Background: The main risk factor for uterine scar dehiscence is a previous caesarean section. Better characterisation of the ultrasonographic features of uterine scar dehiscence may improve preoperative diagnostic accuracy in pregnant women with a caesarean scar. This study aimed to evaluate the ultrasonographic features of uterine scar dehiscence in pregnant women and maternal and neonatal outcomes. Materials and methods: This was a retrospective review of the records of 23 women with a previous caesarean section found to have uterine scar dehiscence during surgery. The integrity and thickness of the lower uterine segment were recorded, ultrasonographic features were evaluated, and maternal and infant outcomes were analysed. Results: Of the 23 cases of uterine scar dehiscence, six were detected by preoperative ultrasonography, while 17 were missed. The ultrasonographic features of the 23 cases of uterine dehiscence included anechoic areas protruding through the caesarean section scar with an intact serosal layer (4/23), disappearance of the muscular layer (2/23), and a thinner lower uterine segment (17/23). There were no cases of maternal or neonatal mortality. One woman chose to undergo pregnancy termination. Conclusion: Preoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality. However, the maximum benefit can only be obtained by scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence. KEY MESSAGES1. Preoperative detection of uterine scar dehiscence in women with previous caesarean delivery helps prevent maternal and neonatal morbidity and mortality. 2. Scanning at appropriate intervals during pregnancy and accurate recognition of the ultrasonographic features of uterine scar dehiscence could be beneficial. 3. Even when uterine dehiscence is detected by ultrasound during the second trimester, conservative management via strict observation alone is also feasible.
Aim To establish reference ranges for fetal mandibular markers in low‐risk singleton pregnancies between 11 and 13 + 6 weeks of gestation in a Chinese population. Methods The inferior facial angle (IFA), transverse, and anteroposterior diameters of the mandible, and mandibular length were measured at 11–13 + 6 weeks of gestation. The utility of these sonographic markers for detecting micrognathia was explored in seven fetuses. Results In healthy fetuses at 11–13 + 6 weeks, there were linear correlations between gestational age and the transverse (Y = −15.615 + 1.987X, r = 0.718, p < 0.001) and anteroposterior (Y = −8.557 + 1.101X, r = 0.581, p < 0.001) diameters of the mandible; mean ratio of the anteroposterior: transverse diameters of the mandible decreased with gestational age (Y = 0.603–0.003X, r = 0.018, p = 0.755); there was a positive correlation between crown rump length and mandibular length (mandible length = 0.861 + 0.137*crown rump length; r = 0.723, p < 0.001); and there was a positive correlation between crown rump length and IFA (r = 0.234, p < 0.05). Reference ranges were: mean ratio of anteroposterior diameter: transverse diameter of the mandible 0.56; mean mandibular length 9.05 mm; and median IFA 66.5°. The values for these mandibular markers in seven cases of fetal micrognathia were outside the normal range. Conclusions Evaluations of fetal mandibular markers during first trimester ultrasound screening may contribute to the early detection and diagnosis of micrognathia. We recommend obtaining a subjective impression of the mandible on the mid‐sagittal view routinely used to measured nuchal translucency, followed by targeted objective measurements on the mid‐sagittal and axial views in suspected cases.
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