Lower uterine segment thickness to prevent uterine rupture and adverse perinatal outcomes: a multicenter prospective study

Jastrow, Nicole; Demers, Suzanne; Chaillet, Nils; Girard, M. Fusco; Gauthier, Robert; Pasquier, Jean-Charles; Abdous, Belkacem; Vachon-Marceau, Chantale; Marcoux, Sylvie; Irion, Olivier; Brassard, Normand; Boulvain, Michel; Bujold, Emmanuel

doi:10.1016/j.ajog.2016.06.018

Cited by 53 publications

(52 citation statements)

References 20 publications

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“…However, in these cases, residual myometrium thickness and isthmocele size were not evaluated. Residual myometrial thickness < 2 mm has been considered as high risk for uterine rupture, during trial labor after cesarean section; however, the reasons for this are not clear . In our study, 16 out of 18 patients improved, and residual myometrial thickness increased from 2.1 mm to 4.2 mm (median) following hysteroscopic surgery.…”

Section: Discussioncontrasting

confidence: 52%

“…Residual myometrial thickness < 2 mm has been considered as high risk for uterine rupture, during trial labor after cesarean section; however, the reasons for this are not clear. 8,9 In our study, 16 out of 18 patients improved, and residual myometrial thickness increased from 2.1 mm to 4.2 mm (median) following hysteroscopic surgery. This indicates that cauterization of the surface of isthmocele and resection of a small fraction under hysteroscopic surgery can reduce perinatal risks and these data validate our decision to permit pregnancy after MRI.…”

Section: Discussionsupporting

confidence: 48%

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Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome

Tsuji

Kimura

Yamanaka

et al. 2017

J of Obstet and Gynaecol

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Aim: Cesarean scar syndrome (CSS) is characterized by increased risk of postmenstrual abnormal uterine bleeding, dysmenorrhea, and infertility, due to a post-cesarean scar defect known as an isthmocele. This study aimed to assess the impact of hysteroscopic surgery on isthmocele associated with CSS. Methods: Eighteen patients with CSS were enrolled. Surgical methods included resection of the inferior edge and superficial cauterization of the isthmocele via hysteroscopic surgery. We evaluated the residual myometrial thickness and isthmocele volume using magnetic resonance imaging, before and after hysteroscopic surgery. Results: All patients underwent surgery without any complications. The residual myometrium was thicker after hysteroscopic surgery (median: 2.1 mm and 4.2 mm, before and after surgery, respectively; P = 0.0001). Isthmocele volume was significantly reduced after hysteroscopic surgery (median: 494.9 mm 3 and 282.8 mm 3, before and after surgery, respectively; P = 0.0016). Conclusion: This study demonstrated that hysteroscopic surgery is effective in increasing the residual myometrial thickness and reducing the size of isthmocele.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionsupporting

confidence: 48%

Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome

Tsuji

Kimura

Yamanaka

et al. 2017

J of Obstet and Gynaecol

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“…Na Nigéria, uma pesquisa retrospectiva apresentou incidência hospitalar de RU Estudo realizado em quatro centros de cuidados terciários mostrou que a integração da espessura do segmento uterino inferior na decisão sobre a via de parto está associada a um baixo risco de RU. Essa estratégia tem o potencial de levar a uma redução global da cesariana em mulheres com parto por cesariana anterior, assegurando tanto às mulheres quanto aos clínicos sobre a segurança relativa do julgamento do parto após a cesariana 45 . Outro estudo mostrou que casos de RU primária durante o parto por via vaginal foram mais suscetíveis de sofrer uma histerectomia do que aqueles que foram por cesariana (63% contra 9%).…”

