PILOT STUDY OF LOWER UTERINE SEGMENT CESAREAN SCAR THICKNESS PREOPERATIVELY BY TRANSVAGINAL SONOGRAPHY AND ITS CORRELATION WITH INTRA-OPERATIVE FINDINGS

NAVDEEP KAUR; MANJIT MOHI; SARABJIT KAUR; SARYU GUPTA

doi:10.22159/ajpcr.2021.v14i9.42491

Authors

NAVDEEP KAUR Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala
MANJIT MOHI Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala
SARABJIT KAUR Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala
SARYU GUPTA Department of Radiodiagnosis, Government Medical College and Rajindra Hospital, Patiala

DOI:

https://doi.org/10.22159/ajpcr.2021.v14i9.42491

Keywords:

Lower segment caesarean section, Scar thickness, Scar measurements, Transvaginal sonography

Abstract

Objectives: Cesarean section rates are increasing with a decrease in the rate of trial of labor after first cesarean section. Proper assessment of uterus especially scar of the previous lower segment cesarean sections (LSCS) in pregnant females is the key stone for the successful vaginal birth after cesarean section. The objective of this pilot study was to evaluate LSCS scar thickness using transvaginal sonography (TVS) and to determine the correlation between TVS and intraoperatively measured lower uterine segment cesarean scar thickness.

Methods: This prospective observational analytic pilot study was carried out jointly by the Departments of Obstetrics and Gynaecology and Radiodiagnosis, Government Medical College and Rajindra Hospital, Patiala after due ethical and research committee approval. 100 women at term with history of previous LSCS and who were scheduled for elective LSCS were recruited for the study after taking the informed consent. Pre-operative scar measurement as on TVS was compared with and analyzed with intraoperative (I/o) scar measurements taken by Calipers.

Results: The cutoff value for TVS readings was found to be ≤2.5 mm using receiver operating characteristic analysis. It has significant correlation with I/o scar measurements. It also has a significant relationship with age, pre-pregnancy overweight, number of the previous LSCS, and gestational age.

Conclusion: Assessment of the scar integrity and quality by TVS will be helpful in selecting candidates for trial of labor with an optimally informed decision but still a number of studies have to be done to develop a robust scoring system.

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References

Swift BE, Shah PS, Farine D. Sonographic lower uterine segment thickness after prior cesarean section to predict uterine rupture: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2019;98:830-41.

Mohammed AB, Hamdy MT, Mohammed EM. Ultrasonographic evaluation of lower uterine segment thickness in pregnancy women with previous cesarean section. Middle East Fertil Soc J 2010;15:188-93.

Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol 2009;34:90-7.

MedCalc®. Statistical Software Version 20.006. Ostend, Belgium: MedCalc Software Ltd.; 2021. Available from: https://www.medcalc. org;2021.

Mangla D, Singh SP, Chauhan J. A study to determine scar integrity in pregnant women with previous lower segment caesarean section. Int J Reprod Contracept Obstet Gynecol 2017;5:4.

Sharma C, Surya M, Soni A, Soni PK, Verma A, Verma S. Sonographic prediction of scar dehiscence in women with previous cesarean section. J Obstet Gynaecol India 2015;65:97-103.

Kumari AS, Sahu S. Transvaginal ultrasonic evaluation of lower uterine segment to predict integrity of caesarean scar during pregnancy and its correlation with obstetric outcome. Indian J Obstet Gynaecol 2015;2:7-10.

Shipp TD, Zelop CM, Repke JT, Cohen A, Lieberman E. Interdelivery interval and risk of symptomatic uterine rupture. Obstet Gynecol 2001;97:175-7.

Stamilio DM, DeFranco E, Paré E, Odibo AO, Peipert JF, Allsworth JE, et al. Short interpregnancy interval: Risk of uterine rupture and complications of vaginal birth after cesarean delivery. Obstet Gynecol 2007;110:1075-82.

Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Obstet Gynecol 2010;115:1003-6.

Qureshi B, Inafuku K, Oshima K, Masamoto H, Kanazawa K. Ultrasonographic evaluation of lower uterine segment to predict the integrity and quality of cesarean scar during pregnancy: A prospective study. Tohoku J Exp Med 1997;183:55-65.

Sen S, Malik S, Salhan S. Ultrasonographic evaluation of lower uterine segment thickness in patients of previous cesarean section. Int J Gynaecol Obstet 2004;87:215-9.

Rozenberg P, Goffinet F, Philippe HJ, Nisand I. Thickness of the lower uterine segment: Its influence in the management of patients with previous cesarean sections. Eur J Obstet Gynecol Reprod Biol 1999;87:39-45.

Cheung VY. Sonographic measurement of the lower uterine segment thickness: Is it truly predictive of uterine rupture? J Obstet Gynaecol Can 2008;30:148-51.

Kushtagi P, Garepalli S. Sonographic assessment of lower uterine segment at term in women with previous cesarean delivery. Arch Gynecol Obstet 2011;283:455-9.

Basic E, Basic-Cetkovic V, Kozaric H, Rama A. Ultrasound evaluation of uterine scar after cesarean section. Acta Inform Med 2012;20:149-53.

Indira KL. Ultrsonographic monitoring of scarred lower uterine segment during pregnancy IOSR J Dent Med Sci 2015;14:56-61.

Brahmalakshmy BL, Kushtagi P. Variables influencing the integrity of lower uterine segment in post-cesarean pregnancy. Arch Gynecol Obstet 2015;291:755-62.

Jastrow N, Chaillet N, Roberge S, Morency AM, Lacasse Y, Bujold E. Sonographic lower uterine segment thickness and risk of uterine scar defect: A systematic review. J Obstet Gynaecol Can 2010;32:321-7.

Kok N, Wiersma IC, Opmeer BC, de Graaf IM, Mol BW, Pajkrt E. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: A meta-analysis. Ultrasound Obstet Gynecol 2013;42:132-9