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• W2000766721 abstract "ObjectiveThe aim was to examine the morphology of the lower uterine segment (LUS) in women with a history of at least one previous lower segment Caesarean section (LSCS), and assess whether any morphological characteristics were associated with subsequent mode of delivery.Study designThis was a case controlled prospective observational study. Transvaginal ultrasound examination of the LUS was performed at 23 weeks gestation. A detailed assessment of LUS morphology including LUS thickness, evidence of constriction, and altered echogenicity at the site of the scar was made.Results1393 of 1672 women invited to join the study participated. 175 women had at least one previous LSCS. 1218 with no history of LSCS were examined as controls. The LUS was significantly thinner in women with a history of at least one LSCS, vs. controls. There was a significant reduction in the thickness of the LUS with increasing previous LSCS. (mean 5.0 mm for no previous LSCS and 4.1 mm, 3.2 mm, and 3.0 mm for one, two and three previous caesareans respectively, P < .001). The LUS was thicker in those women who subsequently had a successful vaginal birth (VBAC) compared with those who required emergency intrapartum LSCS (4.2mm and 3.4mm respectively). There was no significant difference in the echogenicity of scars between these two groups.ConclusionThis study showed a lower success rate of VBAC in those women found to have a thin scar at 23 weeks gestation. By assessing both the thickness and echogenicity of the scar, it may be possible to identify the women who are more likely to have a successful trial of scar. In addition, it may be possible to identify those who would be at lower risk of visceral damage, should an emergency LSCS become necessary during labour. ObjectiveThe aim was to examine the morphology of the lower uterine segment (LUS) in women with a history of at least one previous lower segment Caesarean section (LSCS), and assess whether any morphological characteristics were associated with subsequent mode of delivery. The aim was to examine the morphology of the lower uterine segment (LUS) in women with a history of at least one previous lower segment Caesarean section (LSCS), and assess whether any morphological characteristics were associated with subsequent mode of delivery. Study designThis was a case controlled prospective observational study. Transvaginal ultrasound examination of the LUS was performed at 23 weeks gestation. A detailed assessment of LUS morphology including LUS thickness, evidence of constriction, and altered echogenicity at the site of the scar was made. This was a case controlled prospective observational study. Transvaginal ultrasound examination of the LUS was performed at 23 weeks gestation. A detailed assessment of LUS morphology including LUS thickness, evidence of constriction, and altered echogenicity at the site of the scar was made. Results1393 of 1672 women invited to join the study participated. 175 women had at least one previous LSCS. 1218 with no history of LSCS were examined as controls. The LUS was significantly thinner in women with a history of at least one LSCS, vs. controls. There was a significant reduction in the thickness of the LUS with increasing previous LSCS. (mean 5.0 mm for no previous LSCS and 4.1 mm, 3.2 mm, and 3.0 mm for one, two and three previous caesareans respectively, P < .001). The LUS was thicker in those women who subsequently had a successful vaginal birth (VBAC) compared with those who required emergency intrapartum LSCS (4.2mm and 3.4mm respectively). There was no significant difference in the echogenicity of scars between these two groups. 1393 of 1672 women invited to join the study participated. 175 women had at least one previous LSCS. 1218 with no history of LSCS were examined as controls. The LUS was significantly thinner in women with a history of at least one LSCS, vs. controls. There was a significant reduction in the thickness of the LUS with increasing previous LSCS. (mean 5.0 mm for no previous LSCS and 4.1 mm, 3.2 mm, and 3.0 mm for one, two and three previous caesareans respectively, P < .001). The LUS was thicker in those women who subsequently had a successful vaginal birth (VBAC) compared with those who required emergency intrapartum LSCS (4.2mm and 3.4mm respectively). There was no significant difference in the echogenicity of scars between these two groups. ConclusionThis study showed a lower success rate of VBAC in those women found to have a thin scar at 23 weeks gestation. By assessing both the thickness and echogenicity of the scar, it may be possible to identify the women who are more likely to have a successful trial of scar. In addition, it may be possible to identify those who would be at lower risk of visceral damage, should an emergency LSCS become necessary during labour. This study showed a lower success rate of VBAC in those women found to have a thin scar at 23 weeks gestation. By assessing both the thickness and echogenicity of the scar, it may be possible to identify the women who are more likely to have a successful trial of scar. In addition, it may be possible to identify those who would be at lower risk of visceral damage, should an emergency LSCS become necessary during labour." @default.
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• W2000766721 date "2004-12-01" @default.
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• W2000766721 title "Evaluation of lower uterine segment morphology at 23 weeks gestation. A prospective observational study" @default.
• W2000766721 doi "https://doi.org/10.1016/j.ajog.2004.10.515" @default.
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