Uterine rupture risk assessment with third trimester transvaginal ultrasonography in women with previous cesarean section

C.A. Ionescu, S. Vlădăreanu, E. Brătilă, C.A. Coroleucă, C.B. Coroleucă, I. Pacu, R. Bohîlțea, M. Dimitriu

Abstract: A lot of methods have been used to evaluate the lower uterine segment after cesarean section: hysterography of the uterine scar, pelvic examination, amniography, x-ray pelvimetry and ultrasonography. The present study consisted of 275 secondiparous with the gestational age between 36 and 38 weeks. All recruited patient were evaluated by transvaginal ultrasound in order to characterize the lower uterine segment (LUS). LUS thickness was measured as the distance between the two calipers placed at the urinary bladder - myometrium interface and at the myometrium - chorioamniotic membrane interface. The appearance of the LUS where classified into three categories, where class I and II are considered non-dehiscent and class III was considered dehiscent. Therefore, the intraoperative assessment results included 19.6% patients in class III (dehiscent LUS, uterine content visible) and 80.4% patients in class I and II (non-dehiscent LUS). In the intraoperative non-dehiscent group 25.8% patients were included in class I (normal, well-developed LUS) and 54.6% were included in class II (thin LUS, uterine content not visible). The results showed that at a LUS thickness less than 2 mm carries a higher risk for dehiscence (incomplete uterine rupture) than those with a thickness more than 2 mm.
DOI:10.18643/gieu.2017.97

Keywords: cesarean section, transvaginal ultrasound, uterine rupture.