Department of Radiology, Shaare Zedek Medical Center, Affiliated with the Hadassah School of Medicine - Hebrew University, Jerusalem, Israel.
Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hadassah School of Medicine - Hebrew University, Jerusalem, Israel.
Abdom Radiol (NY). 2018 Aug;43(8):2150-2155. doi: 10.1007/s00261-017-1408-9.
To evaluate whether the characteristics of the radiological uterine myometrial discontinuity (RMD) is associated with maternal-neonatal outcomes and post-cesarean section (CS) complications. A secondary aim was to describe the evolution of the CT uterine surgical incision and the related outcome of a subsequent trial of labor after cesarean (TOLAC).
Single center retrospective cohort study of CT scans was performed within 6 weeks from cesarean delivery. Demographic characteristics of patients were recorded (age, intrapartum fever, CS data, and hospital stay length). Abdominopelvic CT scans were performed using a multidetector CT (16 or 256 slice) with intravenous contrast material. CT analysis was performed by two radiologists in consensus. The RMD seen as low attenuation gap in expected incision site was assessed for: visualization, thickness, and presence of gas. Logistic regression analysis was fitted to assess the relationship of the delivery-CT time interval with the presence of RMD and gas.
Of a total of 75,791 births during the study period there were 8775 CS (11.6%). The study group consisted of 101 CTs in 84 woman after CS. RMD defined in 73 (72.2%) of all CT exams; the mean RMD thickness was 7 mm ± 3.9, "RMD gas" observed in 15 (17.9%) of CT exams. RMD thickness or gas presence were strongly associated with a CS-1st CT exam time interval of less than 7 days, OR 5.8 [CI 1.5-22.6], p = 0.010, but not with maternal, delivery, or neonatal characteristics. A subsequent successful vaginal birth was achieved in 75% of the patients with no uterine rupture, regardless of the RMD gas presence.
RMD gas visualization on CT is not associated with febrile morbidity, cesarean characteristics, and subsequent TOLAC results. RMD gas is a normal post-operative finding and should not lead to changes in the postpartum delivery complication management or recommendations for the future mode of delivery.
评估放射学子宫肌层不连续（RMD）的特征是否与母婴结局和剖宫产（CS）后并发症相关。次要目的是描述 CT 子宫手术切口的演变，以及随后经剖宫产试产（TOLAC）的相关结果。
对 CS 后 6 周内进行的 CT 扫描进行单中心回顾性队列研究。记录患者的人口统计学特征（年龄、产时发热、CS 数据和住院时间长度）。使用多排 CT（16 或 256 排）进行腹盆腔 CT 扫描，静脉内使用造影剂。由两名放射科医生进行 CT 分析。在预期切口部位观察到低衰减间隙的 RMD 评估：可视化、厚度和气体存在。拟合逻辑回归分析以评估分娩与 CT 时间间隔与 RMD 和气体存在的关系。
在研究期间，共有 75791 例分娩，其中 8775 例 CS（11.6%）。研究组由 84 名妇女在 CS 后进行的 101 次 CT 检查组成。在所有 CT 检查中，73 例（72.2%）定义为 RMD；RMD 平均厚度为 7mm±3.9，15 例（17.9%）的 CT 检查观察到“RMD 气体”。RMD 厚度或气体存在与 CS-1 次 CT 检查时间间隔小于 7 天强烈相关，OR 5.8[CI 1.5-22.6]，p=0.010，但与产妇、分娩或新生儿特征无关。75%的患者随后成功阴道分娩，且无子宫破裂，无论 RMD 气体是否存在。
CT 上 RMD 气体的可视化与发热发病率、CS 特征以及随后的 TOLAC 结果无关。RMD 气体是一种正常的术后发现，不应对产后分娩并发症管理或未来分娩方式的建议产生影响。
