Re: Ultrasound measuments of LUS to evaluate the risk of
From: Linda Dipiazza (lindad1@netnitco.net)
Sat Feb 14 09:19:08 2009
Could someone refer me to a reference for measuring the LUS(we are not
talking cervical length?); and when this is supposed to be utilized?
In the past 1. routinely on a gravid uterus 2nd-3rd trimester I will
measure the cervical length. 2. Patient with hx of bleeding; gravid or
non-gravid uterus; if there is fluid in the LUS/cervix I measure according
length/AP/width.
Linda Dipiazza
>----- Original Message -----
From: "art fougner, md" <evsono@pipeline.com>
To: "Multiple recipients of list ULTRASOUND" <ultrasound@mail.obgyn.net>
Sent: Tuesday, February 10, 2009 1:10 PM
Subject: Re: Ultrasound measuments of LUS to evaluate the risk of
> In my own experience, the best time to assess the LUS is via TVS with or
> without saline enhancement in the nonpregnant patient. What to do with
> this info is another matter.
>
> Art
>
> At Mon, 09 Feb 2009, James Smeltzer wrote:
>>
>>This is a MIME message. If you are reading this text, you may want to
>>consider changing to a mail reader or gateway that understands how to
>>properly handle MIME multipart messages.
>>
>>--=__Part644CB0FA.0__
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>>
>>Overall the risk for recurrent uterine rupture is high, about 25%. It is,
>>by definition, potentially catastrophic. I had a woman with a spontaneous
>>uterine rupture of a prior high vertical (classical) incision. With her
>>rupture, she passed out and woke on the floor. It took her 30 min to crawl
>>to the phone to call 911. The baby had died before admission and she was
>>in hypovolemic shock, developed ARF, but did well with resuscitation,
>>three layer uterine repair, and temporary support.
>>
>>She has had two subsequent uneventful pregnancies, against medical
>>advice. During each I asked her to have a cell phone in a neck holster
>>which she was to carry all the time. When she showered she placed it
>>outside on the floor. When she slept, it was on the bedpost. Subsequently
>>I have given this advice to two other patients with a similar history who
>>presented pregnant. As these women have been transfused, their antibody
>>screen is important. If it is negative, group-specific blood can be given
>>in high volume with low risk of transfusion reaction in an emergency. If
>>it is positive, I would strongly consider autologous banking in the
>>current pregnancy (first and early second trimester), with folate, iron
>>extra supplementation. Old units have the problem that they must be
>>deglyced before use - takes hours. Another is to cross-match several
>>potential whole blood donors in the patient's health care provider system.
>>Red cross donor centers are difficult to work with as they do!
> not allow for pre-hydration IV, and many of these patients will contract
> if you take a unit from them without doing so in my experience.
>>The best advice for subsequent pregnancy for a woman with a living child
>>is "for your baby's sake do not try this". Without a living child it is
>>"adopt" or "let your sister or someone else be a surrogate". Uterine
>>ruptures are more frequent with labor but can occur at ANY time, and are
>>catastrophic when they occur.
>>
>>Anyone have a better idea?
>>
>>Jim Smeltze
>>
>>James S. Smeltzer, MD
>>Consultant, Maternal Fetal Medicine
>>Wellstar Physicians Group
>>833 Campbell Hill St., Suite 400
>>Wellstar NW Women's Care
>>Marietta, GA 30060
>>r
>>>>> On 2/8/2009 at 7:12 PM, in message
>>>>> <200902090011.n190Bh505225@mail.obgyn.net>, Elenita L. Mojica-Veloso
>>>>> <lenvelosomd@yahoo.com> wrote:
>>. in the At Sun, 24 Feb 2002, dracheng@yahoo.com wrote:
>>>
>>>At Wed, 3 Jan 2001, Sabina Norderhaug wrote:
>>>>
>>>>>From what I know, 1 cm is quite a thick uterus and there are very few
>>>>women after caserean who will have such a thick LUS before the delivery.
>>>>May be you are talking about some certain measuring technique? Is this
>>>>number based on your own experience? Can you please explain more?
>>>>
>>>>According to Patrick Rozenberg and others' study for transabdominal
>>>>measurements:
>>>>
>>>>FINDINGS: The overall frequency of defective scars was 4.0% (15 uterine
>>>>ruptures and 10 dehiscences). The frequency of defects rose as the
>>>>thickness of the lower uterine segment decreased: there were no defects
>>>>among 278 women with measurements greater than 4.5 mm, three (2%) among
>>>>177 patients with values of 3.6-4.5 mm, 14 (10%) among 136 patients with
>>>>values of 2.6-3.5 mm, and eight (16%) among 51 women with values of
>>>>1.6-2.5 mm. With a cut-off value of 3.5 mm, the sensitivity of
>>>>ultrasonographic measurement was 88.0%, the specificity 73.2%, positive
>>>>predictive value 11.8%, and negative predictive value 99.3%.
