Main Article Content
Objective: The purpose of the study was to establish the validity of the abdominal evaluation of lower uterine segment (LUS) thickness in patients having a previous cesarean section (CS) in predicting uterine rupture, and to evaluate if there is any effect of the number of a previous surgeries on adverse maternal and perinatal outcomes.
Materials and methods: A prospective case-control study was carried out between December 2017 and June 2018 in Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital. 555 patients were classified into three groups; Group 1: patients having one previous CS, Group 2: patients having two previous CS, Group 3: patients having more than the two previous CS). Ultrasonographic measurements of the LUS, intraoperative findings and, adverse pregnancy outcomes were assessed.
Results: LUS thickness of group 2 was significantly less than the LUS thickness of the other groups (p=0.022). The feeling of pain was significantly more in the patients of group 2, when compared with the other groups (p=0.019). Pregnancy interval was the only parameter that had significant predictivity for adverse pregnancy outcomes for group 1(#CS=2) and group 3 (#CS≥4) (p=0.042, and p=0.021, respectively). In group 2 (#CS=3), age, the thickness of LUS, and thickness of subcutaneous adipose tissue were found to have significantly high predictivity for adverse pregnancy outcomes (p=0.012, p≤0.001, and p=0.007, respectively).
Conclusion: Measurement of LUS, in the patients who had previous CS, can be used for risk assessment and management. It is a non-invasive, reliable and, easily applicable method. Standardization of the measurement technique is a necessity.
Hofmeyr GJ, Say L, Gulmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG 2005;112(9):1221-1228.
Gardeil F, Daly S, Turner MJ.Uterine rupture in pregnancy reviewed. Eur J Obstet Gynecol Reprod Biol. 1994;56(2):107-110.
Wen SW, Rusen ID, Walker M, Liston R, Kramer MS, Baskett T, Heaman M, Liu S. Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery. Am J Obstet Gynecol 2004;191(4):1263–1269.
Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu RR, Janik R, Nygren P, Walker M, McDonagh M. Vaginal birth after cesarean: new insights. Evid Rep Technol Assess (Full Rep). 2010;191:1-397.
Kaczmarczyk M, Sparen P, Terry P, Cnattingius S. Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden. BJOG 2007;114(10):1208-1214.
Chauhan SP, Martin JN Jr, Henrichs CE, Morrison JC, Magann EF. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: a review of the literature. Am J Obstet Gynecol. 2003;189(2):408-417.
Al-Zirqi I, Daltveit AK, Forsén L, Stray-Pedersen B, Vangen S. Risk factors for complete uterine rupture. Am J Obstet Gynecol. 2017 Feb;216(2):165-168.
Fukuda M, Fukuda K, Mochizuki M. Examination of previous caesarean section scars by ultrasound. Arch Gynecol Obstet 1988; 243: 221-224.
Rozenberg P, Goffinet F, Philippe HJ, Nisand I. Ultrasonographic measurement of lower uterine segment to assess risk of defects of scarred uterus. Lancet 1996; 347: 281-284.
Bujold E, Jastrow N, Simoneau J, Brunet S, Gauthier RJ. Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment. Am J Obstet Gynecol 2009; 201: 321-326.
Cheung VY, Constantinescu OC, Ahluwalia BS. Sonographic evaluation of the lower uterine segment in patients with previous cesarean delivery. J Ultrasound Med 2004; 23: 1441 –1447.
Cheung VY. Sonographic measurement of the lower uterine segment thickness in women with previous caesarean section. J Obstet Gynaecol Can 2005; 27: 674 – 681.
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 – 219.
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: 321-327.
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(2):132 139.
Ginsberg Y, Goldstein I, Lowenstein L, Weiner Z. Measurements of the lower uterine segment during gestation. J Clin Ultrasound. 2013 May;41(4):214-217
Landon MB, Spong CY, Thom E, et al. Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery. Obstet Gynecol. 2006; 108:12–20.
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(1):55–65.
Chapman K, Meire H, Chapman R. The value of serial ultrasound in the management of recurrent uterine scar rupture. Brit J Obstet Gynecol 1994; 101: 549–551
You SH, Chang YL, Yen CF. Rupture of the scarred and unscarred gravid uterus: Outcomes and risk factors analysis. Taiwan J Obstet Gynecol. 2018 Apr;57(2):248-254
Shipp TD, Zelop CM, Repke JT, Cohen A, Lieberman E. Interdelivery interval and risk of symptomatic uterine rupture. Obstet Gynecol.2001; 97: 175-177
Stamilio DM, DeFranco E, Paré E, Odibo AO, Peipert JF, Allsworth JE, Stevens E, Macones GA. Short interpregnancy interval: risk of uterine rupture and complications of vaginal birth after cesarean delivery. Obstet Gynecol. 2007;110(5):1075-1082.
Cohen A, Cohen Y, Laskov I, Maslovitz S, Lessing JB, Many A. Persistent abdominal pain over uterine scar during labor as a predictor of delivery complications. Int J Gynaecol Obstet. 2013;123(3):200–202.
Bergeron ME, Jastrow N, Brassard N, Paris G, Bujold E. Sonography of lower uterine segment thickness and prediction of uterine rupture. Obstet Gynecol. 2009 Feb; 113:520-522
Cheung VYT. Sonographic measurement of the lower uterine segment thickness: is it truly predictive of uterine rupture? J Obstet Gynaecol Can. 2008;30(2):148-151
Gotoh H, Masuzaki H, Yoshida A, Yoshimura S, Miyamura T, Ishimaru T. Predicting incomplete uterine rupture with vaginal sonography during the late second trimester in women with prior cesarean. Obstet Gynecol 2000; 95: 596 – 600.
Montanari L, Alfei A, Drovanti A, Lepadatu C, Lorenzi D, Facchini D, Iervasi MT, Sampaolo P. [Transvaginal ultrasonic evaluation of the thickness of the section of the uterine wall in previous cesarean sections]. Minerva Ginecol 1999; 51: 107–112.
Jastrow N, Antonelli E, Robyr R, Irion O, Boulvain M. Inter- and intraobserver variability in sonographic measurement of the lower uterine segment after a previous Cesarean section. Ultrasound Obstet Gynecol 2006; 27: 420 – 424.
Laflamme SM, Jastrow N, Girard M, Paris G, Berube L, Bujold E. Pitfall in ultrasound evaluation of uterine scar from prior preterm cesarean section. AJP Rep 2011;1: 65–68.
Holmgren C, Scott JR, Porter TF, Esplin MS, Bardsley T. Uterine rupture with attempted vaginal birth after cesarean delivery: decision-to-delivery time and neonatal outcome. Obstet Gynecol 2012; 119: 725–731.
Guiliano M, Closset E, Therby D, LeGoueff F, Deruelle P, Subtil D. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery. Eur J Obstet Gynecol Reprod Biol 2014; 179: 130–134.