Document Detail

Changes in Cesarean section scar dimensions during pregnancy: a prospective longitudinal study.
MedLine Citation:
PMID:  23108803     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To describe changes in Cesarean section (CS) scars longitudinally throughout pregnancy, and to relate initial scar measurements, demographic variables and obstetric variables to subsequent changes in scar features and to final pregnancy outcome.
METHODS: In this prospective observational study we used transvaginal sonography (TVS) to examine the CS scar of 320 consecutive pregnant women at 11-13, 19-21 and 32-34 weeks' gestation. For scars visible on TVS, the hypoechoic part was measured in three dimensions and the residual myometrial thickness (RMT) was also measured. Analyses were carried out using one-way repeated measures ANOVA and mixed modeling. The incidence of subsequent scar rupture was recorded.
RESULTS: The CS scar was visible in 284/320 cases (89%). Concerning length and depth of the hypoechoic part of the scar and RMT, the larger the initial scar measurement, the larger the decrease observed during pregnancy. For the hypoechoic part of the scar, the width increased on average by 1.8 mm per trimester, while the depth and length decreased by 1.8 and 1.9 mm, respectively (false discovery rate P < 0.0001). Mean RMT in the first trimester was 5.2 mm and on average decreased by 1.1 mm per trimester. Two cases (0.62%) of uterine scar rupture were confirmed following a trial of vaginal delivery; these had a mean RMT of 0.5 mm at second scan and an average decrease of 2.6 mm over the course of pregnancy.
CONCLUSION: This study establishes reference data and confirms that the dimensions of CS scars change throughout pregnancy. Scar rupture was associated with a smaller RMT and greater decrease in RMT during pregnancy. There is the potential to test absolute values and observed changes in CS scar measurements as predictors of uterine scar rupture and outcome in trials of vaginal birth after Cesarean section.
O Naji; A Daemen; A Smith; Y Abdallah; S Saso; C Stalder; A Sayasneh; A McIndoe; S Ghaem-Maghami; D Timmerman; T Bourne
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  41     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-23     Completed Date:  2013-10-28     Revised Date:  2014-03-20    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  556-62     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 ISUOG. Published by John Wiley & Sons Ltd.
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MeSH Terms
Analysis of Variance
Cesarean Section / adverse effects*
Cicatrix / pathology*,  ultrasonography
Pregnancy Complications / pathology*,  ultrasonography
Pregnancy Outcome
Pregnancy Trimesters
Prospective Studies
Ultrasonography, Prenatal
Uterine Rupture / etiology,  pathology
Comment In:
Ultrasound Obstet Gynecol. 2014 Feb;43(2):236   [PMID:  24009144 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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