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Marchant I, Lessard L, Bergeron C, Jastrow N, Gauthier R, Girard M, Guerby P, Vachon-Marceau C, Maheux-Lacroix S, Bujold E. Measurement of Lower Uterine Segment Thickness to Detect Uterine Scar Defect: Comparison of Transabdominal and Transvaginal Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1491-1496. [PMID: 36598096 DOI: 10.1002/jum.16161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Lower uterine segment (LUS) thickness measurement using transabdominal ultrasound (TA-US), transvaginal ultrasound (TV-US), or the combination of both methods can detect scar defect in women with prior cesarean. We aimed to compare the sensitivity of three approaches. METHODS Women with prior cesarean underwent LUS thickness measurement at 34-38 weeks' gestation. Among those who underwent repeat cesarean before labor, we compared the accuracy of TA-US, TV-US, and the thinner of the two measurements (the "combined measurement") for uterine scar dehiscence using the area under the curve (AUC) of receiver operating curves with their 95% confidence intervals (CI). We calculated the sensitivity and specificity of the three approaches using a cut-off of 2.3 mm based on prior literature. RESULTS We included 747 participants. The mean LUS thickness was greater with TA-US (3.8 ± 1.6 mm) compared with TV-US (3.5 ± 1.9 mm) or the combined measurement (3.2 ± 1.5 mm; P < .001). The AUC was 78% (95% CI: 69%-87%), 85% (95% CI: 79%-91%), and 88% (95% CI: 82%-93%), respectively (all with P < .001). The AUC difference between TA-US and the combined measurement was not significant (P = .057). A LUS below 2.3 mm would have predicted 9 (45%) of the 20 cases of uterine scar dehiscence using TA-US, 17 (85%) using TV-US, and 18 (90%) using the combined measurement (P < .01). CONCLUSION The choice of ultrasound approach influences the measurement of the LUS thickness. The combination of the TA-US and TV-US seems to be superior for the detection of uterine dehiscence.
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Affiliation(s)
- Isobel Marchant
- Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Lauriane Lessard
- Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
| | - Catherine Bergeron
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Nicole Jastrow
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Robert Gauthier
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Mario Girard
- Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
| | - Paul Guerby
- Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
- Department of Gynecology and Obstetrics, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Chantale Vachon-Marceau
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Sarah Maheux-Lacroix
- Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Emmanuel Bujold
- Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
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Cesarean section scar in 3 T magnetic resonance imaging and ultrasound: image characteristics and comparison of the methods. Arch Gynecol Obstet 2018; 299:439-449. [DOI: 10.1007/s00404-018-4988-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/22/2018] [Indexed: 01/11/2023]
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Seliger G, Chaoui K, Lautenschläger C, Riemer M, Tchirikov M. Technique of sonographic assessment of lower uterine segment in women with previous cesarean delivery: a prospective, pre/intraoperative comparative ultrasound study. Arch Gynecol Obstet 2018; 298:297-306. [PMID: 29948165 DOI: 10.1007/s00404-018-4805-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was: (A) to establish the effects of different ultrasound measurement methods (linear versus curved array) and measuring conditions [impact of pressure by fetal head/pelvis on the lower uterine segment (LUS)] during LUS-muscular-thickness measurement, (B) to introduce the intraoperative ultrasound measurement of LUS-muscular thickness (reference measurement method), and (C) to evaluate the correlation between different combinations of LUS-muscular-thickness measurement ultrasound techniques at birth planning and preoperative versus intraoperative measurements. METHODS A prospective clinical observational study of women with the previous cesarean delivery was conducted. LUS-muscular thickness was measured: first at birth planning and second preoperatively using linear and curved probes (transabdominal) and an endocavitar probe (transvaginal), examined with and without pressure by fetal head/pelvis on LUS during measurement and third intraoperatively during repeat cesarean. Bland-Altman plots, paired t tests, Pearson's correlation coefficient, and scatter plots were used. RESULTS Thirty-three women were included in the study (ultrasound measurements: n = 601). There was no systematic difference between LUS-muscular-thickness measurements with linear versus curved array (mean difference = 0.06 mm; p = 0.24; nm = 133) but between measurements with pressure by the fetus versus without (mean difference = - 0.37 mm; p < 0.001; nm = 243). The highest correlation coefficients were detected for the preoperative (at the day of cesarean section), transabdominal-vaginal approach combined ultrasound measurements versus the intraoperative ultrasound measurements of LUS-muscular thickness-as long as the measurements were made without pressure from the fetal head/pelvis on the LUS [0.86, p < 0.001, n = 24, 95% CI (0.70, 0.94)]. CONCLUSIONS The systematic application of predetermined measuring conditions, standardized setup criteria improves the performance of LUS thickness measurement by ultrasound near term. CLINICALTRIALS. GOV IDENTIFIER NCT02827604.
