significant correlation with thickness of LUS. Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.

The Consequences of Previous Uterine Scar Dehiscence and Cesarean Delivery on Subsequent Births

article i nfo Cesarean delivery Fetal complication Obstetric complication Risk factor Uterine rupture Uterine scar dehiscence Objective: To determine whether women with a previous uterine scar dehiscence are at increased risk of adverse perinatal outcomes in the following delivery. Methods: A retrospective cohort study was conducted of all subsequent singleton cesarean deliveries performed at the Soroka University Medical Center, Beer-Sheva, Israel, between January 1, 1988, and December 31, 2011. Clinical and demographic characteristics, maternal obstetric complications, and fetal complications were evaluated among women with or without a previous documented uterine scar dehiscence. Results: Of the 5635 pregnancies associated with at least two previous cesarean deliveries, 180 (3.2%) occurred among women with a previous uterine scar dehiscence. Women with this condition in a prior pregnancy were more likely than those without previous uterine scar dehiscence to experience subsequent preterm delivery (86 (47.8%) vs 1350 (24.7%); P b 0.001), low birth weight (47 (26.1%) vs861(15.8%);Pb 0.001),andperipartumhysterectomy(5(2.8%)vs20(0.4%);Pb 0.001).Nevertheless,previous uterine scar dehiscence did not increase the risk of uterine rupture, placenta accreta, or adverse perinatal out- comes, such as low Apgar scores at 5 minutes and perinatal mortality. Conclusion: Uterine scar dehiscence in a previouspregnancyisapotentialriskfactorforpretermdelivery,lowbirthweight,andperipartumhysterectomy

Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the nonpregnant uterus: a prospective observational study

BackgroundEvery year 1.5 million cesarean section procedures are performed worldwide. As many women decide to get pregnant again, the population of pregnant women with a history of cesarean section is growing rapidly. For these women prediction of cesarean section scar performance is still a serious clinical problem.The purpose of the study was to assess whether the parameters of cesarean section scar in the nonpregnant uterus as determined using ultrasound can be used to predict uterine dehiscence in the next pregnancy.MethodsStarting in 2005, the study included 308 nonpregnant women with a history of low transverse cesarean section. The following ultrasonographic parameters of the cesarean section scar in the nonpregnant uterus were assessed: the residual myometrial thickness (RMT) and the width (W) and the depth (D) of the triangular hypoechoic scar niche. During 8 years of follow-up, 41 of these women were referred to our department for delivery. In all cases, a repeat cesarean section was performed and the lower uterine segment was assessed. Two independent statistical methods namely the logit model and Decision Tree analysis were used to determine the relation between the appearance of the cesarean section scar in the nonpregnat state and the performance of the scar in the next pregnancy.ResultsThe logit model revealed that the D/RMT ratio showed significant correlation with cesarean section scar dehiscence (P-value of 0.007). Specifically, a D/RMT ratio value greater than 1.3035 indicated that the likelihood of dehiscence was greater than 50%. The Decision Tree analysis revealed that a diagnosis of dehiscence versus non-dehiscence could be based solely on one criterion, a D/RMT ratio of at least 0.785. The sensitivity of this method was 71%, and the specificity was 94%.ConclusionsAssessment of the cesarean section scar in the nonpregant uterus can be used to predict the occurrence of scar dehiscence in the next pregnancy.

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 .

Rupture and dehiscence of uterine scar: cases study at a low-risk maternity in the Brazilian Southeast

To evaluate the cases of uterine rupture and dehiscence of the uterine scar at a low-risk maternity and to point out possibilities for an improved approach to these complications. A descriptive study was conducted at a 30-bed low-risk maternity hospital that provides care to users of the public health system. The investigation was carried out by searching for cases in the delivery room registry book and later reading the medical records in order to obtain the data. The information was inserted on a form previously elaborated for this study. Cases of uterine rupture and dehiscence of the uterine scar diagnosed from 1998 to 2012 were included, with the determination of incidence, aspects related to risk factors and diagnosis, association with the use of misoprostol and oxytocin, and the outcomes observed. A total of 39,206 deliveries were performed in this maternity during the study period, with 12 cases of uterine rupture and 16 cases of dehiscence of uterine scar being observed. The most relevant results were a high perinatal mortality associated with uterine rupture and the unsuccessful diagnosis of this complications. It was not possible to demonstrate an association with the use of misoprostol or oxytocin. The adverse outcomes of uterine rupture could be minimized if efforts were directed at improving the diagnostic performance of the assisting teams.