Section: Discussionunclassified

Rotura uterina: uma revisão de literatura

Machado¹,

Moraes²

2017

Rev Pat Tocantins

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Direitos Autorais: © 2017 Machado et al. Este é um artigo de acesso aberto que permite o uso, a distribuição e a reprodução sem restrições em qualquer meio, desde que o autor original e a fonte sejam creditados. Conflito de interesses RESUMOIntrodução: A ruptura uterina (RU) é uma emergência obstétrica com o maior risco de morbidade e mortalidade para a mãe e principalmente para o feto. Apesar da ausência de definição consistente na literatura, a RU pode ser descrita como deiscência ou ruptura da parede do útero, precedendo eventos sintomáticos ou clinicamente significativos. Objetivo: abordar a RU por meio de revisão da literatura existente, a fim de fornecer dados atualizados aos profissionais que lidam com essa complicação obstétrica. Metodologia: Foi realizada uma pesquisa nas bases Science Direct, Pub Med e Google Scholar para publicações de dezembro de 2012 a agosto de 2017 sobre a ocorrência de ruptura uterina utilizando a palavra chave: uterine break. Foram incluídos para a revisão 53 artigos. Os dados encontrados nos relatos de casos foram analisados em frequências absolutas e relativas. Resultados: Em revisão dos relatos de caso encontrados, constatou-se que o principal sintoma relatado pelas pacientes no momento do diagnóstico de RU foi dor abdominal intensa. A idade média relatada das pacientes foi de 30,14 anos. A maioria encontrava-se no terceiro trimestre de gestação (51,85%). Ocorreu morte fetal em 64,28% dos casos e nenhuma morte materna foi relatada. A principal conduta obstétrica foi a laparotomia exploradora (LE) (85,71%). A localização do defeito uterino ocorreu principalmente na parede anterior, e a causa provável mais relatada foi a deiscência de cicatriz prévia (35,71%). Constatamos que o fator de risco (FR) para RU mais citado foi cesariana anterior/cicatriz uterina. Conclusão: A RU deve ser pensada como diagnóstico possível sempre que uma gestante se apresente com dor abdominal aguda e presença de coleção líquida na cavidade peritoneal, mesmo que esteja no início da gestação e não apresente FR identificados na história obstétrica. Palavras-chave: Ruptura uterina, Gravidez, Ruptura uterina na gravidez, Desfecho materno, Desfecho fetal. ABSTRACTIntroduction: Uterine rupture (UR) is an obstetric emergency with the highest risk of morbidity and mortality for the mother and especially for the fetus. Despite the lack of consistent definition in the literature, UR can be described as dehiscence or rupture of the uterine wall, preceding symptomatic or clinically significant events. Objective: to approach the UK through a review of the existing literature, in order to provide updated data to professionals dealing with this obstetric complication. Methodology: A study was carried out at the bases Science Direct, Pub Med and Google Scholar for publications from December 2012 to August 2017 on the occurrence of UR using the key word: uterine break. 53 articles were included for the review. Data found in the case reports were analyzed in absolute and relative frequencies. Results: In review of the ...

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“…13 And since residual myometrial thickness of less than 2 mm is associated with a significant increase in the risk of uterine rupture, this technique should theoretically be associated with decreased possibility of a uterine rupture during subsequent trials of labor. 14,15 Similarly, the duration of menses after hysteroscopic treatment of isthmocele was shown to be significantly shorter from a mean of 12 days to 7.8 days along with a significant increase in patient satisfaction. 16 Another prospective study evaluated 41 patients with secondary infertility, abnormal uterine bleeding after their menses and suprapubic pelvic pain, diagnosed with a cesarean scar defect.…”

Section: Histologic Analysis Of the Scar Edges Usually Show Chronic Imentioning

confidence: 95%

Hysteroscopy Versus Laparoscopy in the Management of Isthmocele: A Review of the Literature

Jaffal¹,

Mouanness²,

Salame³

et al. 2019

Women Health Open J

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ObjectiveIsthmocele is a pouch defect of the anterior uterine wall, detected at the site of the previous cesarean scar. It can be asymptomatic or cause abnormal uterine bleeding, pelvic discomfort and difficulty conceiving. The main objective of this review is to highlight the hysteroscopic and laparoscopic approaches in the management of this disorder. Main FindingsDuring the hysteroscopic approach, the superior and inferior edges or just the superior edge of the defect are resected, removing the fibrotic tissue and allowing renewal of the continuous canal between the cervix and the uterine cavity. Whereas, the laparoscopic approach consists of direct visualization and removal of the defect followed by re-approximation of the myometrium. Both methods lead to significant improvement in symptoms and fertility. ConclusionWhile hysteroscopy is a quick non-morbid procedure that allows concurrent removal of other uterine pathology, laparoscopy is characterized by improved visualization and decreased risk of complications with defects less than 3 mm as well as the possible correction of uterine retroversion. Definitely, randomized controlled trials are required in this field for better guidance of the diagnosis and management.

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Lower uterine segment thickness to prevent uterine rupture and adverse perinatal outcomes: a multicenter prospective study

Cited by 53 publications

References 20 publications

Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome

Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome

Rotura uterina: uma revisão de literatura

Hysteroscopy Versus Laparoscopy in the Management of Isthmocele: A Review of the Literature

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