Re: Ultrasound measuments of LUS to evaluate the risk of
From: mojiks (lenvelosomd@yahoo.com)
Sat Feb 14 15:37:38 2009
measurement of the lus may be done transabdominally or tranvaginally.trans abd-the whole thickness-serosa , myometrial and endometrial layers are measured. if the thickness is 3.5mm or less at 36 weeks the n ther is an icreased risk of rupture.
transvaginally, only the myometrial layer is measured-if 2mm or less at 1 week before delivery then there is a high incidence of scar dehiscence.Note this is done on previously sectioned uteri and the scar is not included in the measurement.best info is attained if done before 36th week. i am not a sonologist but i have a lecture and reviewed 2 meta analysis involving 2.5Million women and the study spanned 30 years. good luck to you.hope i was able to help.emv
--- On Sun, 2/15/09, Linda Dipiazza <lindad1@netnitco.net> wrote:
> From: Linda Dipiazza <lindad1@netnitco.net>
> Subject: Re: Ultrasound measuments of LUS to evaluate the risk of
> To: "Multiple recipients of list ULTRASOUND" <ultrasound@mail.obgyn.net>
> Date: Sunday, 15 February, 2009, 12:21 AM
> 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__
> >> Content-Type: text/plain; charset=US-ASCII
> >> Content-Transfer-Encoding: quoted-printable
> >>
> >> 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
> >
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