Sonographic lower uterine segment thickness and risk of uterine scar defect: a systematic review.
ABSTRACT To study the diagnostic accuracy of sonographic measurements of the lower uterine segment (LUS) thickness near term in predicting uterine scar defects in women with prior Caesarean section (CS).
PubMed, Embase, and Cochrane Library (1965-2009).
Studies of populations of women with previous low transverse CS who underwent third-trimester evaluation of LUS thickness were selected. We retrieved articles in which number of patients, sensitivity, and specificity to predict a uterine scar defect were available.
Twelve eligible studies including 1834 women were identified. Uterine scar defect was reported in a total of 121 cases (6.6%). Seven studies examined the full LUS thickness only, four examined the myometrial layer specifically, and one examined both measurements. Weighted mean differences in LUS thickness and associated 95% confidence intervals between women with and without uterine scar defect were calculated. Summary receiver operating characteristic (SROC) analysis and summary diagnostic odds ratios (DOR) were used to evaluate and compare the area under the curve (AUC) and the association between LUS thickness and uterine scar defect. Women with a uterine scar defect had thinner full LUS and thinner myometrial layer (weighted mean difference of 0.98 mm; 95% CI 0.37 to 1.59, P = 0.002; and 1.13 mm; 95% CI 0.32 to 1.94 mm, P = 0.006, respectively). SROC analysis showed a stronger association between full LUS thickness and uterine scar defect (AUC: 0.84 +/- 0.03, P < 0.001) than between myometrial layer and scar defect (AUC: 0.75 +/- 0.05, P < 0.01). The optimal cut-off value varied from 2.0 to 3.5 mm for full LUS thickness and from 1.4 to 2.0 for myometrial layer.
Sonographic LUS thickness is a strong predictor for uterine scar defect in women with prior Caesarean section. However, because of the heterogeneity of the studies we analyzed, no ideal cut-off value can yet be recommended, which underlines the need for more standardized measurement techniques in future studies.
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ABSTRACT: Context Uterine scar defects or scar niche are relatively common after cesarean delivery. An association has been observed between the severity of scar defect, also known as isthmocele, some gynecologic symptoms, and the risk of uterine scar dehiscence at the next delivery. It has been suggested that surgical repair of scar defect could improve the gynecological symptoms, but it remains unclear whether such surgery mends the uterine scar itself. Case Report We report the case of a woman with uterine scar defect in whom laparoscopic repair significantly improved the gynecological symptoms without affecting the uterine scar, evaluated by hysterosonography. Conclusion This case highlights the significant dearth of knowledge surrounding the diagnosis, consequences, and benefits of surgical repair of uterine scar defect after cesarean.11/2014; 4(2):e65-e68. DOI:10.1055/s-0034-1376187
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ABSTRACT: Placenta percreta retention within the scar of a previous cesarean section is rare. We report here one of these cases treated successfully by laparoscopy, with uterine repair. Different therapeutic options are described.
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ABSTRACT: Every year 1.5 million cesarean section procedures are performed worldwide. As many women decide to get pregnant again, the population of pregnant women with a history of cesarean section is growing rapidly. For these women prediction of cesarean section scar performance is still a serious clinical problem. Starting in 2005, the study included 308 nonpregnant women with a history of low transverse cesarean section. The following ultrasonographic parameters of the cesarean section scar in the nonpregnant uterus were assessed: the residual myometrial thickness (RMT) and the width (W) and the depth (D) of the triangular hypoechoic scar niche. During 8 years of follow-up, 41 of these women were referred to our department for delivery. In all cases, a repeat cesarean section was performed and the lower uterine segment was assessed. Two independent statistical methods namely the logit model and Decision Tree analysis were used to determine the relation between the appearance of the cesarean section scar in the nonpregnat state and the performance of the scar in the next pregnancy. The logit model revealed that the D/RMT ratio showed significant correlation with cesarean section scar dehiscence (P-value of 0.007). Specifically, a D/RMT ratio value greater than 1.3035 indicated that the likelihood of dehiscence was greater than 50%. The Decision Tree analysis revealed that a diagnosis of dehiscence versus non-dehiscence could be based solely on one criterion, a D/RMT ratio of at least 0.785. The sensitivity of this method was 71%, and the specificity was 94%. Assessment of the cesarean section scar in the nonpregant uterus can be used to predict the occurrence of scar dehiscence in the next pregnancy.BMC Pregnancy and Childbirth 10/2014; 14:365. DOI:10.1186/s12884-014-0365-3 · 2.15 Impact Factor