Predicting incomplete uterine rupture with vaginal sonography during the late second trimester in women with prior cesarean

Abstract

Transvaginal ultrasonography is useful for measurement of the uterine wall after previous cesarean delivery.

Prediction of scar integrity and vaginal birth after caesarean delivery

“…The review comprises 12 studies published between 1988 and 2009 [12,[33][34][35][36][37][38][39][40][41][42][43] including together 1834 women with a previous low transverse caesarean hysterotomy who underwent ultrasound measurement of the thickness of the lower uterine segment at [35][36][37][38][39][40] gestational weeks. In seven of the 12 studies the full lower uterine segment thickness was measured [12,33,36,[38][39][40]42], in four studies the myometrial thickness was measured [34,35,37,43], and in one study both measurements were taken [41].…”

“…In seven of the 12 studies the full lower uterine segment thickness was measured [12,33,36,[38][39][40]42], in four studies the myometrial thickness was measured [34,35,37,43], and in one study both measurements were taken [41]. Because only three of the 12 studies reported the frequency of uterine rupture separately, the outcome measure was "uterine rupture or uterine dehiscence", i.e.…”

“…The cutoffs suggested for the full lower uterine segment thickness in the different studies varied between 2.0 mm and 3.5 mm and those for the myometrial thickness between 1.4 mm and 2.0 mm. It is of note that in nine of the 12 studies included in the review the ultrasound results were available to the staff managing the pregnancies and deliveries [33][34][35][38][39][40][41][42][43]. This is inappropriate when estimating sensitivity and specificity of a diagnostic test.…”

“…In studies reporting on measurements of the thickness of the lower uterine segment the measurement technique was described with varying detail [12,[33][34][35][36][37][38][39][40][41][42][43]. Therefore, it is unlikely that exactly the same transabdominal measurement technique or exactly the same transvaginal measurement technique was used in all studies: there may be differences between the degree of bladder filling, the site of measurement, the placement of the callipers, the number of measurements taken and in the measurement selected to be representative if more than one was taken.…”

A study to determine scar integrity in pregnant women with previous lower segment caesarean section

“…The benefits of a VBAC include reduced risk of thrombo-embolism, shorter duration of hospital stay, lesser requirement of blood transfusion, lower rate of postpartum fever, wound infection, uterine infection and fewer neonatal problems. 1 The present study was designed to determine whether the clinical, radio pathological and biomechanical criteria can be utilized to devise objective method for decision making regarding mode of delivery in patients with previous caesarean section without compromising maternal and fetal outcomes.…”