Intrapartum ultrasound measurement of the lower uterine segment thickness in parturients with previous scar in labor: a cross-sectional study

Alalaf, Shahla K.; Mansour, Tarek; Sileem, Sileem Ahmad; Shabila, Nazar P.

doi:10.1186/s12884-022-04747-3

Cited by 9 publications

(5 citation statements)

References 35 publications

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“…Additionally, a full LUS thickness of 2.3 mm in women during the first stage of labor is associated with a high risk of complete uterine rupture during a trial of labor. We believe that measuring the full thickness of the LUS may be of practical use when deciding on the mode of delivery and may lead to a reduction in the incidence of uterine ruptures [24]. Despite the high predictive value of this measurement, in our case, it did not protect the patient from uterine rupture.…”

Section: Discussionmentioning

confidence: 55%

Unexpected Uterine Rupture—A Case Report, Review of the Literature and Clinical Suggestions

Flis,

Socha,

Wartęga

et al. 2023

JCM

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Background and Objectives: Women with a history of cesarean section are a high-risk group because they are likely to develop uterine rupture during their next pregnancy. Current evidence suggests that a vaginal birth after cesarean section (VBAC) is associated with lower maternal mortality and morbidity than elective repeat cesarean delivery (ERCD). Additionally, research suggests that uterine rupture can occur in 0.47% of cases of trial of labor after cesarean section (TOLAC). Case Description: A healthy 32-year-old woman at 41 weeks of gestation, in her fourth pregnancy, was admitted to the hospital due to a dubious CTG record. Following this, the patient gave birth vaginally, underwent a cesarean section, and successfully underwent a VBAC. Due to her advanced gestational age and favorable cervix, the patient qualified for a trial of vaginal labor (TOL). During labor induction, she displayed a pathological CTG pattern and presented symptoms such as abdominal pain and heavy vaginal bleeding. Suspecting a violent uterine rupture, an emergency cesarean section was performed. The presumed diagnosis was confirmed during the procedure—a full-thickness rupture of the pregnant uterus was found. The fetus was delivered without signs of life and successfully resuscitated after 3 min. The newborn girl of weight 3150 g had an Apgar score of 0/6/8/8 at 1, 3, 5, and 10 min. The uterine wall rupture was closed with two layers of sutures. The patient was discharged 4 days after the cesarean section without significant complications, with a healthy newborn girl. Conclusions: Uterine rupture is a rare but severe obstetric emergency and can be associated with maternal and neonatal fatal outcomes. The risk of uterine rupture during a TOLAC attempt should always be considered, even if it is a subsequent TOLAC.

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Section: Discussionmentioning

confidence: 55%

Unexpected Uterine Rupture—A Case Report, Review of the Literature and Clinical Suggestions

Flis,

Socha,

Wartęga

et al. 2023

JCM

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“…According to Alalaf et al, there is a greater probability of uterine defects during a labor trial if the first stage of labor is characterized by a lower uterine segment thickness of 2.3mm and a myometrial thickness of 1.9mm. The body mass index, birth weight, inter-delivery interval, mother age, or gestational age at labor did not correlate with the uterine defects [16] .…”

Section: Discussionmentioning

confidence: 73%

Correlation between Sonographic Caesarean Section Scar Thickness and Intraoperative Appearance of Lower Uterine Segment

Bassiony,

kamal,

Fikry

et al. 2024

Evidence Based Women's Health Journal

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Objective: Detection of the relation between transvaginal ultrasound measurement of cesarean scar thickness with intraoperative uterine scar grading assessed sonographically, and intraoperative integrity. Patients and Methods: A total of 44 pregnant women with previous CS scheduled for elective caesarean delivery at term were enrolled and subjected to pre-delivery transvaginal ultrasound examination of caesarean scar thickness and correlated with intraoperative lower uterine segment grading. Results:The best cut off value of transvaginal sonographic measurements of caesarean section scar thickness for detection of dehiscence was <3.5 mm i.e. grade III and IV with sensitivity 75%% and specificity 88.9%, positive predictive value 60% and negative predictive value 94.1%. The mean value of cesarean section scar thickness was 2.32±0.40mm for scar dehiscence group. Conclusion:Transvaginal sonographic measurements of caesarean section scar thickness had a proper sensitivity in prediction of possibility of cesarean scar dehiscence and it give an idea about risk and benefits of performing trial of labor after cesarean section.

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“…Previous studies by us 34 and He et al 35 found that lower uterine segment thickness reduction was associated with uterine rupture and TOLAC failure in women who underwent planned cesarean delivery. Sonography of the lower uterine segment in the pregnancy interval or first trimester, 36 before labor, 34 or during labor 37 have been reported, together with a standardized ultrasonic evaluation and reporting system for cesarean delivery scar pregnancy in the first trimester 38 . It could be an option to also measure the lower uterine segment or scar before and during labor as an independent prediction factor.…”

Section: Discussionmentioning

confidence: 99%

Prediction of vaginal birth after cesarean in China

Rao

Fan

et al. 2023

Intl J Gynecology & Obste

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ObjectiveThis study aimed to develop and validate a prediction model of vaginal birth after cesarean delivery (VBAC) in China.MethodsA nomogram for effective prediction of VBAC of singleton, cephalic and one previous low‐transverse cesarean section deliveries was created by comparing the combinations of ultrasonographic and non‐ultrasonographic factors from five hospitals between 2018 and 2019.ResultsA total of 1066 women were included. Of the women who underwent trial of labor after cesarean (TOLAC), 854 (80.1%) had a VBAC. Ultrasound factors included reached a higher area under the curve (AUC) combined with non‐ultrasonographic factors. Of the three ultrasonographic factors analyzed, the best predictive factor for successful TOLAC was fetal abdominal circumference. A nomogram was generated with eight validated factors, including maternal age, gestational week, height, previous vaginal delivery, Bishop score, dilatation of the cervix at the time of admission, body mass index at delivery, and fetal abdominal circumference by ultrasound. The trained and validated AUC were 0.719 (95% confident interval 0.674–0.764) and 0.774 (95% confident interval 0.712–0.837), respectively.ConclusionOur VBAC nomogram based on obstetric factors and fetal abdominal circumference obtained by ultrasound could be used to counsel women who are considering TOLAC.

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Intrapartum ultrasound measurement of the lower uterine segment thickness in parturients with previous scar in labor: a cross-sectional study

Cited by 9 publications

References 35 publications

Unexpected Uterine Rupture—A Case Report, Review of the Literature and Clinical Suggestions

Unexpected Uterine Rupture—A Case Report, Review of the Literature and Clinical Suggestions

Correlation between Sonographic Caesarean Section Scar Thickness and Intraoperative Appearance of Lower Uterine Segment

Prediction of vaginal birth after cesarean in China

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