P25.17: Elastographic evaluation of Caesarean section uterine scar may be useful in identifying patients with high risk of uterine scar dehiscence

<scp>P</scp>25.17: Elastographic evaluation of Caesarean section uterine scar may be useful in identifying patients with high risk of uterine scar dehiscence

Chirurgie bariatrique en ambulatoire : étude observationnelle à propos de 68 sleeve gastrectomies

The development of outpatient surgery is one of the major goals of the public health policy in 2010. The purpose of this observational study is to evaluate the feasibility of the laparoscopic sleeve gastrectomy (LSG) in ambulatory. MethodsThis prospective observational study was conducted from May 2011 to June 2013. The procedure was proposed for patients undergoing LSG who were predetermined inclusion criteria. Following preoxygenation, anaesthesia was induced with propofol and sufentanil. Tracheal intubation was facilitated with rocuronium. Anaesthesia was maintained with desflurane and remifentanil target-controlled infusion. Antiemetic prophylaxis was supplied with intravenous (IV) droperidol and dexamethasone; postoperative pain prophylaxis was IV paracetamol, nefopam, tramadol, and ropivacaine infiltration. The patients were extubated in the operating room and kept in the postoperative care unit. A water-soluble contrast examination was performed in the output of the postoperative care unit. Oral feeding was resumed immediately in the absence of fistula on this leak test in an ambulatory surgical unit. When the patient has satisfied the modified Post-Anaesthesia Discharge Scoring System (PADSS) criteria, he or she can then be discharged and sent home. ResultsAmong 280 patients operated on for obesity by laparoscopic sleeve gastrectomy during the study period, 68 (24.2 %) underwent ambulatory procedure. Of the 68 obese patients, 94.1 % were female. Mean age was 34.4 years (22–55). Mean preoperative BMI was 42.6kg/m2. Thirteen patients (19.1 %) had HTN; 7 (10.2 %) had dyslipidemia and 6 (8.8 %) had diabetes not requiring treatment. The mean operating time was 60minutes (range, 45–95) and there were no conversions to open surgery. No intra-operative anesthetic or surgical complications occurred. Mean time in the recovery room was 86.5minutes (35–240). The overall satisfaction rate was 92.6 % (n=63). No patients were admitted because of nausea or inadequate pain control. There were no re-admissions or hospitalizations were reported. We recorded five surgical complications including two case of gastric fistula, one case of gastric stenosis, one case of scar dehiscence and one case of splenic upper pole ischemia. Its complications have arisen from the fourth postoperative day. This does not undermine the ambulatory procedure. ConclusionThe laparoscopic sleeve gastrectomy in ambulatory is feasible with a dedicated anesthesiological concept in an expert surgical team. Appropriate patient selection is important in order to secure safety and quality of care within outpatient program. The risk versus benefit must be adequately evaluated on an individual basis.

Uterine Scar Defect at 12 Weeks’ Gestation

A 38-year-old woman with a history of Caesarean section was found to have a large defect in the lower uterine segment (LUS) on ultrasound examination at 12weeks’ gestation. The residual myometrium thickness (RMT) was thin (2.6mm) compared with the full LUS thickness beside the defect (9.0mm). Serial ultrasound examinations at 16, 23, and 33weeks revealed no significant change in RMT (2.8, 4.2, and 3.2mm, respectively). Repeat Caesarean section was performed during labour at 38weeks’ gestation, and no evidence of uterine scar dehiscence was found.

OC14.07: Lower uterine segment thickness for prevention of uterine rupture and prediction of uterine scar dehiscence: a multicentre prospective study

<scp>OC</scp>14.07: Lower uterine segment thickness for prevention of uterine rupture and prediction of uterine scar dehiscence: a multicentre prospective study