Ultrasonographic evaluation of lower uterine segment thickness in pregnant women with previous cesarean section

Mohammed, Abdel Baset F.; Al-Moghazi, Diaa A.; Hamdy, Mamdouh; Mohammed, Enas Mostafa

doi:10.1016/j.mefs.2010.06.006

Cited by 20 publications

(18 citation statements)

References 20 publications

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“…Pelvic transabdominal ultrasound was requested to rule out scar rupture. The myometrium–bladder interface was preserved, and scar thickness was 5 mm, which was normal for a previous cesarean section 8,9. All laboratory findings were within the normal ranges.…”

Section: Case Presentationmentioning

confidence: 81%

Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review

AlSaad¹,

Al-Obaidly

Abdulrouf³

et al. 2017

TCRM

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Background Misoprostol is an effective medical method for the management of pregnancy loss. However, data on its efficacy and safety in women with previous cesarean deliveries are limited. Case presentation We report a 36-year-old patient, gravida 11 para 6, with a diagnosis of missed miscarriage at 15 weeks of gestation. The patient had a significant obstetric history of previous five cesarean deliveries and uterine rupture. Following patient counseling about the medical and surgical options of managing her miscarriage, the patient opted for medical method. Low-dose misoprostol of 100 µg was inserted vaginally and repeated again after 6 hours. The patient had an uneventful complete miscarriage following the second dose of misoprostol. No uterine rupture, no extra vaginal bleeding, and no blood transfusion were observed. Conclusion We conclude that adopting a low-dose misoprostol protocol could be potentially safe and effective in managing second trimester missed miscarriage in women with repeated cesarean deliveries and/or uterine rupture history. Further studies are needed to confirm these results.

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Section: Case Presentationmentioning

confidence: 81%

Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review

AlSaad¹,

Al-Obaidly

Abdulrouf³

et al. 2017

TCRM

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show abstract

“…Clinically, she also noticed intermenstrual bleeding for which Investigations of this condition were commonly done by using ultrasonogram [3]. Armstrong and Hansen 2003 claimed that transvaginal ultrasound was highly accurate in detecting Caesarean scar defect and they defined it as the presence of fluid within the scar site [4].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the clinical implications of this condition on cervical or CS scar ectopic pregnancy and uterine rupture are often overlooked by most gynaecologists. Ultrasound scan is commonly performed in gynaecological practice and has been shown to be useful in diagnosing CSD as reported in the literature [1][2][3]. However, the sensitivity of ultrasound scan in diagnosing a CS scar defect depends on the expertise of the operator and whether a deliberate search for this condition is made at the time of the scanning.…”

Section: Introductionmentioning

confidence: 99%

Incidental Findings of Caesarean Section Scar Defect - Case Reports and a Review of its Investigations and Management

Shun¹

2015

J Clin Case Rep

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The clinical awareness of Caesarean scar defect (CSD) as a cause of abnormal uterine bleeding and adverse obstetrical outcome is still lacking among gynaecologists and their patients. Patients with CSD are mostly asymptomatic, though the lesion may be associated with symptoms like abnormal uterine bleeding, pelvic pain, infertility, and adverse pregnancy outcome. This paper is to report two patients with incidental findings of CSD on ultrasound scanning and MRI and to discuss on their presentations, investigations, and dilemma on treatment options of this condition.

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“…22 A study done by Mohammed A et al at LUS thickness <2.5 mm, there was a higher risk for dehiscence than those with a thickness more than 2.5 mm. 20 In his study he found that there is a strong correlation between degree of LUS thinning antenetally and the risk of uterine scar defect during labour. 20 Thus authors can conclude that scar/LUS thickness may thus serve as an excellent predictor of uterine scar defect in women contemplating VBAC.…”

Section: Scar In Millimeter On Scan and Outcome And Association Of Scmentioning

confidence: 96%

“…In a similar study done by Mohammed A et al and Sen et al, 2.5 mm was considered the critical cut off value of the LUS thickness above which safe vaginal delivery can be achieved below which dehiscence and rupture of uterus rate was high. 20,21 Cheung et al in his another study reported that a cut off thickness of 1.5 mm had a sensitivity of 88.9%, a specificity of 59.5%, a PPV of 32.0%, and a NPV of 96.2% in predicting a paper-thin or dehiscenced LUS. 22 A study done by Mohammed A et al at LUS thickness <2.5 mm, there was a higher risk for dehiscence than those with a thickness more than 2.5 mm.…”

Section: Scar In Millimeter On Scan and Outcome And Association Of Scmentioning

confidence: 99%

Ultrasonographic measurement of uterine lower segment scar thickness in cases of previous one caesarean section and obstetric outcome

Ganapathi

Chaudhari

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Vaginal birth after caesarean section (VBAC) has become an integral part of modern obstetrics with more than 1lakh VBACs achieved each year nationwide. Several studies have reported perinatal risks associated with failed trial of labour and uterine rupture in women attempting VBAC, due to concerns about these complications, the rate of VBAC deliveries has continued to fall in developed countries, with an inverse increase in Caesarean Sections (CS). To better assess the risk of uterine rupture, many authors have proposed sonographic measurement of scar or lower uterine segment (LUS) thickness near term, assuming that there is an inverse correlation between LUS thickness and the risk of uterine scar defect. Therefore, this assessment for the management of women with prior CS has increased safety by selecting women with the lowest risk of uterine rupture.Methods: Present study was a prospective observational study which assessed the obstetric outcome in women with previous lower segment caesarean section willing for trial of labour. Secondly, authors aimed to ascertain the best cut off values for predicting uterine rupture.Results: Present study found that as duration between previous LSCS and next pregnancy increased there was better chance of VBAC. As the baby weight increased VBAC rate reduced. Study also showed that scar thickness of 2.55mm and above measured by transabdominal method in the third trimester can be safely given trial of VBAC.Conclusions: Authors thus conclude that measurement of lower uterine segment/ scar thickness can help obstetrician decide whether VBAC is safe or not in patients with previous one LSCS willing for VBAC. Scar thickness of more than 2.55mm can be given safe trial of labour in women with previous one lower segment caesarean section.

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Ultrasonographic evaluation of lower uterine segment thickness in pregnant women with previous cesarean section

Cited by 20 publications

References 20 publications

Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review

Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review

Incidental Findings of Caesarean Section Scar Defect - Case Reports and a Review of its Investigations and Management

Ultrasonographic measurement of uterine lower segment scar thickness in cases of previous one caesarean section and obstetric outcome

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