Al Naimi Ammar, Mouzakiti Niki, Wolnicki Bartosch, Louwen Frank, Bahlmann Franz
Department of Obstetrics and Gynecology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Hessen, Germany; Department of Obstetrics and Gynecology, Buergerhospital - Dr. Senckenbergische Stiftung, Frankfurt, Hessen, Germany.
Department of Obstetrics and Gynecology, Buergerhospital - Dr. Senckenbergische Stiftung, Frankfurt, Hessen, Germany.
Eur J Obstet Gynecol Reprod Biol. 2021 Mar;258:391-395. doi: 10.1016/j.ejogrb.2021.01.033. Epub 2021 Jan 22.
Lateral wall ruptures in women with a history of cesarean section are less common but more complicated than anterior wall ruptures. Residual myometrial thickness (RMT) is believed to be valuable for assessing the probability of ruptures. This study aimed to assess the utility of OmniView (a sonographic reslicing technique) in evaluating the lateral uterine wall after cesarean section and evaluate the relationship between lateral and anterior wall RMT using OmniView and sagittal two-dimensional ultrasound.
This cross-sectional study examined changes in both the anterior and lateral uterine wall in women with a history of cesarean section in the past 12-18 months. OmniView with volume contrast imaging with a 2-mm slice thickness was used to generate coronal planes, and the OmniView RMT (OV-RMT) was calculated as a percentage. Blinded to the OV-RMT results, sonographic multiplanar views were used to acquire the optimum sagittal plane for evaluating the RMT, and the sagittal RMT (S-RMT) was calculated as a percentage. The reproducibility of OV-RMT and S-RMT between two observers was tested using interclass correlation (ICC). The relationship between two variables was tested using Spearman's rank correlation.
In 208 recruited patients, the prevalence of lateral uterine wall defects was 79 %. The interobserver and intraobserver reproducibility of S-RMT and OV-RMT had ICC coefficients over 0.9 with a p-value <0.001. S-RMT and OV-RMT did not follow a normal distribution, and the medians were significantly different (55.5 and 85.7, respectively). Spearman's rank correlation between OV-RMT and S-RMT had a rho (ρ) value of 0.24 (p < 0.05). Passing-Bablok regression had an intercept of 47.95 and a slope of 0.65.
OmniView can be used to assess lateral uterine wall defects, and OV-RMT is a reproducible and reliable method for quantifying this assessment. The RMT on the coronal plane was independently more intact than that on the sagittal plane, which might account for the lower incidence of lateral ruptures. Further studies could reveal a critical OV-RMT value that is safe for a trial of labor.
有剖宫产史的女性子宫侧壁破裂较前壁破裂少见，但更复杂。残留肌层厚度（RMT）被认为对评估破裂概率有重要价值。本研究旨在评估OmniView（一种超声重切片技术）在剖宫产术后评估子宫侧壁方面的效用，并使用OmniView和矢状面二维超声评估子宫侧壁和前壁RMT之间的关系。
这项横断面研究检查了过去12 - 18个月内有剖宫产史的女性子宫前壁和侧壁的变化。使用OmniView结合容积对比成像，切片厚度为2毫米，生成冠状面，并计算OmniView RMT（OV - RMT）的百分比。在不知道OV - RMT结果的情况下，使用超声多平面视图获取评估RMT的最佳矢状面，并计算矢状面RMT（S - RMT）的百分比。使用组内相关系数（ICC）测试两位观察者之间OV - RMT和S - RMT的可重复性。使用Spearman等级相关性测试两个变量之间的关系。
在208名招募的患者中，子宫侧壁缺陷的患病率为79%。S - RMT和OV - RMT在观察者间和观察者内的可重复性的ICC系数均超过0.9，p值<0.001。S - RMT和OV - RMT不遵循正态分布，中位数有显著差异（分别为55.5和85.7）。OV - RMT和S - RMT之间的Spearman等级相关性的rho（ρ）值为0.24（p < 0.05）。Passing - Bablok回归的截距为47.95，斜率为0.65。
OmniView可用于评估子宫侧壁缺陷，OV - RMT是一种可重复且可靠的量化评估方法。冠状面上的RMT比矢状面上的更完整，这可能是侧壁破裂发生率较低的原因。进一步的研究可能会揭示一个对于试产安全的关键OV - RMT值。
