Outcome of pregnant women with previous cesarean section after
sonographic assessment suggesting uterine dehiscence
Abstract
Rationale, aims and objectives: Pregnant women at vaginal labor may
occur uterine rupture, especially these who had previous caesarean
section (CS). Lower uterine segment (LUS) dehiscence is different from
uterine rupture, which may not cause serious event. The objective of
this study was to investigate the outcome of pregnant women with
previous caesarean section (CS) after sonographic evaluation revealing
lower uterine segment (LUS) dehiscence. Methods: 107 pregnant women with
previous CS and LUS thickness <1.0 mm were recruited, the LUS
and myometrium was measured, and ultrasound findings suggestive of
uterine rupture were compared with findings at laparotomy. The included
pregnant women were assigned into two groups, including 64 pregnant
women had vaginal delivery at full-term and 43 pregnant women underwent
repeat CS at preterm. Results: Ultrasound findings suggestive of uterine
rupture and dehiscence were 18 and 89 women, respectively; 10 of them
developed uterine rupture, and the incidence of uterine rupture was
9.34%. The sensitivity, specificity, accuracy, positive and negative
predictive values of ultrasound for the evaluation of LUS dehiscence and
rupture were 100.00%, 91.75%, 92.52%, 55.56%, and 100%,
respectively. There was no severe maternal obstetric complication, one
fetus died, and the other fetuses were born with a 5-minute Apgar score
of 7-10. Conclusions: Pregnant woman with previous CS and LUS myometrial
thickness < 1.0mm has higher risk of LUS rupture. LUS rupture
is usually not catastrophic if it is managed timely. If there are no
findings suggestive of LUS rupture by ultrasound, the gestation can
sustain uneventfully to term under closely monitoring.