ROLE OF THREE DIMENSIONAL ULTRASOUND IN PREDICTION OF CESAREAN SECTION SCAR DEHISCENCE
Sara Mohammed Ahmed Mahmoud;
Abstract
Summary
T
he number of deliveries by caesarean section has been increasing steadily worldwide in recent decades. Although it is often assumed that caesarean section improves neonatal outcomes, there is no hard scientific evidence to support this. The safety of caesarean section, however, has increased owing to improvements in surgical and anaesthetic techniques, increased safety of blood transfusion and routine use of antibiotics and thromboprophylaxis.
Uterine rupture is an uncommon but potentially catastrophic complication of a trial of VBAC. Several studies have reported the perinatal risks of failed TOL and uterine rupture in women attempting VBAC.
Studies have shown that the risk of uterine rupture in the presence of a defective scar is directly related to the degree of thinning of the LUS.
The aim of the current study was to measure the LUS thickness of caesarean section scar using 3D ultrasonography transabdominaly in pregnant women at the late third trimester with previous one caesarean section to assess accuracy by comparing the outcome of each measurement to intraoperative visual assessment of the scar.
The current study included 300 women with previous one caesarean section recruited from the obstetric outpatient clinic of Ain Shams university maternity hospital from July 2013 to December 2013. The lower segment thickness was measured from the muscularis and mucosa of the bladder on the outer side to the chorioamnionitic membrane inside by transabdominal 3D ultrasound.
Transabdominal 3D ultrasound scans were performed to all included women to measure the thickness of the LUS, the mean LUS thickness was 3.9±1.1 mm.
The lower uterine segment was inspected intraoperatively during the caesarean section to note the grade according to Qureshi et al. (1997)classification. Birth weight was also measured.
There was a statistically significant difference betweenLUS intraoperative grading& 3D ultrasound LUS thickness (P<0.01). LUS thickness was significantly highest in cases of grade-I and lowest in grade-IV.
There was a statistically significant difference between LUS intraoperative grading & parity, interval since previous pregnancy, gestational age & fetal birth weight (p<0.001). Parity, gestational age & fetal birth weight were significantly highest in cases of grade-IV and lowest in grade-I. Interval since previous pregnancy was significantly lowest in cases of grade-IV and highest in grade-I.
While there was no statistically significant difference between LUS intraoperative grading & age or BMI (P>0.001).
Transabdominal 3D ultrasound is a perfect test to distinguish different intraoperative LUS grades & to predict scar dehiscence.
To distinguish grade II from grade I, thickness ≤4.5mm had the highest sensitivity 90.8%, specificity 90.2% (highest DA). To distinguish grade III from grade II, thickness ≤3.0 mm had the highest sensitivity 96.9%, specificity 100% (highest DA). To distinguish grade IV from grade III, the thickness ≤1.9 mm was the best cutoff value in prediction of previous cesarean scar dehiscence, it had highest sensitivity 95.7%, specificity 100% (highest DA).
In conclusion,prenatal sonographic examination is potentially capable of diagnosing a uterine defect and determining the degree of LUS thinning in patients with previous caesarean delivery. Ultrasound measurement of the LUS may increase the safe use of TOL, because it provides an additional element for assessing the risk of uterine rupture.
T
he number of deliveries by caesarean section has been increasing steadily worldwide in recent decades. Although it is often assumed that caesarean section improves neonatal outcomes, there is no hard scientific evidence to support this. The safety of caesarean section, however, has increased owing to improvements in surgical and anaesthetic techniques, increased safety of blood transfusion and routine use of antibiotics and thromboprophylaxis.
Uterine rupture is an uncommon but potentially catastrophic complication of a trial of VBAC. Several studies have reported the perinatal risks of failed TOL and uterine rupture in women attempting VBAC.
Studies have shown that the risk of uterine rupture in the presence of a defective scar is directly related to the degree of thinning of the LUS.
The aim of the current study was to measure the LUS thickness of caesarean section scar using 3D ultrasonography transabdominaly in pregnant women at the late third trimester with previous one caesarean section to assess accuracy by comparing the outcome of each measurement to intraoperative visual assessment of the scar.
The current study included 300 women with previous one caesarean section recruited from the obstetric outpatient clinic of Ain Shams university maternity hospital from July 2013 to December 2013. The lower segment thickness was measured from the muscularis and mucosa of the bladder on the outer side to the chorioamnionitic membrane inside by transabdominal 3D ultrasound.
Transabdominal 3D ultrasound scans were performed to all included women to measure the thickness of the LUS, the mean LUS thickness was 3.9±1.1 mm.
The lower uterine segment was inspected intraoperatively during the caesarean section to note the grade according to Qureshi et al. (1997)classification. Birth weight was also measured.
There was a statistically significant difference betweenLUS intraoperative grading& 3D ultrasound LUS thickness (P<0.01). LUS thickness was significantly highest in cases of grade-I and lowest in grade-IV.
There was a statistically significant difference between LUS intraoperative grading & parity, interval since previous pregnancy, gestational age & fetal birth weight (p<0.001). Parity, gestational age & fetal birth weight were significantly highest in cases of grade-IV and lowest in grade-I. Interval since previous pregnancy was significantly lowest in cases of grade-IV and highest in grade-I.
While there was no statistically significant difference between LUS intraoperative grading & age or BMI (P>0.001).
Transabdominal 3D ultrasound is a perfect test to distinguish different intraoperative LUS grades & to predict scar dehiscence.
To distinguish grade II from grade I, thickness ≤4.5mm had the highest sensitivity 90.8%, specificity 90.2% (highest DA). To distinguish grade III from grade II, thickness ≤3.0 mm had the highest sensitivity 96.9%, specificity 100% (highest DA). To distinguish grade IV from grade III, the thickness ≤1.9 mm was the best cutoff value in prediction of previous cesarean scar dehiscence, it had highest sensitivity 95.7%, specificity 100% (highest DA).
In conclusion,prenatal sonographic examination is potentially capable of diagnosing a uterine defect and determining the degree of LUS thinning in patients with previous caesarean delivery. Ultrasound measurement of the LUS may increase the safe use of TOL, because it provides an additional element for assessing the risk of uterine rupture.
Other data
| Title | ROLE OF THREE DIMENSIONAL ULTRASOUND IN PREDICTION OF CESAREAN SECTION SCAR DEHISCENCE | Other Titles | دور الموجات فوق الصوتية ثلاثية الأبعادفى توقعوجود تفزر فى ندبة قيصرية من قبل | Authors | Sara Mohammed Ahmed Mahmoud | Issue Date | 2014 |
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