Ultrasonographic evaluation of lower uterine segment thickness in patients of previous cesarean section

Sen, Sebnem; Malik, Sunita; Salhan, Sudha

doi:10.1016/j.ijgo.2004.07.023

Cited by 103 publications

(84 citation statements)

References 12 publications

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“…7 Sen et al conducted a study in North India and reported the rate of successful VBAC to be 63.5%. 8 Various other studies like Vidyadhar et al showing 85% and Shakti V et al showing 72% VBAC in periphery centers. 9,10 A study conducted at LHMC Delhi by Madaan M et al showed a success rate of 53.6%.…”

Section: Discussionmentioning

confidence: 89%

Maternal and fetal outcome in pregnant women with previous one lower segment cesarean section

Singh

Dhama

Chaudhary

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONCesarean section is one of the most commonly performed abdominal operations on women in most countries. Cesareans section aims at reducing maternal and fetal mortality and morbidity by virtue of its cautions and careful approach. In many countries, C-sections have become the mode of delivery in over a quarter of all the birth. The World Health Statistics (WHS), 2012, released on Wednesday, said 9% of all births in India were by Caesarian section. The latest figure has gone up by 5% since nearly one in 10 women in India, who gave birth between 2005 and 2010, had gone under the surgical knife.1 Using the data of national family health survey India (1992-93) Mishra and Ramanathan found that among 18 large states two states has CS rate near 15 percent and the rest had less than 5 percent. ABSTRACTBackground: Cesarean section is one of the most commonly performed abdominal operations on women. Because of increasing incidence of Cesarean sections the no. of patients with previous 1 LSCS is also increasing. Thus proper antenatal counseling and institutional delivery should be done. Methods: A prospective observational study was conducted at department of Obstetrics and Gynaecology, LLRM Medical College Meerut during one year period from Nov 2015-May 2016. Participants to study the maternal and fetal outcome in pregnant women with previous one LSCS. 200 pregnant women were included in the study and outcomes were studied. Results: Maternal Outcome: Out of 200 cases 122 patients underwent vaginal birth after Cesarean (VBAC) accounting for 61% and 78 patients underwent 2nd LSCS (76 emergency LSCS and 2 elective LSCS). Out of 76, 55 patients were given trial of VBAC but failed and end up in C-Section showing success rate of 68.92% for VBAC (122 out of 177). Adhesions were found in 21patients out of 78 (26.92%) who underwent LSCS. Uterine rupture seen in 2 patients out of 200 cases (1.0%). Scar dehiscence was seen in 6 out of 78 patients (7.69%). Post-partum Hemorrhage was seen in only 20 (10%) patients. Pre-term Pregnancy occurred in 16 (8%) patients. Caesarean Hysterectomy had to be done in 3 (1.5%) patients. Placenta Previa was seen in 6 out of the 200 patients (3%) and placenta accrete was seen in 1 patient (0.5%). Out of 200 patients, 2 twins were born. The total number of babies born was 201. 8 IUDs occurred out of 201 babies (3.98%) and a total of 25 out of 193 live babies (12.95%) required admission to Neonatal Intensive Care Unit out of which 2 babies died. Conclusions: Cesarean section should not be always followed by a repeat cesarean section. Patient should have hospital delivery in a well-equipped hospital and complications should be diagnosed at an early stage so that maternal and perinatal morbidity and mortality could be prevented.

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Section: Discussionmentioning

confidence: 89%

Maternal and fetal outcome in pregnant women with previous one lower segment cesarean section

Singh

Dhama

Chaudhary

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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“…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].…”

Section: Gestational Weeks Predict Uterine Rupture or Dehiscence?mentioning

confidence: 99%

“…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.…”

Section: Gestational Weeks Predict Uterine Rupture or Dehiscence?mentioning

confidence: 99%

“…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.…”

Section: B How Should the Thickness Of The Lower Uterine Segment Durimentioning

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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“…4 Ultrasound evaluation permits better assessment of scar complication intrapartum and could allow for safer management of delivery. 5 The present study was conducted to sonographically evaluate scar thickness in previous cesarean and study the obstetric and perinatal outcome.…”

Section: Introductionmentioning

confidence: 99%

Study of obstetric and perinatal outcome in previous cesarean by sonographic evaluation of scar thickness of lower uterine segment at term

Kaur¹,

Singh

2015

Int J Sci Rep

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Background: Aim of study was to evaluate sonographically the scar thickness in pregnant women with previous one cesarean and study obstetric and perinatal outcome after trial of labour based on scar thickness.Methods: 50 pregnant women of gestational age >37 weeks were included in this prospective study. They were subjected to transabdominal ultrasound to search for thinnest zone of lower segment. Cases with scar thickness <3.5 mm were subjected to elective caesarean LSCS. Cases with scar thickness ≥3.5 were subjected to a trial of labour. Obstetric, perinatal outcome and hospital stay was studied.Results: 32 women had scar thickness ≥3.5 mm (mean = 3.99 ± 0.32). 18 women had scar thickness of <3.5 mm (mean = 3.16 ± 0.29). All patients subjected to elective LSCS showed Grade 2 and Grade 3 thinning of lower segment. This finding was found to be highly significant (p<0.001). Cases who delivered vaginally had hospital stay ranging from 30 hours to 70 hours while those undergoing LSCS stayed 230 to 280 hours. This difference was statistically highly significant (p<0.001). The perinatal outcome was good.Conclusions: Sonographic evaluation of scar thickness is safe and accurate procedure and is recommended in considering a trial of labour after previous one caesarean.

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Ultrasonographic evaluation of lower uterine segment thickness in patients of previous cesarean section

Abstract: Ultrasonographic evaluation permits better assessment of the risk of scar complication intrapartum, and could allow for safer management of delivery.

Cited by 103 publications

References 12 publications

Maternal and fetal outcome in pregnant women with previous one lower segment cesarean section

Maternal and fetal outcome in pregnant women with previous one lower segment cesarean section

Prediction of scar integrity and vaginal birth after caesarean delivery

Study of obstetric and perinatal outcome in previous cesarean by sonographic evaluation of scar thickness of lower uterine segment at term

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