>>>>INTERPRETATION: Our results show that the risk of a defective scar is
>>>>directly correlated to the degree of thinning of the lower uterine
>>>>segment at around 37 weeks of pregnancy. The high negative predictive
>>>>value of the method may encourage obstetricians in hospitals where
>>>>routine repeat elective cesarean is the standard procedure to offer a
>>>>trial of labor to patients with a thickness value of 3.5 mm or greater.
>>>>
>>>>According to Asakura and others' study for transvaginal measurements of
>>>>muscular layer only:
>>>>
>>>>Conclusion: Measurement of the lower uterine segment is useful in
>>>>predicting the absence of dehiscence among gravidas with previous
>>>>cesarean section. If the thickness of the lower uterine segment is more
>>>>than 1.6 mm, the possibility of dehiscence during the subsequent trials
>>>>of labor is very small.
>>>>
>>>>Sabina
>>>>
>>>>At Thu, 04 Jan 2001, Dr. Fazeel-uz-Zaman wrote:
>>>>>
>>>>>--------------7B8F6A2709897892ECC148E0
>>>>>Content-Type: text/plain; charset=us-ascii
>>>>>Content-Transfer-Encoding: 7bit
>>>>>
>>>>>I guess if the scar thickness is less than 1 cms, there is risk og
>>>>>rupture.
>>>>>Fazeel
>>>>>I am presently a resident of the Department of Obstetrics and
>>>>>Gynecology at Capitol Medical CEnter, Philippines. I am very interested
>>>>>in doing a research on the thickness of the lower uterine segment in
>>>>>previously sectioned women who would like to undergo trial of labor. I
>>>>>would like to request for copies of journals or previous studies done
>>>>>on this topic. Our department is advocating VDAC (vaginal delivery
>>>>>after a ceasarian), and with this would like to reiterate the
>>>>>possibility of such by doing this research paper. would like to thank
>>>>>you in advance for a favorable response to my request.
>>
>>--
>>I am interested in the succeeding pregnancy outcome of women whose
>>ruptured uteri were repaired.
>>
>>________________________________________________
>>This email and any files transmitted with it may contain
>>________________________________________________
>>________________________________________________
>>confidential and /or proprietary information in the possession
>>of WellStar Health System, Inc. ("WellStar") and is intended
>>only for the individual or entity to whom addressed. This email
>>may contain information that is held to be privileged, confidential
>>and exempt from disclosure under applicable law. If the reader
>>of this message is not the intended recipient, you are hereby
>>notified that any unauthorized access, dissemination, distribution
>>or copying of any information from this email is strictly prohibited,
>>and may subject you to criminal and/or civil liability. If you have
>>received this email in error, please notify the sender by reply email
>>and then delete this email and its attachments from your computer.
>>- Thank you.
>>
>>--=__Part644CB0FA.0__
>>Content-Type: text/html; charset=US-ASCII
>>Content-Transfer-Encoding: quoted-printable
>>Content-Description: HTML
>>
>>Overall the risk for recurrent uterine rupture is high, about 25%. It is,
>>by definition, potentially catastrophic. I had a woman with a spontaneous
>>uterine rupture of a prior high vertical (classical) incision. With her
>>rupture, she passed out and woke on the floor. It took her 30 min to crawl
>>to the phone to call 911. The baby had died before admission and she was
>>in hypovolemic shock, developed ARF, but did well with resuscitation,
>>three layer uterine repair, and temporary support.
>>
>>She has had two subsequent uneventful pregnancies, against medical advice.
>>During each I asked her to have a cell phone in a neck holster which she
>>was to carry all the time. When she showered she placed it outside on the
>>floor. When she slept, it was on the bedpost. Subsequently I have given
>>this advice to two other patients with a similar history who presented
>>pregnant. As these women have been transfused, their antibody screen is
>>important. If it is negative, group-specific blood can be given in high
>>volume with low risk of transfusion reaction in an emergency. If it is
>>positive, I would strongly consider autologous banking in the current
>>pregnancy (first and early second trimester), with folate, iron extra
>>supplementation. Old units have the problem that they must be deglyced
>>before use - takes hours. Another is to cross-match several potential
>>whole blood donors in the patient's health care provider system. Red cross
>>donor centers are difficult to work with as they do!
> not allow for pre-hydration IV, and many of these patients will contract
> if you take a unit from them without doing so in my experience.
