Position and integrity of uterine scar are determined by degree of cervical dilatation at time of Cesarean section.
Adult
Cervix Uteri
/ diagnostic imaging
Cesarean Section
/ adverse effects
Cicatrix
/ complications
Female
Humans
Labor Stage, First
Labor, Obstetric
Postoperative Complications
/ epidemiology
Pregnancy
Pregnancy, Ectopic
/ epidemiology
Prospective Studies
Ultrasonography, Prenatal
/ statistics & numerical data
Uterus
/ surgery
Cesarean section
abnormal placental invasion
labor
morbidly adherent placenta
placenta accreta
scar defect
uterine niche
uterine scar
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
04
02
2020
revised:
02
04
2020
accepted:
11
04
2020
pubmed:
25
4
2020
medline:
15
12
2021
entrez:
25
4
2020
Statut:
ppublish
Résumé
Abnormal placental invasion is more common after an elective Cesarean delivery, suggesting that prelabor Cesarean section (CS) increases the likelihood of the CS scar being above the internal cervical os and predisposing to a scar pregnancy in the future. The aim of this study was to assess the location and integrity of the CS scar in postpartum women delivered by CS at different stages of labor. This was a prospective cohort study of women at term who underwent a CS for the first time. In all women, cervical dilatation was determined by digital examination at the time of the CS. All patients had a transvaginal ultrasound examination to assess the location of the CS scar in relation to the internal cervical os, as well as the presence of a scar niche. A total of 407 pregnant women were recruited into the study: 103 with cervical dilatation ≤ 2 cm, 261 with cervical dilatation 3-7 cm and 43 with cervical dilatation ≥ 8 cm at the time of the CS. A statistically significant correlation was observed between cervical dilatation at the time of the CS and the position of the CS scar. The scar was positioned in the uterus above the internal cervical os in 97.1% (100/103) of women delivered at a cervical dilatation of 0-2 cm, whereas the scar was located at or below the internal cervical os in 97.7% (42/43) of cases delivered at a cervical dilatation of 8-10 cm (P < 0.001). A uterine-scar defect (niche) was observed in 38.1% (64/168) of women with the scar located above, compared with 18.0% (43/239) of those with the scar situated at or below, the internal cervical os (P < 0.001). Prelabor and early-labor Cesarean delivery are associated with an increased prevalence of a scar in the uterine cavity as well as a scar niche. CS in late labor is associated with the uterine scar being situated in the endocervical canal and with a lower incidence of a niche. The position and integrity of the CS scar after prelabor and early-labor Cesarean delivery explain the predisposition to abnormal placental invasion in subsequent pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
466-470Informations de copyright
© 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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