Re: Uterine segment
From: Allen Worrall (jworrall@alaska.net)
Thu Oct 10 23:27:32 2002
I often see small cysts at the site of previous section scar. I do not know
if this is anything to worry about. I do not think so.
--
Allen Worrall
>----- Original Message -----
From: "James S Smeltzer MD" <gaperina@mindspring.com>
To: "Multiple recipients of list ULTRASOUND"
<ultrasound@mail.medispecialty.com>
Sent: Thursday, October 10, 2002 8:07 PM
Subject: Re: Uterine segment
> Has anyone noted anterior isthmic "nabothian" cysts in the women with
prior
> cesarean section? Does this change prognosis?
>
> Jim
>
> At 05:17 PM 5/17/2000 -0500, you wrote:
> >here are some abstracts you may find helpful -
> >
> >Eur J Obstet Gynecol Reprod Biol 1999 Nov;87(1):39-45
> >
> >Thickness of the lower uterine segment: its influence in the management
> >of patients with previous cesarean sections.
> >
> >Rozenberg P, Goffinet F, Philippe HJ, Nisand I
> >Department of Gynecology and Obstetrics, Poissy Hospital, University
> >Paris V, France. gynobs.poissy@wanadoo.fr
> >
> >OBJECTIVE: To determine how ultrasound measurement of the lower uterine
> >segment affects the decision about delivery for patients with previous
> >cesarean sections (CS) and what are the consequences on cesarean section
> >rates and uterine rupture or dehiscence. DESIGN: Prospective open
> >study. PATIENTS: 198 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 weeks and who underwent ultrasound
> >measurement of their lower uterine segment (95-96 study group), compared
> >with a similar population from 1989 to 1994 whose 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 period 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
> >delivery for the 95-96 study period among patients with two previous CS
> >(26.7% vs. 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 with an elective CS (4.5+/-1.4 mm compared with 3.8 +/- 1.5
> >mm; P=0.006); and the trial of labor group contained significantly fewer
> >women with a lower uterine 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 observed 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, because it provides
> >an additional element for assessing the risk of uterine rupture.
> >
> >PMID: 10579615, UI: 20044216
> >
> >Minerva Ginecol 1999 Apr;51(4):107-12
> >
> >[Transvaginal ultrasonic evaluation of the thickness of the section of
> >the uterine wall in previous cesarean sections].
> >[Article in Italian]
> >
> >Montanari L, Alfei A, Drovanti A, Lepadatu C, Lorenzi D, Facchini D,
> >Iervasi MT, Sampaolo P
> >Istituto di Clinica Ostetrica e Ginecologica, Universita degli Studi,
> >IRCCS San Matteo, Pavia.
> >
> >BACKGROUND: The aim of this study is to evaluate accuracy of
> >transvaginal sonographic examination of the lower uterine segment in
> >pregnant women with previous cesarean section. METHODS: Sixty-one
> >pregnant women between 37 and 40 weeks of gestation, with previous
> >cesarean section underwent transvaginal ultrasonography. Wall thickness
> >of the lower uterine segment, the length of cervix, dilation of the
> >isthmus uteri were measured. On the basis of the surgical findings (in
> >53 patients) and outcome of the trial of labor (in 8 patients) a Score
> >was assigned to the pregnant women: Score 1 to the women who had good
> >healing or a trial of labor without complications; Score 2 to the women
> >with a thin or discontinued scar and in case of threatened rupture of
> >the uterus in the trial of labor. RESULTS: The mean thickness of the
> >lower uterine segment is 3.82 mm +/- 0.99 mm. The Score 1 group shows a
> >mean thickness of 4.2 mm +/- 2.5 mm, and the Score 2 group a mean
> >thickness of 2.8 mm +/- 1.06 mm. The transvaginal sonographic
> >examination provides a sensitivity and a specificity respectively of 100
> >and 75%, for a thickness cut-off of 3.5 mm, and a positive and negative
> >predictive values of 60.7% and 100% respectively. CONCLUSIONS: The
> >transvaginal sonographic evaluation of the lower uterine segment
> >improves therefore the obstetrical decision-making regarding the trial
> >of labor in women with previous cesarean section.
> >
> >PMID: 10379144, UI: 99307817
> >
> >Tohoku J Exp Med 1997 Sep;183(1):55-65
> >
> >Ultrasonographic evaluation of lower uterine segment to predict the
> >integrity and quality of cesarean scar during pregnancy: a prospective
> >study.
> >
> >Qureshi B, Inafuku K, Oshima K, Masamoto H, Kanazawa K
> >Department of Obstetrics and Gynecology, School of Medicine, University
> >of the Ryukyus, Okinawa, Japan.
