Cesarean Wound Disruption Clinical Trial
Official title:
2D and 3D Ultrasound Assessment of Cesarean Section Scars and Its Correlation to Intraoperative Findings
Prospective observational study conducted on women with previous 1 or 2 CS candidate for elective CS. Ultrasonographic evaluation of lower uterine segment using 2D and 3D transabdominal and transvaginal then correlated to scar integrity assessed intraoperatively
Transabdominal ultrasound examination to obtain full obstetric ultrasound report including
estimated gestational age, fetal lie, presentation, amniotic fluid volume, placental
location with special focus on relation to the uterine scar.
The second step was to measure the thickness of the LUS using 2D ultrasound. View of the LUS
was obtained in the mid-sagittal plane and the view was magnified looking for the thinnest
area of the LUS. Also, the LUS was examined in a lateral view to detect any apparent
rupture, ballooning or funneling. The measurement was taken with the cursors at the
urine-Urinary bladder interface and the amniotic fluid -decidua interface after sufficient
magnification and measurement was taken to the nearest tenth of millimeter. The numeric
display was covered during the examination to avoid bias when performing the 3D measurement
in the next step. Three measurements were taken and the least measurement was recorded.
After the entire thickness was measured by 2D ultrasound, 3 D measurement were taken in the
mid-saggittal plan using the multiplanar display mode and then moving through the acquired
3-D volume in the saggittal plane till the thinnest area was seen and then measurements were
taken.3-D volume dataset was obtained of the LUS by the same operator. The acquired volume
was manipulated on the multiplanar display mode, searching for the thinnest part of the LUS
avoiding obliquity.
Transvaginal ultrasound examination was done following the transabdominal one. The vaginal
probe was inserted into the posterior vaginal fornix with the patient lying supine and the
patient's knees are gently flexed and hips are slightly elevated with a pillow. Clear view
of the LUS was obtained in the midsagittal plane visualizing the cervical canal to ensure
that the view is midline one and avoiding obliquity.
On transvaginal examination the muscular layer of the LUS was clearly seen as hypoechoic
line between the hyperechoic uterovesical fold and the decidualized endometrium and the
chorioamniotic membranes. The scar area was magnified so the scar occupies at least 75% of
the image to ensure consistent and accurate measurements. The thickness of the muscular
layer of LUS was taken with the measuring caliber placed at the urinary bladder
wall-myometrium interface and the myometrial/ chorioamniotic membrane interface .Three
measurements of the LUS were taken, and again, the least measurement was recorded.
Again, 3D volume data set of the LUS was obtained .The acquired volume was manipulated on
the multiplanar display looking for the thinnest part of the muscular layer. The thickness
was measured to the nearest tenth of millimeter and recorded. The same operator has
performed the transabdominal and transvaginal sonographic examination, and the surgeon
performing the CS was always blinded of the sonographic findings.
The ultrasound examination to CS time interval varied from one to forty eight hours. During
Cesarean delivery the LUS was defined as the part of the uterus below the uterovesical
peritoneal reflection. After opening the visceral peritoneum and performing the bladder
dissection, the LUS was assessed for integrity of the CS scar by the operating surgeon to
avoid bias by the sonographic findings. Scar dehiscence was defined as the presence of
either transparent LUS with visible contents, presence of well-circumscribed scar defect or
presence of frank uterine rupture.
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