P. Rozenberg et al., Thickness of the lower uterine segment: its influence in the management ofpatients with previous cesarean sections, EUR J OB GY, 87(1), 1999, pp. 39-45
Citations number
9
Categorie Soggetti
Reproductive Medicine
Journal title
EUROPEAN JOURNAL OF OBSTETRICS GYNECOLOGY AND REPRODUCTIVE BIOLOGY
Objective: To determine how ultrasound measurement of the lower uterine seg
ment affects the decision about delivery for patients with previous cesarea
n sections (CS) and what are the consequences on cesarean section rates and
uterine rupture or dehiscence. Design: Prospective open study. Patients: 1
98 patients: all women with a previous CS who gave birth in our department
during 1995 and 1996 to an infant with a gestational age of at least 36 wee
ks and who underwent ultrasound measurement of their lower uterine segment
(95-96 study group), compared with a similar population from 1989 to 1994 w
hose measurements were not provided to the treating obstetrician. Results:
Among the patients with one previous CS, the vaginal delivery rate did not
differ significantly during the two periods (70.3% for the 89-94 study peri
od vs. 67.9% for the 95-96 study period, P=0.53), but the 95-96 study group
experienced a significant increase in the rate of elective CS, compensated
by a reduction in the rate of emergency CS (6.3% and 23.4%, respectively,
for the 89-94 study period vs. 11.9% and 20.1% for the 95-96 study period,
P=0.01). There was a very significant increase in the rate of vaginal deliv
ery for the 95-96 study period among patients with two previous CS (26.7% v
s. 8.0% for the 89-95 study period, P=0.01). The lower uterine segment was
significantly thicker among women with a trial of labor than among those wi
th an elective CS (4.5+/-1.4 mm compared with 3.8+/-1.5 mm; P=0.006); and t
he trial of labor group contained significantly fewer women with a lower ut
erine segment measurement less than 3.5 mm than did the elective CS group (
24.0% compared with 56.6%; P<0.001). Two patients (0.8%) were found to have
a defect of the uterine scar, a rate significantly lower than that observe
d in the early group (3.9%, P=0.03). Conclusions: Ultrasound measurement of
the lower uterine segment can increase the safe use of trial of labor, bec
ause it provides an additional element for assessing the risk of uterine ru
pture. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.