> >
> >A prospective randomized study was conducted to measure the serial
> >thickness of the lower uterine segment (LUS) by transvaginal
> >ultrasonography in a control group of 80 women having no history of
> >uterine surgery and in a study group of 43 women having a history of
> >previous cesarean section (C/S). In the study group, more than 2 mm of
> >thickness of the LUS was considered as good healing and less than 2 mm
> >of thickness as poor healing. After serial sonographic examination, the
> >women with good healing were given trial for labor unless an obstetrical
> >indication for C/S existed. The appearance of the LUS during surgery
> >was compared with antenatal ultrasonographic assessment by direct
> >inspection. Twenty two (79%) of 28 women with a well healed scar had
> >trial labor with the result that 46% had a successful vaginal birth
> >without any uterine rupture of dehiscence. Eight women with poor
> >healing all had elective C/S. Seven women with a 2 mm LUS thickness
> >were individually categorized for delivery mode. Two of those women
> >delivered vaginally. The LUS was found to be thin to translucent in
> >these later two groups. Two mm or less as a criterion for poor healing
> >had the sensitivity and specificity of 86.7% and 100% respectively. The
> >positive predictive value was 100% and the negative predictive value was
> >86.7%. Ultrasonographic evaluation is effective in predicting the
> >quality of a uterine scar and in differentiating the risk group of
> >probable uterine rupture from the non risk group.
> >
> >Ultrasound Med Biol 1990;16(5):443-7
> >
> >Observation of cesarean section scar by transvaginal ultrasonography.
> >
> >Chen HY, Chen SJ, Hsieh FJ
> >Department of Obstetrics and Gynecology, National Taiwan University
> >Hospital, Taipei, R.O.C.
> >
> >Transvaginal ultrasonography, with its higher frequency and proximity to
> >the pelvic structures has offered us a powerful tool for observing the
> >uterine scar of a previous Cesarean section. We have examined 87
> >previous Cesarean section scars by transvaginal ultrasonography. Forty
> >cases (group A) were in the third trimester. Fifty-two percent of this
> >group showed normal patterns. In the remaining cases, thickening of the
> >previous incision site was the most common finding. Also, thinning,
> >ballooning and wedge defect were noted. Forty-seven cases (group B)
> >were examined within 3 months (group B1) or after 3 months of Cesarean
> >section (group B2). Similarly half of them showed normal patterns. In
> >the remaining cases, wedge defect was the most common finding. The
> >others were outward or inward protrusions, hematoma formation and inward
> >retraction. An evaluation of the previous section scar, preferably by
> >high resolution transvaginal ultrasonography is highly recommended in
> >considering a trial of labor after previous Cesarean deliveries
> >
> >good luck!
> >
> >art
> >
> >At Wed, 17 May 2000, Pablo D'Angelo wrote:
> >>
> >>Thanks for your fast answer, Mr. DuBose.
> >>I agree with you that it is important to look for accretism in cesarian
> >>scar. But my question is oriented to the prediction of uterine rupture
by
> >>measuring the segment.
> >>
> >>Pablo J. D'Angelo
> >>pjd@post.com
> >>
>> >>----- Original Message -----
> >>From: <DuboseTerryJ@exchange.uams.edu>
> >>To: Multiple recipients of list ULTRASOUND <ultrasound@forum.obgyn.net>
> >>Sent: Wednesday, May 17, 2000 4:07 PM
> >>Subject: Re: Uterine segment
> >>
> >>> I mainly pay attention to previous C Section scars in subsequent
> >>pregnancies
> >>> when there is a low, anterior placenta. There is a higher association
> >>with
> >>> accreta, increta, or percreta in association with prior C Sections if
the
> >>> placenta implants over the scar.
> >>>
> >>> Terry J. DuBose, M.S., RDMS
> >>> Director, Diagnostic Medical Sonography Program
> >>> CHRP, University of Arkansas for Medical Sciences
> >>> Little Rock, Arkansas, USA
> >>> 501-686-6510
> >>> http://www.io.com/~dubose/ <http://www.io.com/~dubose/>
> >>> http://www.uams.edu/CHRP/dmshome.htm
> >><http://www.uams.edu/CHRP/dmshome.htm>
> >>>
> >>> http://www.obgyn.net/us/panel/panel.htm
> >>> <http://www.obgyn.net/us/panel/panel.htm>
> >>>
> >>> -----Original Message-----
> >>> From: Pablo D'Angelo [mailto:pablo_@radar.com.ar]
> >>> Sent: Wednesday, May 17, 2000 2:01 PM
> >>> To: Multiple recipients of list ULTRASOUND
> >>> Subject: Uterine segment
> >>>
> >>> Do you measure the thickness of the uterine segment in
> >>> previous cesarean
> >>> section, or just look at the integrity of it?
> >>> Do you find it useful to measure the segment?
> >>>
> >>> Pablo J. D'Angelo
> >>> pjd@post.com
> >>>
> >
> >--
> >art fougner, md
> >
> >A series of 1000 cases begins with but a single anecdote.
> >
>
