Prediction of Uterine Dehiscence in the Nonpregnant Uterus
Prediction of Uterine Dehiscence in the Nonpregnant Uterus
The number of women who have undergone cesarean sections (CS) increases by 1.5 million every year. Thus, management of pregnant patients that have previously undergone CS has become routine in delivery rooms worldwide. However, we still don¿t have sufficient predictive factors for individualized assessment of the risk of uterine rupture. In addition, there are few tools for assessing the risk of uterine dehiscence, which itself is a strong risk factor for uterine rupture in vaginal birth after cesarean (VBAC).
The method currently used to predict CS scar rupture is ultrasonographic measurement of the thickness of the lower uterine segment (LUS) in gestational week 36¿38 as pioneered by Rozenberg et al. in 1996. The recent meta-analysis by Kok et al. supports the use of the LUS thickness for predicting uterine rupture during VBAC. However, the heterogeneity of the methods used to measure LUS limit the clinical usefulness of this factor and does not allow the determination of universal cut-off values.
Recently, Naji et al. introduced a standardized approach for imaging and measuring CS scars during pregnancy and provided reference values for CS scar dimensions up to the 34 week of gestation. They also suggested that uterine scar rupture is associated with smaller residual myometrial thickness and with greater decrease in its thickness during the course of the pregnancy.
Another globally accepted option for assessing the CS scar is transvaginal ultrasonography of the nonpregnant uterus. When compared to the transabdominal approach, the proximity of the transvaginal probe to the pelvic organs enables obtaining high resolution images of the CS scar. Several studies have assessed variations in the morphologic parameters of CS scars in the nonpregnant uterus in relation to the number of previously performed CS, clinical symptoms, flexion of the uterus, and maternal characteristics. However, the principal question remained unanswered: Can the morphological parameters of CS scars in nonpregnant uterus be used to predict the integrity of the scar in the next pregnancy?
A search of Pubmed identified just one study by Olga Vikhareva Osser and Lil Valentin that compares the appearance of the scar in the nonpregnant uterus with the outcome of subsequent pregnancies.
The aim of the present study was to assess whether the ultrasound parameters of CS scars in the nonpregnant uterus can be used to predict uterine dehiscence in the next pregnancy.
Background
The number of women who have undergone cesarean sections (CS) increases by 1.5 million every year. Thus, management of pregnant patients that have previously undergone CS has become routine in delivery rooms worldwide. However, we still don¿t have sufficient predictive factors for individualized assessment of the risk of uterine rupture. In addition, there are few tools for assessing the risk of uterine dehiscence, which itself is a strong risk factor for uterine rupture in vaginal birth after cesarean (VBAC).
The method currently used to predict CS scar rupture is ultrasonographic measurement of the thickness of the lower uterine segment (LUS) in gestational week 36¿38 as pioneered by Rozenberg et al. in 1996. The recent meta-analysis by Kok et al. supports the use of the LUS thickness for predicting uterine rupture during VBAC. However, the heterogeneity of the methods used to measure LUS limit the clinical usefulness of this factor and does not allow the determination of universal cut-off values.
Recently, Naji et al. introduced a standardized approach for imaging and measuring CS scars during pregnancy and provided reference values for CS scar dimensions up to the 34 week of gestation. They also suggested that uterine scar rupture is associated with smaller residual myometrial thickness and with greater decrease in its thickness during the course of the pregnancy.
Another globally accepted option for assessing the CS scar is transvaginal ultrasonography of the nonpregnant uterus. When compared to the transabdominal approach, the proximity of the transvaginal probe to the pelvic organs enables obtaining high resolution images of the CS scar. Several studies have assessed variations in the morphologic parameters of CS scars in the nonpregnant uterus in relation to the number of previously performed CS, clinical symptoms, flexion of the uterus, and maternal characteristics. However, the principal question remained unanswered: Can the morphological parameters of CS scars in nonpregnant uterus be used to predict the integrity of the scar in the next pregnancy?
A search of Pubmed identified just one study by Olga Vikhareva Osser and Lil Valentin that compares the appearance of the scar in the nonpregnant uterus with the outcome of subsequent pregnancies.
The aim of the present study was to assess whether the ultrasound parameters of CS scars in the nonpregnant uterus can be used to predict uterine dehiscence in the next pregnancy.
Source...