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Background: With an aim to reduce the rates of repeat cesarean section inwomen with a previous scar, prediction of scar rupture or dehiscence isimportant. If we could predict the risk of rupture by measuring the scarthickness closer to term, we could pursue a trial of scar safely. Aims: Toevaluate the use of ultrasound measured thickness of lower uterine segment asone of the predictors of scar rupture or dehiscence in labour and establish acut off beyond which trial of labour can be attempted safely. Methodology: 187randomly selected pregnant women with history of one previous cesarean sectionin the past who satisfied the inclusion criteria, attending the outpatientclinic over a period of six months, at a tertiary level teaching institution insouthern India were selected and counseled to undergo a transvaginalmeasurement of the scar region. These women were then followed up untildelivery and the outcome of trial of scar, successful vaginal delivery, ruptureor dehiscence of uterus was analysed in relation to the scar thickness andvarious other contributing factors. Results: 187 women with history of previouscesarean section, attending the outpatient clinic were randomly chosen toundergo trans vaginal scan at term. 52 underwent elective cesarean section and135 went through trial of scar. The median cut-off of the lower uterine segmentin this study population of 135 was 2.4 mm. The sensitivity was 90.9%,specificity was 43.5%, positive predictive value was 12.5%, and negativepredictive value was 98.3% at this cut-off for scar rupture or dehiscence. Conclusions:The lower uterine scar thickness could be a useful tool to predict scarrupture. This could aid in making decisions regarding induction of labour withoxytocin in women with previous cesarean section.

KEYWORDS

TOLAC, Transvaginal Ultrasonography, Scar Thickness

Cite this paper

Thomas, A. , Rebekah, G. , Vijayaselvi, R. and Jose, R. 2015 Transvaginal Ultrasonographic Measurement of Lower Uterine Segment in Term Pregnant Patients with Previous Cesarean Section. Open Journal of Obstetrics and Gynecology, 5, 646-653. doi: 10.4236-ojog.2015.511091.





Autor: Anitha Thomas*, Grace Rebekah, Reeta Vijayaselvi, Ruby Jose

Fuente: http://www.scirp.org/



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