TITLE:
Measurements of the Lower Uterine Segment at Term in Women with Previous Cesarean Delivery
AUTHORS:
Tadatsugu Kinjo, Hitoshi Masamoto, Keiko Mekaru, Yusuke Taira, Yukiko Chinen, Hayase Nitta, Yoichi Aoki
KEYWORDS:
Lower Uterine Segment, Sonographic Measurement, Previous Cesarean, Uterine Rupture, Uterine Dehiscence
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.6 No.1,
January
11,
2016
ABSTRACT: Purpose: To evaluate the accuracy of sonographic measurements of the
lower uterine segment (LUS) thickness at term in predicting uterine scar
defects in women with previous Cesarean delivery (CD). Methods: Eighty-nine
pregnant women who underwent CD between 37 and 41 weeks of gestation from 2013
to 2015 were enrolled in this study and divided into two groups. Group A
consisted of women with previous CD, and Group B consisted of women with
previous vaginal deliveries. We performed an ultrasound evaluation of the
myometrial and full thickness of LUS (mLUS and fLUS) transvaginally before a CD
and evaluated the appearance of LUS during surgery, which was defined as
follows: grade I, well-developed; grade II, thin without visible content; grade
III, translucent with visible content; and grade IV, either dehiscence or
rupture. Results: The median mLUS and fLUS were 1.50 and 4.07 mm in the group
A, and 2.75 and 5.37 mm in the group B. We observed significant differences in
the median mLUS and fLUS between grades I/II (2.07 and 4.37 mm) and grades
III/IV (0.67 and 2.52 mm). Both mLUS and fLUS were predictive factors for
grades III/IV and cutoff values were 0.97 mm of mLUS and 3.13 mm of fLUS,
having a sensitivity of 87.5% and 75.0%, and a specificity of 87.7% and 91.4%
in mLUS and fLUS measurement, respectively. Conclusion: Sonographic
measurements of LUS at term may be a feasible and reliable method to predict
uterine rupture or uterine dehiscence in women with prior CD.