Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Kurdistan Region, Erbil city, Iraq.
Department of Radiology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt.
BMC Pregnancy Childbirth. 2022 May 14;22(1):409. doi: 10.1186/s12884-022-04747-3.
There is a lack of reliable methods to estimate the risk of uterine rupture or dehiscence during a trial of labor in women with previous cesarean sections. This study aimed to assess the lower uterine segment and myometrial thickness by ultrasonography in women with previous cesarean sections during labor and assess their association with the uterine defect.
A cross-sectional study was conducted on 161 women in the active phase of labor having one previous cesarean section. The study was conducted et al.-Azhar University Hospital, Assiut City, Egypt, from March 2018 to March 2019. Ultrasound measurements of lower uterine segment thickness and myometrial thickness were conducted by vaginal and abdominal ultrasound by two observers. The correlation of both thicknesses with the uterine defect was analyzed.
Uterine defects were reported in 42 women (25.9%), uterine rupture in four women (2.5%), and dehiscence in 38 women (23.5%). The uterine defects were not associated with maternal factors (maternal age, gestational age at labor, body mass index, birth weight, interpregnancy, and inter-delivery interval). Receiver operating curve analysis demonstrated that lower uterine segment thickness was linked with uterine defect, with an area under the curve of 60% (95% CI, 51-70%, P = 0.044). Myometrial thickness was also linked to the uterine defect, with an area under the curve of 61% (95% CI, 52-71%, P = 0.025). Full lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm were the cutoff value with the best combination of sensitivity and specificity for the uterine defect. Lower uterine segment thickness (OR = 0.49, 95%CI 0.24-0.96) and myometrial thickness (OR = 0.44, 95%CI 0.20-0.94) were significantly associated with the uterine defect. Lower uterine segment thickness (OR = 0.41, 95%CI 0.22-0.76) and myometrial thickness (OR = 0.33, 95%CI 0.16-0.66) were also significantly associated with cesarean section delivery.
A lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm during the first stage of labor are associated with a high risk of uterine defects during a labor trial. These measurements during labor can have a practical application in deciding the mode of delivery in women with previous cesarean sections and might reduce uterine rupture.
在有剖宫产史的产妇试产过程中，缺乏可靠的方法来估计子宫破裂或破裂的风险。本研究旨在评估经阴道和经腹超声测量有剖宫产史的产妇在产程中的子宫下段和子宫肌层厚度，并评估其与子宫缺陷的关系。
2018 年 3 月至 2019 年 3 月在埃及阿西尤特市 Azhar 大学医院进行了一项前瞻性队列研究，纳入了 161 名在活跃期有一次剖宫产史的产妇。由两位观察者通过阴道和腹部超声测量子宫下段厚度和子宫肌层厚度。分析了这两种厚度与子宫缺陷的相关性。
42 名产妇（25.9%）有子宫缺陷，4 名产妇（2.5%）有子宫破裂，38 名产妇（23.5%）有子宫破裂。子宫缺陷与产妇因素（产妇年龄、分娩时的孕周、体重指数、出生体重、产次和两次分娩间隔）无关。受试者工作特征曲线分析显示，子宫下段厚度与子宫缺陷相关，曲线下面积为 60%（95%CI，51-70%，P=0.044）。子宫肌层厚度也与子宫缺陷相关，曲线下面积为 61%（95%CI，52-71%，P=0.025）。子宫下段完全厚度 2.3mm 和子宫肌层厚度 1.9mm 是诊断子宫缺陷的最佳截断值，具有较高的敏感性和特异性。子宫下段厚度（OR=0.49，95%CI 0.24-0.96）和子宫肌层厚度（OR=0.44，95%CI 0.20-0.94）与子宫缺陷显著相关。子宫下段厚度（OR=0.41，95%CI 0.22-0.76）和子宫肌层厚度（OR=0.33，95%CI 0.16-0.66）与剖宫产分娩显著相关。
在第一产程中，子宫下段厚度为 2.3mm，子宫肌层厚度为 1.9mm，与试产过程中发生子宫缺陷的风险较高相关。这些在产程中的测量值可用于决定有剖宫产史的产妇的分娩方式，并可能降低子宫破裂的风险。
