Ultrasound assessment of uterine scar competence during labor


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Background: Fear of vaginal delivery is most commonly associated with uterine rupture in women with postcesarean uterine scar. The fact that the morphological competence of the scar and its ability to dehisce at the onset of labor cannot be prognostically evaluated necessitates the exchange of experience in managing vaginal delivery with uterine scar. Materials and methods: A prospective study of 41 pregnant women with a uterine scar after a single cesarean section was conducted. All the women were scheduled for vaginal delivery. Uterine scar competence was assessed clinically and ultrasonographically at the onset of labor. Results: Twenty-six women delivered vaginally; 15 were re-operated. The indications for repeat cesarean section were labor abnormalities (n=7), clinically narrow pelvis (n=4), and threat of uterine scar incompetence (n=4). Intraoperatively, the uterine scar was competent in 11 patients; there was scar incompetence, incomplete uterine rupture, and uterine scar dehiscence in 4, 2, and 2 patients, respectively. Conclusion: The causes of unsuccessful attempts at vaginal delivery after caesarean section are not always associated with scar incompetence. The scars most commonly turn out to be intraoperatively competent. It is advisable to ultrasonographically assess scar competence at the onset of labor in women planning vaginal delivery.

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作者简介

Natalya Kuznetsova

Rostov State Medical University, Ministry of Health of the Russian Federation; Professor Bushtyreva Clinic LLC

Email: lauranb@inbox.ru
Dr. Med. Sci., Professor at the Center for Simulation Training

Gulmira Ilyasova

Rostov State Medical University, Ministry of Health of the Russian Federation

Email: gulmirka666@mail.ru
post-graduate student

Irina Bushtyreva

Professor Bushtyreva Clinic LLC

Email: kio4@mail.ru
Dr. Med. Sci., Professor, Director

Sergey Todorov

Rostov State Medical University, Ministry of Health of the Russian Federation

Email: sertodorov@gmail.com
Dr. Med. Sci., Associate Professor, Head of the Department Pathological Anatomy, Head of the Morphological Department of the Clinic

Viktoriya Barinova

Rostov State Medical University, Ministry of Health of the Russian Federation; Professor Bushtyreva Clinic LLC

Email: victoria-barinova@yandex.ru
PhD, Assistant Professor at the Department of Obstetrics and Gynecology No. l

参考

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