Sonographic Lower Uterine Segment Thickness and Risk of Uterine Scar Defect: A Systematic Review

Jastrow, Nicole; Chaillet, Nils; Roberge, Stéphanie; Morency, Anne‐Maude; Lacasse, Yves; Bujold, Emmanuel

doi:10.1016/s1701-2163(16)34475-9

Cited by 152 publications

(152 citation statements)

References 38 publications

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“…These studies seem to have included only symptomatic uterine rupture. In prospective studies in which women, who had the thickness of their lower uterine segment measured with ultrasound, were followed up with regard to pregnancy outcome, the rate of uterine rupture or dehiscence is on average 6.6% (range 1% to 46%) [11]. The prospective studies include not only complete uterine rupture but also uterine dehiscence, and they also include diagnoses made at elective caesarean, not only rupture occurring during a trial of labour.…”

Section: B How Common Is Uterine Rupture After Caesarean Delivery?mentioning

confidence: 99%

“…C The prospective observational study by Bujold et al [41] The study by Bujold et al [41] is the second largest study in the systematic review by Jastrow et al [11]. It includes 236 women who had the full lower uterine segment thickness and the myometrial thickness measured using both transabdominal and transvaginal ultrasound at 35-38 weeks of gestation.…”

Section: The Prospective Observational Study By Rozenberg Et Al [12]mentioning

confidence: 99%

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Prediction of scar integrity and vaginal birth after caesarean delivery

Valentin¹

2013

Best Practice & Research Clinical Obstetrics & Gynaecol

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A statistically significant association with uterine rupture during a trial of labour after caesarean delivery was found in at least two studies for the following variables: interdelivery interval (higher risk with short interval), birthweight (higher risk if > 4000g), induction of labour (higher risk), oxytocin dose (higher risk with higher doses), and previous vaginal delivery (lower risk). However, no clinically useful risk estimation model including clinical variables has been published. A thin lower uterine segment at 35-40 weeks as measured by ultrasound in women with a caesarean hysterotomy scar increases the risk of uterine rupture or dehiscence. However, no cutoff for lower uterine segment thickness can be suggested because of study heterogeneity, and because prospective validation is lacking. Large caesarean hysterotomy scar defects in nonpregnant women seen at ultrasound examination increase the risk of uterine rupture or dehiscence in subsequent pregnancy but the strength of the association is unknown. To sum up, we currently lack a method that can provide a reliable estimate of the risk of uterine rupture or dehiscence during a trial of labour in women with caesarean hysterotomy scar(s).

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Section: B How Common Is Uterine Rupture After Caesarean Delivery?mentioning

confidence: 99%

Section: The Prospective Observational Study By Rozenberg Et Al [12]mentioning

confidence: 99%

Prediction of scar integrity and vaginal birth after caesarean delivery

Valentin¹

2013

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…However, an association between RMT and successful VBAC in the current study was not investigated prior to variable selection. It is also important to note that third-trimester sonographic measurements of the thickness of the lower uterine segment and scar features have been reported as a predictor of vaginal delivery 3 . Accordingly, this variable would be considered as a possible factor in any predictive model on the basis of expert knowledge and was the basis of our hypothesis when we planned the study.…”

Section: Replymentioning

confidence: 99%

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Naji

Wynants

Smith

et al. 2013

Ultrasound in Obstet & Gyne

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“…Uterine scar dehiscence can also cause prolonged menstrual bleeding if the defect serves as a reservoir for blood 6 . Many authors suggest evaluating the lower uterine segment in late pregnancy to support the physician's decision on SC or vaginal delivery, and to explain or justify such decision to the patient [7][8][9] . Other authors believe the assessment of scar defect should be done on the non-pregnant uterus, either by ultrasonography, sonohysterography or MRI (ref.…”

Section: Introductionmentioning

confidence: 99%

Dehiscent scar in the lower uterine segment after Caesarean section and IVF infertility treatment: A case report

Filipčíková

Oborná²,

Březinová³

et al. 2014

BIOMED PAP

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Aims. Caesarean section is the most common obstetric operation associated with short and long term risks, one of which is uterine scar dehiscence. In this case report we describe four cases of in vitro fertilization and embryo transfer (IVF + ET) treatment where the embryo was transferred into the uterus with known scar dehiscence in the lower uterine segment after a previous Caesarean section (SC). Methods. All transfers of embryos were ultrasound guided directly into the middle of uterine cavity. All resulting pregnancies continued without problems related to the dehiscent scar and babies were delivered in the third trimester by elective/emergency SC. Results. Our cases suggest that IVF + ET can be offered as an infertility treatment option despite a dehiscent scar in the lower uterine segment after previous SC.

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Sonographic Lower Uterine Segment Thickness and Risk of Uterine Scar Defect: A Systematic Review

Cited by 152 publications

References 38 publications

Prediction of scar integrity and vaginal birth after caesarean delivery

Prediction of scar integrity and vaginal birth after caesarean delivery

Reply

Dehiscent scar in the lower uterine segment after Caesarean section and IVF infertility treatment: A case report

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