Ultrasound elastography of the lower uterine segment in women with a previous cesarean section: Comparison of in-/ex-vivo elastography versus tensile-stress-strain-rupture analysis

Seliger, G; Chaoui, K; Lautenschläger, Christine; Jenderka, Klaus-Vitold; Kunze, Christian; Hiller, Grit Gesine Ruth; Tchirikov, M

doi:10.1016/j.ejogrb.2018.04.013

Cited by 10 publications

(3 citation statements)

References 47 publications

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“…This decrease in stiffness is statistically and clinically relevant, with moderate effect ( W = 0.30). Observations are consistent with the expected behavior as observed by Seliger et al, Buhimschi et al, and Kiener et al, 40–42 who found that stiffness is present following a C-section, although they focused on uterine scars. The authors observed that stiffness is also present within the superficial scar tissue layers.…”

Section: Discussionsupporting

confidence: 91%

Exploring the Effects of Standardized Soft Tissue Mobilization on the Viscoelastic Properties, Pressure Pain Thresholds, and Tactile Pressure Thresholds of the Cesarean Section Scar

Gilbert

Gaudreault

Gaboury

2022

Journal of Integrative and Complementary Medicine

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Background: Objectives of soft tissue mobilization applied to cesarean section (C-section) scars are to decrease stiffness and to reduce pain. Research investigating these effects is lacking. Materials and methods: The authors conducted a descriptive, exploratory, proof-of-concept clinical study. Women aged 18 to 40 years who had undergone at least one C-section were recruited. A trained osteopath performed standardized mobilization of the C-section scar once a week for 2 weeks. Scar quality and pain characteristics, viscoelastic properties, pressure pain thresholds, and tactile pressure thresholds were measured before and after each session. Paired Student's t -tests and Friedman's test with Dunn–Bonferroni adjustment were performed to assess the immediate and short-term effects of mobilizations. Kendall's W and Cohen's d were calculated to determine effect sizes over the short term. Simple bootstrapped bias-corrected and accelerated 95% median confidence intervals were computed. Results: Thirty-two participants completed the study. The Patient and Observer Scar Assessment Scale questionnaire revealed differences with small and moderate effects for stiffness ( p = 0.021, d = 0.43), relief ( p < 0.001, d = 0.28), surface area ( p = 0.040, d = 0.36), flexibility ( p = 0.007, d = 0.52), and participant opinion ( p = 0.001, d = 0.62). Mobilizations increased elasticity ( p < 0.001, W = 0.11), decreased stiffness ( p < 0.001, W = 0.30), and improved pressure pain thresholds ( p < 0.001, W = 0.10) of the C-section, with small to moderate effects. The results also showed decreased tone and mechanical stress relaxation time, as well as increased tactile pressure thresholds at the different measurement times ( p < 0.05), but trivial effect sizes ( W < 0.10). Creep showed trivial effect and no significant difference ( p = 0.09). Conclusion: This study showed that two sessions of mobilization of C-section scar might have a beneficial effect on some viscoelastic properties of the C-section as well as on pain. Some variables of interest useful for future empirical studies are highlighted. ClinicalTrial. Gov NCT04320355.

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Section: Discussionsupporting

confidence: 91%

Exploring the Effects of Standardized Soft Tissue Mobilization on the Viscoelastic Properties, Pressure Pain Thresholds, and Tactile Pressure Thresholds of the Cesarean Section Scar

Gilbert

Gaudreault

Gaboury

2022

Journal of Integrative and Complementary Medicine

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“…Möglicherweise ist die Sonografie des uUS besser für die Diagnostik als für die Vorhersage von Uterusdefekten geeignet. Es gibt Hinweise, dass die Belastungsfähigkeit und Integrität des Narbengewebes unter der Geburt weniger von der Dicke als von seinen biochemischen und physikalischen Eigenschaften abhängig sind [27,28]. Hierfür spricht auch, dass in einer prospektiven Studie keine Korrelation zwischen der Dicke der residuellen Myometriumschicht im ersten Trimenon und der Dicke des uUS im dritten Trimenon oder dem Auftreten von Uterusdefekten bestand [29].…”

Section: Materials Und Methodikunclassified

Verbessert die Diagnostik des unteren Uterinsegments die Geburtsplanung bei Status nach Sectio?

