Evaluation of The Lower Uterine Segment Thickness Via Sonogram In Pregnant Women With Previous One Cesarean Delivery | ||
| IRAQI JOURNALOF COMMUNITY MEDICINE | ||
| Article 1, Volume 29, Issue 1, March 2016, Pages 26-31 | ||
| Authors | ||
| Shaimaa S Athab; Iman F Hassan; Maha M Al-Bayati | ||
| Abstract | ||
| Background: Vaginal birth after cesarean section is a healthy issue. The success rate ranges from 50-77%. Several ultrasound studies have been performed to predict the appropriate lower uterine segment thickness for a safe trial of labour and the risk of uterine rupture during a trial of labor after cesarean section by measuring Lower Uterine Segment thickness. Objective: To evaluate the appearance of the lower uterine segment by ultrasound in pregnant women with previous cesarean delivery and to compare it with that in women with unscarreduteri. Methods: A prospective study was conducted from the beginning of March 2010 to the end of June 2011 in the department of Obstetrics and Gynecology at AL- Kadhimiya Teaching Hospital, Sonographic examination was performed on107 pregnant women: 53 pregnant women with history of previous cesarean delivery(study group), 31nulliparas (nullip-control), and 23 women who had 1 or more childbirths with unscarred uteri (multip-control)with gestational age 36 and 39 weeks of gestation both study and control groups were subjected to sonography to assess & compare lower uterine segment. In the cesarean group, the sonographic findings were correlated with the delivery outcome and the intraoperative Lower uterine segment appearance. Results The study revealed44 patients (83.0%) had a normal-appearing lower uterine indistinguishable from that of control group. 2patients (3.8%) had a sonographically very thin lower uterine segment thickness measurement suggestive of future dehiscence; and 7 patients (13.2%) had thickened areas of increased ecohogenicity with or without myometrial thinning. Although the cesarean group had a thinner lower uterine segment (3.6 ±0.9 mm) when compared with both the nullip-control group (3.8± 0.8 mm; P = .02) and the multip-control group (4.01± 1.3 mm; P = .04). Only the latter difference achieved statistical significance. One of the 2 patients who had a sonographically suspected lower uterine segment defect had confirmed uterine dehiscence during surgery. An intra-operatively diagnosed paper-thin lower uterine segment, when compared with a lower uterine segment of normal thickness, had significantly smaller sonographic lower uterine segment measurement. Conclusion: Prior cesarean delivery is associated with a sonographically thinner lower uterine segment when compared with those with prior vaginal delivery. Prenatal sonographic examination is potentially capable of diagnosing a uterine defect and determining the degree of lower uterine segment thinning in patients with previous cesarean delivery. | ||
| Keywords | ||
| Sonography; Lower uterine segment thickness; Pregnant; Previous one caesarean delivery | ||
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