>>The best advice for subsequent pregnancy for a woman with a living child
>>is "for your baby's sake do not try this". Without a living child it is
>>"adopt" or "let your sister or someone else be a surrogate". Uterine
>>ruptures are more frequent with labor but can occur at ANY time, and are
>>catastrophic when they occur.
>>
>>Anyone have a better idea?
>>
>>Jim Smeltze
>>
>>James S. Smeltzer, MD
>>Consultant, Maternal Fetal Medicine
>>Wellstar Physicians Group
>>833 Campbell Hill St., Suite 400
>>Wellstar NW Women's Care
>>Marietta, GA 30060r>>> On 2/8/2009 at 7:12 PM, in message
>><200902090011.n190Bh505225@mail.obgyn.net>, Elenita L. Mojica-Veloso
>><lenvelosomd@yahoo.com> wrote:
>>. in the At Sun, 24 Feb 2002, dracheng@yahoo.com wrote:>>At Wed, 3 Jan
>>2001, Sabina Norderhaug wrote:>>>>>From what I know, 1 cm is quite a thick
>>uterus and there are very few>>women after caserean who will have such a
>>thick LUS before the delivery.>>May be you are talking about some certain
>>measuring technique? Is this>>number based on your own experience? Can you
>>please explain more?>>>>According to Patrick Rozenberg and others' study
>>for transabdominal>>measurements:>>>>FINDINGS: The overall frequency of
>>defective scars was 4.0% (15 uterine>>ruptures and 10 dehiscences). The
>>frequency of defects rose as the>>thickness of the lower uterine segment
>>decreased: there were no defects>>among 278 women with measurements
>>greater than 4.5 mm, three (2%) among>>177 patients with values of 3.6-4.5
>>mm, 14 (10%) among 136 patients with>>values of 2.6-3.5 mm, and eight
>>(16%) among 51 women with values of>>1.6-2.5 mm. With a cut-off value of
>>3.5 mm, the sensitivity of>>ultrasonogra!
> phic measurement was 88.0%, the specificity 73.2%, positive>>predictive
> value 11.8%, and negative predictive value 99.3%.>>INTERPRETATION: Our
> results show that the risk of a defective scar is>>directly correlated to
> the degree of thinning of the lower uterine>>segment at around 37 weeks of
> pregnancy. The high negative predictive>>value of the method may encourage
> obstetricians in hospitals where>>routine repeat elective cesarean is the
> standard procedure to offer a>>trial of labor to patients with a thickness
> value of 3.5 mm or greater.>>>>According to Asakura and others' study for
> transvaginal measurements of>>muscular layer only:>>>>Conclusion:
> Measurement of the lower uterine segment is useful in>>predicting the
> absence of dehiscence among gravidas with previous>>cesarean section. If
> the thickness of the lower uterine segment is more>>than 1.6 mm, the
> possibility of dehiscence during the subsequent trials>>of labor is very
> small.>>>>Sabina>>>>At Thu, 04 Jan 2001, Dr. F!
> azeel-uz-Zaman
> wrote:>>>>>>--------------7B8F6A2709897892ECC148E0>>>Content-Type:
> text/plain; charset=us-ascii>>>Content-Transfer-Encoding: 7bit>>>>>>I
> guess if the scar thickness is less than 1 cms, there is risk og
> rupture.>>>Fazeel>>>I am presently a resident of the Department of
> Obstetrics and Gynecology at Capitol Medical CEnter, Philippines. I am
> very interested in doing a research on the thickness of the lower uterine
> segment in previously sectioned women who would like to undergo trial of
> labor. I would like to request for copies of journals or previous studies
> done on this topic. Our department is advocating VDAC (vaginal delivery
> after a ceasarian), and with this would like to reiterate the possibility
> of such by doing this research paper. would like to thank you in advance
> for a favorable response to my request.--I am interested in the succeeding
> pregnancy outcome of women whose ruptured uteri were repaired.
>>
>> ____________________________________________________________
>> ____________________________________________________________
>> ____________________________________________________________
>>
>> This email and any files transmitted with it may contain
>> confidential and /or proprietary information in the possession of
>> WellStar Health System, Inc. ("WellStar") and is intended only for
>> the
>> individual or entity to whom addressed. This email may contain
>> information that is held to be privileged, confidential and exempt
>> from
>> disclosure under applicable law. If the reader of this message is
>> not
>> the intended recipient, you are hereby notified that any
>> unauthorized
>> access, dissemination, distribution or copying of any information
>> from
>> this email is strictly prohibited, and may subject you to criminal
>> and/or civil liability. If you have received this email in error,
>> please
>> notify the sender by reply email and then delete this email and its
>> attachments from your computer.
>>- Thank you.
>>
>
> --
> art fougner, md
> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
