Abstract:
BACKGROUND:Prenatal risk stratification of women with previous cesarean section (CS) by ultrasound thickness measurement of the lower uterine segment (LUS) is challenging. There is a wide range of proposed cutoff values and a valuable algorithm for selection before birth is not available. Using 3 T magnetic resonance imaging (MRI), we aimed to identify possible shortcomings of the current protocols used for birth selection after CS. Therefore, we evaluated anatomic and morphologic differences of the LUS and its thickness in patients with CS and those without. Possible impact factors on LUS thickness were studied. METHODS:We retrospectively analyzed 3 T MRI scans of 164 pregnant women in their second or third trimester, with (patient group, n = 60) and without previous CS (control group, n = 104). Sagittal T2-weighted images were studied. Normal findings of the LUS in MRI, reliability of MRI measurements, as well as factors influencing LUS thickness were assessed. MRI findings were compared to intraoperative findings. RESULTS:MRI provided good intra- (ICC 0.872) and fair inter-rater reliability (ICC 0.643). The relationship of the LUS and the cesarean scar to the surrounding anatomical structures and also its morphology varied strongly in patients and controls. Scar identification was possible in only 9/60 (15.0%) patients. The LUS was thinner in patients (1.9 ± 0.7 mm) than in controls (2.7 ± 1.3 mm). An LUS thinning up to 1 mm was observed in 23% of women without a previous CS and in 34% of women with normal intraoperative findings. Suspicion of a uterine dehiscence (LUS thickness < 1 mm) was only found in the patient group (5/59 (8.5%)) and was intraoperatively confirmed. In controls, LUS thickness was influenced by fetal weight, gestational age and amniotic fluid amounts. CONCLUSION:Variability in anatomy, thickness and morphology seem to limit common prenatal LUS imaging diagnostics. Therefore, we consider that diagnostic protocols must be re-evaluated and imaging should be adjusted to the individual patient conditions. Due to its independency of ultrasound limitations, an additional MRI might be useful for altered anatomy and impaired ultrasound conditions. An LUS thinning up to 1 mm might be a normal finding and should be further investigated as reference value.
journal_name
BMC Pregnancy Childbirthjournal_title
BMC pregnancy and childbirthauthors
Hoffmann J,Exner M,Bremicker K,Grothoff M,Stumpp P,Stepan Hdoi
10.1186/s12884-019-2314-7subject
Has Abstractpub_date
2019-05-08 00:00:00pages
160issue
1issn
1471-2393pii
10.1186/s12884-019-2314-7journal_volume
19pub_type
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
doi:10.1186/s12884-015-0648-3
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
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pub_type: 杂志文章
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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journal_title:BMC pregnancy and childbirth
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pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究
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更新日期:2014-04-10 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章
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更新日期:2019-12-05 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,随机对照试验
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更新日期:2012-06-21 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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更新日期:2017-07-14 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,评审
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更新日期:2016-05-31 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,评审
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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更新日期:2017-09-12 00:00:00
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更新日期:2016-03-21 00:00:00
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pub_type: 杂志文章
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更新日期:2020-10-07 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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更新日期:2018-07-04 00:00:00