di Pasquo Elvira, Kiener Ariane Jeanne Odette, DallAsta Andrea, Commare Arianna, Angeli Laura, Frusca Tiziana, Ghi Tullio
Department of Obstetrics and Gynecology, University of Parma, Italy.
Department of Obstetrics and Gynecology, University of Parma, Italy.
Clin Imaging. 2020 Aug;64:53-56. doi: 10.1016/j.clinimag.2020.03.006. Epub 2020 Mar 31.
To evaluate by means of elastography if the quantitative assessment of the cesarean scar elasticity is feasible using as reference the surrounding intact myometrium and to investigate if the cesarean scar stiffness is influenced by the clinical characteristics of the previous cesarean delivery.
Prospective study including women with a previous Cesarean Section (CS) ≥ 37 weeks' gestation performed 12-15 months before. By transvaginal ultrasound two regions of interest (ROI) were selected: uterine scar (Region 1) and surrounding myometrium (Region 2). Strain index (SI) for each ROI was calculated and the Strain Ratio (SR) was defined as Region 1 SI/Region 2 SI. The primary outcome was to compare SR among women who were grouped in accordance to presence of previous vaginal delivery, CS during labor, type of suture or pyrexia during post-partum. The secondary outcome of this study was to evaluate the correlation between SR and maternal, neonatal and labor characteristics.
68 women were included. The mean SR was 1.8 ± 0.7 thus indicating an increased stiffness of the uterine scar compared to the surrounding myometrium. No significant differences were found in terms of SR according to presence of previous VD, CS during labor, type of suture or pyrexia during post-partum period. Strain Ratio was not correlated to maternal characteristics nor to labor and neonatal outcome.
Evaluation of uterine scar stiffness is feasible by using elastography. The stiffness of the uterine scar is higher than that of the surrounding myometrium and is not correlated to maternal and labor characteristics.
通过弹性成像技术评估以周围完整的子宫肌层为参照对剖宫产瘢痕弹性进行定量评估是否可行，并研究剖宫产瘢痕的硬度是否受既往剖宫产分娩临床特征的影响。
前瞻性研究，纳入既往在妊娠≥37周时行剖宫产且时间在12 - 15个月前的女性。经阴道超声选择两个感兴趣区域（ROI）：子宫瘢痕（区域1）和周围子宫肌层（区域2）。计算每个ROI的应变指数（SI），应变比（SR）定义为区域1的SI/区域2的SI。主要结局是比较根据既往阴道分娩情况、产时剖宫产、缝合类型或产后发热分组的女性之间的SR。本研究的次要结局是评估SR与母体、新生儿及分娩特征之间的相关性。
纳入68名女性。平均SR为1.8±0.7，表明子宫瘢痕的硬度高于周围子宫肌层。根据既往阴道分娩情况、产时剖宫产、缝合类型或产后发热情况，SR未发现显著差异。应变比与母体特征、分娩及新生儿结局均无相关性。
通过弹性成像技术评估子宫瘢痕硬度是可行的。子宫瘢痕的硬度高于周围子宫肌层，且与母体及分娩特征无关。
