Scar; Previous Cesarean Section Clinical Trial
Official title:
Multimodale Beurteilung Der Stabilität Von Uterusnarbengewebe Bei Z.n. Sectio Caesarea
This prospective, clinical, observational trial compares the measured value with quantitative ultrasonic (preoperatively) Elastic modulus E (kPA) with the measured value with quantitative ultrasonic Elastic modulus E (kPA) in vitro (postoperatively) and with the experimental measurement done in vitro (postoperatively) of lower uterine segment of women who underwent second cesarean section.
In 1991, 126.297 (15.3%) women delivered by caesarean section in Germany. Since then, the
rate of caesarean section increased steadily over the next 20 years, reaching up to 32.2% in
2011. The absolute risk of uterine rupture in vaginal birth after Caesarean section is 1 in
100 deliveries. The risk of perinatal death or the outcome of extremely neurological
impairment is 1 in 1000 deliveries.
Statistically more than 300 pregnant women with a prior caesarean delivery visit daily
ultrasound departments of german hospitals to investigate the C-section scar before
delivery. They have one important question: Is it possible to predict successful trial of
labor after cesarean delivery? The information for the risk of uterine rupture remains
insufficient based only on ultrasonography assessment.
What are the possibilities of additional parameters to examine the stability of uterine scar
tissue? Currently, there is no defined cut-off value of scar thickness for the prediction of
uterine rupture. It remains questionable whether the thickness of the lower uterine segment
is the determinant factor for the stability of the scar and the probability of rupture.
However, another important factor is the functional elasticity or the structure of the
connective tissue. It has not been further investigated until now (both quantitatively and
qualitatively).
Objective of this project: Multimodalities of assessments, including ultrasonography and
elastography, validate the accuracy of uterine scar stability in women with previous history
of Caesarean section in vitro and in vivo.
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Observational Model: Cohort, Time Perspective: Prospective
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