Objective
This study aimed to evaluate the effi cacy of three-dimensional (3D) ultrasonography in the
prediction of cesarean scar dehiscence in pregnant patients at term and to compare the
outcome of measurement with the intraoperative visual assessment of the scar.
Design
This was a prospective study.
Patients and methods
Seventy pregnant women with a history of a previous cesarean section attending Benha
University Hospital were included in this study. All participants underwent a 3D transabdominal
scan at third trimester and the data were recorded. We measured the lower segment thickness
from the muscularis and mucosa of the bladder on the outer side to the chorioamniotic
membrane on the inner side, with the myometrium in between, and hence, depending on a
three-layered pattern. This was compared with the pregnancy outcome and the intraoperative
scar condition. The data were then statistically analyzed.
Results
The mean scar thickness as measured by 3D transabdominal sonography in the third trimester
was 4.63 ± 0.85 mm. The best cut-off level for predicting uterine scar defects was less than or
equal to 2.75 mm (highest diagnostic accuracy) with sensitivity 25%, specifi city 100%, positive
predictive value 100%, and negative predictive value 95%.
Conclusion
The current study suggests that prenatal 3D US examination determining the degree of lower
uterine segment thinning in patients with previous cesarean delivery provides an additional
element for assessing the risk of uterine rupture and may increase safe management of trial
of labor. |
