OPERATIVE AND ULTRA-SONOLOGICAL ASSESSMENT OF LOWER UTERINE SEGMENT THICKNESS IN PREDICTING SCAR DEHISCENCE

Sidra Batool, Hira Naeem, Hafiza Fareeha, Ayesha Naeem, Kamran Waheed, Muhammad Adnan Rashid, Muhammad Saddozai

Abstract


Background: As caesarean section rates are increasing so a valid, non-invasive and reliable method to assess integrity of caesarean scar is required to select patients for safe trial of labour. The objective of this study was to determine accuracy of ultrasound-based lower uterine segment thickness assessment in predicting risk of scar dehiscence in women with previous one lower uterine caesarean scar.

Materials & Methods: The study design was descriptive longitudinal conducted in Gynae and Obstetrics Department, PIMS Hospital, Islamabad for the duration of 6 months. Sample size was 93 and sampling technique was consecutive non probability. Our sociodemographic variables were age and parity. Our research variables were thickness of lower uterine segment on ultrasonography and scar thickness intraoperatively. Data was stratified for age and parity and validity of ultrasound findings was evaluated taking intra-operative scar assessment as gold standard. All variables were described descriptively as frequency and percentages for each stratum. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of USG assessment was calculated.

Results: The sensitivity, specificity, PPV, NPV and diagnostic accuracy of ultrasonographic findings was 89.36%, 91.3%, 91.3%, 89.36%, 90.32% respectively taking intra-operative scar assessment as gold standard.

Conclusion: The measurement of lower uterine segment thickness by transabdominal ultrasound agrees strongly with intra-operative assessment having high diagnostic accuracy.


Keywords


Ultrasonography; caesarean section; age; parity.

Full Text:

PDF

References


Thomas A, Rebekah G, Vijayaselvi R, Jose R. Transvaginal Ultrasonographic Measurement of Lower Uterine Segment in Term Pregnant Patients with Previous Cesarean Section. Open J Obstet Gynecol 2015;5:646-53. https://doi.org/10.4236/ojog.2015.511091

Asakura H, Nakai A, Ishikawa G, Suzuki S, Araki T. Prediction of Uterine Dehiscence by Measuring Lower Uterine Segment Thickness Prior to the Onset of Labor. J Nippon Med Sch 2015;67(5):352-6. https://doi.org/10.1272/jnms.67.352

AbosireM, Elhadi Mohammad Farah MA. Prediction of cesarean section scar dehiscence before delivery using three dimensional Transabdominal ultrasonography. Benha Med J 2015;32:101-6. https://doi.org/10.4103/1110-208X.180322

ManourGM, ElMekkawiSF, khairyHT, Mossad AEM. Feasibility of prediction of cesarean section scar dehiscence in the third trimester by three-dimensional ultrasound. J Matern Fetal Neonatal Med. 2015;28:944-8. https://doi.org/10.3109/14767058.2014.938626

Birth After Previous Caesarean Birth, RCOG Greentop Guideline 45 October 2015.

LeeJ, kimKW, choiSH, HuhJ, ParkSH. Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers. Korean J Radiol 2015;16:1188-96. https://doi.org/10.3348/kjr.2015.16.6.1188

IonescuLA, VladareanuS, BratilaE. Uterine rupture risk assessment with third trimester transvaginal ultrasonography in women with previous cesarean section. Gineco eu 2017;13(3):97- https://doi.org/10.18643/gieu.2017.97

SatpathyG, Kumari,MatahM. VermaA. Comparative accuracy of magnetic resonance morphometry at sonography in assessment of post - cesarean uterine scar. Indian J Radiol Imaging 2018;28(2):169-74. https://doi.org/10.4103/ijri.IJRI_325_17

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 Gynecol India. 2015;65:97-103. https://doi.org/10.1007/s13224-014-0630-4

Mohammad Rashad Amer T, Ahmad Mohammad Ali A. Lower uterine segment thickness measurement and uterine scar integrity in pregnant women with prior cesarean section using two-dimensional transabdominal ultrasound: a prospectivecontrolled study in sharm international hospital. Al-Azhar Medical Journal. 2022 Jul 1;51(3):1837-50. https://doi.org/10.21608/amj.2022.245224

Uharček P, Brešťanský A, Ravinger J, Máňová A, Zajacová M. Sonographic assessment of lower uterine segment thickness at term in women with previous cesarean delivery. Arch gynecol obstet 2015;292(3):609-12. https://doi.org/10.1007/s00404-015-3687-0

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(7):830-41. https://doi.org/10.1111/aogs.13585

Rozenberg P, Sénat MV, Deruelle P, Winer N, Simon E, Ville Y, Kayem G, Porcher R, Perrodeau É, Desbrière R, Boutron I. Evaluation of the usefulness of ultrasound measurement of the lower uterine segment before delivery of women with a prior cesarean delivery: a randomized trial. Am J Obstet Gynecol 2022 ;226(2):253-e1. https://doi.org/10.1016/j.ajog.2021.08.005

Uharček P, Brešťanský A, Ravinger J, Máňová A, Zajacová M. Sonographic assessment of lower uterine segment thickness at term in women with previous cesarean delivery. Arch gynecol obstet 2015 Sep;292:609-12. https://doi.org/10.1007/s00404-015-3687-0

Jastrow N, Demers S, Chaillet N, Girard M, Gauthier RJ, Pasquier JC, Abdous B, Vachon-Marceau C, Marcoux S, Irion O, Brassard N. Lower uterine segment thickness to prevent uterine rupture and adverse perinatal outcomes: a multicenter prospective study. Am J obstet and gynecol 2016 Nov 1;215(5):604-e1. https://doi.org/10.1016/j.ajog.2016.06.018

Ashmawy NI, El Noury MA, Assar TM, El Gawad AM. Sonographic Assessment of Lower Uterine Segment Thickness in Patients with Previous Single Cesarean Section. Benha J Appl Sci 2020 Mar 1;5:181-5. https://doi.org/10.21608/bjas.2020.135953




DOI: https://doi.org/10.46903/gjms/22.02.1593

Refbacks

  • There are currently no refbacks.


Copyright (c) 2024. Sidra Batool, Hira Naeem, Hafiza Fareeha, Ayesha Naeem, Kamran Waheed, Muhammad Adnan Rashid, Muhammad Saddozai

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Gomal Medical College, Daraban Road, Dera Ismail Khan, Pakistan

ISSN: 1819-7973, e-ISSN: 1997-2067

Website: https://www.gmcdikhan.edu.pk

Phone: +92-966-747373

Scimago Journal & Country Rank