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Affiliation(s)
- Gregor Seliger
- University Clinic of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Katharina Chaoui
- University Clinic of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christine Lautenschläger
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University, Halle (Saale), Germany
| | - Marcus Riemer
- University Clinic of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Tchirikov
- University Clinic of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Ultrasound elastography of the lower uterine segment in women with a previous cesarean section: Comparison of in-/ex-vivo elastography versus tensile-stress-strain-rupture analysis. Eur J Obstet Gynecol Reprod Biol 2018; 225:172-180. [PMID: 29729520 DOI: 10.1016/j.ejogrb.2018.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/10/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The purpose of this study was to assess, if the biomechanical properties of the lower uterine segment (LUS) in women with a previous cesarean section (CS) can be determined by ultrasound (US) elastography. The first aim was to establish an ex-vivo LUS tensile-stress-strain-rupture(break point) analysis with the possibility of simultaneously using US elastography. The second aim was to investigate the relationship between measurement results of LUS stiffness using US elastography in-/ex-vivo with results of tensile-stress-strain-rupture analysis, and to compare different US elastography LUS-stiffness-measurement methods ex-vivo. STUDY DESIGN An explorative experimental, in-/ex-vivo US study of women with previous CS was conducted. LUS elasticity was measured by point Shear Wave Elastography (pSWE) and bidimensional Shear-Wave-Elastography (2D-SWE) first in-vivo during preoperative examination within 24 h before repeat CS (including resection of the thinnest part of the LUS = uterine scar area during CS), second within 1 h after operation during the ex-vivo experiment, followed by tensile-stress-strain-rupture analysis. Pearson's correlation coefficient and scatter plots, Bland-Altman plots and paired T-tests, were used. RESULTS Thirty three women were included in the study; elastography measurements n = 1412. The feasibility of ex-vivo assessment of LUS by quantitative US elastography using pSWE and 2D-SWE to detect stiffness of LUS was demonstrated. The strongest correlation with tensile-stress-strain analysis was found in the US elastography examination carried out with 2D-SWE (0.78, p < 0.001, 95%CI [0.48, 0.92]). The laboratory experiment illustrated that, the break point - as a surrogate marker for the risk of rupture of the LUS after CS - is linearly dependent on the thickness of the LUS in the scar area (Coefficient of correlation: 0.79, p < 0.001, 95%CI [0.55, 0.91]). Two extremely stiff LUS-specimens (outlier or extreme values) rupture even at less stroke/strain than would be expected by their thickness. CONCLUSION This study confirms that US elastography can help in determining viscoelastic properties of the LUS in women with a previous CS. The data from our small series are promising. However whether individual extreme values of high stiffness and consecutive restricted biomechanical resilience can explain the phenomenon of rupture during TOLAC in cases of LUS with adequate thickness remains a question which prospective trials have to analyze before US elastography can be introduced into clinical practice.
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Jastrow N, Demers S, Chaillet N, Girard M, Gauthier RJ, Pasquier JC, Abdous B, Vachon-Marceau C, Marcoux S, Irion O, Brassard N, Boulvain M, Bujold E. Lower uterine segment thickness to prevent uterine rupture and adverse perinatal outcomes: a multicenter prospective study. Am J Obstet Gynecol 2016; 215:604.e1-604.e6. [PMID: 27342045 DOI: 10.1016/j.ajog.2016.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/03/2016] [Accepted: 06/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Choice of delivery route after previous cesarean delivery can be difficult because both trial of labor after cesarean delivery and elective repeat cesarean delivery are associated with risks. The major risk that is associated with trial of labor after cesarean delivery is uterine rupture that requires emergency laparotomy. OBJECTIVE This study aimed to estimate the occurrence of uterine rupture during trial of labor after cesarean delivery when lower uterine segment thickness measurement is included in the decision-making process about the route of delivery. STUDY DESIGN In 4 tertiary-care centers, we prospectively recruited women between 34 and 38 weeks of gestation who were contemplating a vaginal birth after a previous single low-transverse cesarean delivery. Lower uterine segment thickness was measured by ultrasound imaging and integrated in the decision of delivery route. According to lower uterine segment thickness, women were classified in 3 risk categories for uterine rupture: high risk (<2.0 mm), intermediate risk (2.0-2.4 mm), and low risk (≥2.5 mm). Our primary outcome was symptomatic uterine rupture, which was defined as requiring urgent laparotomy. We calculated that 942 women who were undergoing a trial of labor after cesarean delivery should be included to be able to show a risk of uterine rupture <0.8%. RESULTS We recruited 1856 women, of whom 1849 (99%) had a complete follow-up data. Lower uterine segment thickness was <2.0 mm in 194 women (11%), 2.0-2.4 mm in 217 women (12%), and ≥2.5 mm in 1438 women (78%). Rate of trial of labor was 9%, 42%, and 61% in the 3 categories, respectively (P<.0001). Of 984 trials of labor, there were no symptomatic uterine ruptures, which is a rate that was lower than the 0.8% expected rate (P=.0001). CONCLUSION The inclusion of lower uterine segment thickness measurement in the decision of the route of delivery allows a low risk of uterine rupture during trial of labor after cesarean delivery.
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Jastrow N, Vikhareva O, Gauthier RJ, Irion O, Boulvain M, Bujold E. Can third-trimester assessment of uterine scar in women with prior Cesarean section predict uterine rupture? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:410-414. [PMID: 26483275 DOI: 10.1002/uog.15786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/28/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Affiliation(s)
- N Jastrow
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - O Vikhareva
- Department of Obstetrics and Gynaecology, Skane University Hospital Malmö, Lund University, Malmö, Sweden
| | - R J Gauthier
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - O Irion
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - M Boulvain
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - E Bujold
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
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