Standardized approach for imaging and measuring Cesarean section scars using ultrasonography

Naji, O.; Abdallah, Y.; Vaate, A.J.M. Bij de; Smith, Alison; Pexsters, A.; Stalder, C.; McIndoe, Angus; Ghaem‐Maghami, Sadaf; Lees, C.; Brölmann, Hans A.M.; Huirne, Judith A.F.; Timmerman, Dirk; Bourne, T.

doi:10.1002/uog.10077

Cited by 171 publications

(142 citation statements)

References 37 publications

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“…A standardized approach for imaging and measuring a CS scar via ultrasonography was used, which is described in detail in our previous publications [7,15]. For standardization purposes, we used the terms introduced by Naji et al [17]. Additionally, an assessment of the location of the CS scar was performed.…”

Section: Methodsmentioning

confidence: 99%

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Pomorski¹,

Fuchs²,

Rosner-Tenerowicz³

et al. 2017

Ginekol Pol

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Objectives: A growing number of studies suggest that the incomplete healing of the CS scar in the uterus increase the risk of uterine dehiscence or rupture during subsequent pregnancies. Thus, the factors that affect wound healing should be evaluated. We aimed to determine whether the morphology of the CS scar in non-pregnant women after one elective CS was affected by the site of the uterine incision, uterine flexion, maternal age, and fetal birth weight. Material and methods:208 non-pregnant women were invited for participation in the study, but only 101 of them met inclusion criteria. Standardized scar parameters (residual myometrial thickness (RMT), depth (D) and width (W) of the hypoechoic niche) were measured using ultrasonography at least 6 weeks after the CS.Results: Scar defect was detected in 26 of 101 subjects. Women without scar defect had significantly higher RMT values (1.87 vs. 0.87), lower newborn birth weight (3127 g vs. 3295 g), and higher scar location above the internal cervical os (62% vs. 16%), than those with scar defect. Maternal age was significantly correlated with D value (R = 0.40). Uterine retroflexion was significantly correlated with a larger D value (R = 0.63) and a larger D/RMT ratio (R = 0.24). Conclusions:In low-risk women who have undergone one elective CS, several risk factors are associated with development of the scar defect, but only scar location can be modified during surgery. Future research is needed to determine whether a relatively higher incision location in the uterus can ensure optimal healing of the CS scar.

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Section: Methodsmentioning

confidence: 99%

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Pomorski¹,

Fuchs²,

Rosner-Tenerowicz³

et al. 2017

Ginekol Pol

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“…A wedge-shaped defect in the uterine wall following CS was first described using hysterosalpingography in 1961 (Poidevin, 1961). The terminology used to describe these scar abnormalities, scar defects, or niches in the uterine scar, differs in the various publications on this subject (Osser et al, 2009;Bij de Vaate et al, 2011;Naji et al, 2012). We prefer to use the term 'niche', which was introduced by Monteagudo et al in 2001(Monteagudo et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…We prefer to use the term 'niche', which was introduced by Monteagudo et al in 2001(Monteagudo et al, 2001). The term 'niche' describes the presence of a hypoechoic area within the myometrium of the lower uterine segment, reflecting a discontinuation of the myometrium at the site of a previous CS (Bij de Vaate et al, 2011;Naji et al, 2012) (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Why Do Niches Develop in Caesarean Uterine Scars? Hypotheses on the Aetiology of Niche Development

Vervoort

Uittenbogaard

Hehenkamp

et al. 2016

Obstetrical &Amp; Gynecological Survey

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108

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Caesarean section (CS) results in the occurrence of the phenomenon 'niche'. A 'niche' describes the presence of a hypoechoic area within the myometrium of the lower uterine segment, reflecting a discontinuation of the myometrium at the site of a previous CS. Using gel or saline instillation sonohysterography, a niche is identified in the scar in more than half of the women who had had a CS, most with the uterus closed in one single layer, without closure of the peritoneum. An incompletely healed scar is a long-term complication of the CS and is associated with more gynaecological symptoms than is commonly acknowledged. Approximately 30% of women with a niche report spotting at 6-12 months after their CS. Other reported symptoms in women with a niche are dysmenorrhoea, chronic pelvic pain and dyspareunia. Given the association between a niche and gynaecological symptoms, obstetric complications and potentially with subfertility, it is important to elucidate the aetiology of niche development after CS in order to develop preventive strategies. Based on current published data and our observations during sonographic, hysteroscopic and laparoscopic evaluations of niches we postulate some hypotheses on niche development. Possible factors that could play a role in niche development include a very low incision through cervical tissue, inadequate suturing technique during closure of the uterine scar, surgical interventions that increase adhesion formation or patient-related factors that impair wound healing or increase inflammation or adhesion formation.

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“…The thickness of the residual myometrium in the lower uterine segment and the width, depth, and length of the hypoechoic uterine defect at the site of the previous cesarean site are the typical areas evaluated to determine risk of rupture. 7 There is currently no myometrial thickness depth that is sensitive enough to use in clinical practice to predict whether a cesarean scar will rupture or remain intact. 8 In the case of our patient, placenta percreta may have been detected earlier if the patient had undergone an MRI earlier in her pregnancy to evaluate the integrity of her classical cesarean scar.…”

Section: Introductionmentioning

confidence: 99%

Difficulties in evaluating the pregnant patient with abdominal pain: A complicated case of uterine rupture

Murray¹

2015

AMSRJ

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Standardized approach for imaging and measuring Cesarean section scars using ultrasonography

Abstract: Incomplete healing of the scar is a recognized sequel of Cesarean section (CS) and may be associated with

Cited by 171 publications

References 37 publications

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Why Do Niches Develop in Caesarean Uterine Scars? Hypotheses on the Aetiology of Niche Development

Difficulties in evaluating the pregnant patient with abdominal pain: A complicated case of uterine rupture

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