ROLE OF THREE DIMENSIONAL TRANSABDOMINAL ULTRASONOGRAPHY IN PREDICTION OF CAESAREAN SCAR DEHISCENCE PRIOR TO DELIVERY IN WOMEN WITH PREVIOUS CAESAREAN SECTION
Tamer Mahmoud Assar and Ashraf Nassif Mahmoud Elmantwe
Department Obstetrics and Gynecology, Faculty of Medicine Benha University
Objective: to access of the efficacy of three dimensional ultrasound (3DUS) in prediction of cesarean scar dehiscence in pregnant patients at term and comparing the outcome of measurement to the intraoperative visual assessment of the scar.
Design: prospective study.
Participants & Methods: 70 pregnant women with a history of prior cesarean section attending benha University hospital. All participants underwent a 3D transabdominal scan at third trimester and the data was recorded. We measured the lower segment thickness from the muscularis and mucosa of the bladder on the outer side to the chorioamniotic membrane on the inner side, with the myometrium in between and hence, depending on a 3-layered pattern. This was compared with the pregnancy outcome and the intraoperative scar condition. The data was then statistically analyzed.
Results: The mean scar thickness as measured by 3D transabdominal sonography in the third trimester was4.63±0.85 mm. the best cut-off level for predicting uterine scar defects was ≤2.5 mm (highest diagnostic accuracy) with sensitivity 25%, specificity 100%, PPV 100% & NPV 95%.
Conclusions: The current study suggests that prenatal 3D US examination determining the degree of LUS thinning in patients with previous caesarean delivery which is considered better negative screening test than positive due to higher specificity than sensitivity 3D Ultrasound provides an additional element for assessing the risk of uterine rupture and may increase safe management of trial of labour