Schmitz

Stepan²,

Schrey-Petersen³

et al. 2019

Z Geburtshilfe Neonatol

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Zusammenfassung Einleitung Bei Patientinnen mit Status nach Sectio ist die sonografische Diagnostik des unteren Uterinsegments (uUS) weit verbreitet. Ihr Nutzen für die Geburtsplanung ist jedoch nicht ausreichend belegt. Es gibt weder ein einheitliches Untersuchungsprotokoll noch einen sicheren Cut-off-Wert. Ziel dieser Studie war es, den Wert der uUS-Diagnostik in der klinischen Routine zu prüfen. Material und Methoden In die retrospektive Analyse wurden 631 Patientinnen mit Status nach Sectio eingeschlossen. Bei 399 (63%) Patientinnen war eine sonografische Dickenmessung des Myometriums (muUS) und/oder des gesamten uUS (guUS)) erfolgt. Die Inzidenz von Uterusdefekten sowie der Zeitpunkt und die Modalität ihrer Diagnostik wurden eruiert. Sensitivitäten, Spezifitäten, positive (PPV) und negative prädiktive Werte (NPV) wurden für verschiedene Cut-offs errechnet. Ergebnisse Uterusdefekte traten bei 28 (4,4%) Patientinnen auf. Die Detektionsrate für die Sonografie war gering (13,6%), die Sensitivität/ Spezifität/ PPV/ NPV für niedrigere Cut-off-Werte (2 mm (guUS)/ 1 mm (muUS): 75/96/48,3/98,7%) jedoch besser als für höhere (3 mm (guUS)/ 2 mm (muUS): 15,8/93,2/10,4/68,7%). Diskussion Der Nutzen der sonografischen uUS-Diagnostik erscheint überschätzt. Da ihre Genauigkeit von zahlreichen methodischen Faktoren beeinflusst wird, könnte sie durch ein einheitliches Protokoll mit einem transabdominellen und transvaginalen Scan durch einen erfahrenen Untersucher verbessert werden. Ein geeigneteres Untersuchungsziel für die Selektion nach Sectio könnte der Ausschluss von Uterusdefekten sein.

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“…Another small experimental study used shear wave elastography both in vivo and ex vivo to evaluate the LUS thickness and its relation to tensile strength of the cesarean scar tissue. 18 The patients, all who had prior cesarean deliveries, received an ultrasound 24 hours before repeat cesarean birth, and shear wave elastography was used to measure the stiffness of the tissue. At the time of planned cesarean delivery, ultrasound was used to identify the thinnest portion of the LUS/prior scar, which was then surgically resected in full thickness.…”

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confidence: 99%

Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review

McLeish

Murchison

Smith

et al. 2023

Obstetrical &Amp; Gynecological Survey

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Importance: Uterine rupture during labor is a calamitous event that can result in maternal/neonatal morbidity/ mortality. Lower uterine segment (LUS) thickness measurement is a proposed method to determine the risk factor of uterine rupture in women undergoing trial of labor after cesarean. Does this measurement predict uterine rupture risk?Objectives: This review examines current evidence to determine if a thin LUS ultrasound diagnosis during pregnancy with prior cesarean delivery(s) can reliably predict uterine rupture risk while attempting vaginal birth after cesarean (VBAC).Evidence Acquisition: Electronic databases (PubMed and CINAHL) were searched with one limitation of abstracts in English. Search terms used were "lower uterine segment" AND "risk(s)" AND "rupture" OR "dehiscence.Results: After reviewing 164 identified articles, 15 were used in this review. Of the studies including LUS thickness measurement, notable differences were found: gestational age at time of measurement, full thickness measurement versus myometrial thickness, number of sonographers involved, ultrasound technique (transabdominal vs transvaginal), and blinding. Other factors influencing LUS thickness include fetal weight, amniotic fluid volume, and gestational age. The most recent systematic review and meta-analysis suggests that an LUS > 3.65 mm should be safe for a VBAC, 2-3.65 mm is probably safe, and <2 mm identifies a patient at higher risk for uterine rupture/dehiscence.Conclusions: Study heterogeneity, absence of an agreed upon thickness threshold, poor correlation between ultrasound and MRI measurements, or physical cesarean measurements currently make VBAC uterine rupture risk prediction uncertain.Relevance: Our aim is to analyze existing literature to determine if evidence supports LUS measurement in women undergoing VBAC after cesarean to determine risk of uterine rupture.Target Audience: Obstetricians and gynecologist, family physicians Learning Objectives: After completing this learning activity, the participant should be able to identify the differences and how they occur between studies evaluating the thinness of the LUS in women undergoing a trial of labor after cesarean delivery; compare the accuracy of LUS measurement between ultrasound, MRI, and physical measurement at cesarean delivery; and describe the factors that influence the thinness of the LUS.Uterine rupture is an acute catastrophic event that mandates a timely diagnosis and immediate operative intervention for the best maternal/fetal outcome. Although an uncommon even during labor with an incidence of 22/10,000 births, uterine rupture is one of the true obstetric emergencies. 1 All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity.

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Ultrasound elastography of the lower uterine segment in women with a previous cesarean section: Comparison of in-/ex-vivo elastography versus tensile-stress-strain-rupture analysis

Cited by 10 publications

References 47 publications

Exploring the Effects of Standardized Soft Tissue Mobilization on the Viscoelastic Properties, Pressure Pain Thresholds, and Tactile Pressure Thresholds of the Cesarean Section Scar

Exploring the Effects of Standardized Soft Tissue Mobilization on the Viscoelastic Properties, Pressure Pain Thresholds, and Tactile Pressure Thresholds of the Cesarean Section Scar

Verbessert die Diagnostik des unteren Uterinsegments die Geburtsplanung bei Status nach Sectio?

Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review

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