Ultrasound assessment of uterine scar competence during labor
Background: Fear of vaginal delivery is most commonly associated with uterine rupture in women with post-cesarean 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.Kuznetsova N.B., Ilyasova G.M., Bushtyreva I.O., Todorov S.S., Barinova V.V.
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.
Keywords
attempt at vaginal delivery in the presence of uterine scar
cesarean section
incomplete uterine rupture
uterine scar dehiscence
References
- Reif P., Brezinka С., Fischer Т., Husslein P., Lang U., Ramoni A. еt al. Recommendations of the austrian society of obstetrics and gynaecology (OEGGG). Geburtshilfe Frauenheilkd. 2016; 76(12): 1279-86. https://dx.doi.org/10.1055/s-0042-118335.
- Wu Y., Kataria Y., Wang Z., Ming W.K., Ellervik C. Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019; 19(1): 360. https://dx.doi.org/10.1186/s12884-019-2517-у.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 205: Vaginal birth after cesarean delivery. Obstet. Gynecol. 2019; 133(2): e110-27. https://dx.doi.org/10.1097/AOG.0000000000003078.
- Royal College of Obstetricians and Gynaecologists. RCOG Green-top Guideline No. 45: birth after previous caesarean birth. 2015. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf Accessed 10.12.2021.
- Queensland Clinical Guideline: Vaginal birth after caesarean (VBAC). 2020. Available at: www.health.qld.gov.au/qcg Accessed 10.12.2021.
- Пекарев О.Г., Адамян Л.В., Артымук Н.В. и др. Послеоперационный рубец на матке, требующий предоставления медицинской помощи матери во время беременности, родов и в послеродовом периоде. Клинические рекомендации. 2021. Доступно по: https://minzdrav.midural.ru/uploads/2021/07/Послеоперационный%20рубец%20на%20матке.pdf Активна на: 02.01.2022. [Pekarev O.G., Adamyan L.V., Artymuk N.V. et al. A postoperative scar on the uterus that requires the provision of medical care to the mother during pregnancy, childbirth and in the postpartum period. Clinical guidelines. 2021. Available at: https://minzdrav.midural.ru/uploads/2021/07/Послеоперационный%20рубец%20на%20матке.pdf Accessed 02.01.2022. (in Russian)].
- Zhang M., Su Q., Cao Y., Zhao M., Huang D. Safety and feasibility of trial of vaginal labor after cesarean section: A retrospective study. Medicine (Baltimore). 2020; 99(46): e22844. https://dx.doi.org/10.1097/MD.0000000000022844.
- Вученович Ю.Д., Новикова В.А., Костин И.Н., Радзинский В.Е. Риски несостоятельности рубца и попытки вагинальных родов после кесарева сечения. Акушерство и гинекология: новости, мнения, обучение. 2019; 7(3, Приложение): 93-100. [Vuchenovich Yu.D., Novikova V.A., Kostin I.N., Radzinsky V.E. The risk of scar failure and attempts at vaginal delivery after cesarean section. Obstetrics and Gynecology: News, Opinions, Training. 2019; 7(3, Suppl.): 93-100. (in Russian)]. https://dx.doi.org/10.24411/2303-9698-2019-13913.
- Кравченко Е.Н., Куклина Л.В., Синицына С.С., Рублева Г.Ф., Владимирова М.П. Роды через естественные родовые пути у женщин с рубцом на матке. Мать и дитя в Кузбассе. 2021; 2: 83-7. [Kravchenko E.N., Kuklina L.V., Sinitsyna S.S., Rubleva G.F., Vladimirova M.P. Childbirth through the natural birth canal in women with a scar on the uterus. Mother and Child in Kuzbass. 2021; 2(85): 83-7. (in Russian)].
- Вученович Ю.Д., Новикова В.А., Радзинский В.Е. Успех попытки родов через естественные родовые пути после двух кесаревых сечений. Каковы шансы? Российский вестник акушера-гинеколога. 2020; 20(5): 61-7. [Vuchenovich Yu.D., Novikova V.A., Radzinsky V.E. The success of an attempt to give birth through the natural birth canal after two cesarean sections. What are the chances? Russian Bulletin of the obstetrician-gynecologist. 2020; 20(5): 61-7. (in Russian)]. https://dx.doi.org/10.17116/rosakush20202005161.
- Савельева Г.М., Курцер М.А., Бреслав И.Ю., Коноплянников А.Г., Латышкевич О.А. Разрывы матки в современном акушерстве. Акушерство и гинекология. 2020; 9: 48-55. [Savelyeva G.M., Kurtzer M.A., Breslav I.Yu., Konoplyannikov A.G., Latyshkevich O.A. Uterine ruptures in modern obstetrics. Obstetrics and Gynecology. 2020; 9: 48-55. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.9.48-55.
- Радзинский В.Е. Акушерская агрессия, v. 2.0. М.: StatusPraesens; 2017. 872с. [Radzinsky V.E. Obstetric aggression, v. 2.0. M.: StatusPraesens; 2017. 872 p. (in Russian)].
- Савельева Г.М., Курцер М.А., Бреслав И.Ю., Караганова Е.Я., Неклюдова Ю.Г. Непроникающий разрыв матки по рубцу после кесарева сечения и расползание/аневризма рубца на матке во второй половине беременности и в родах. Акушерство и гинекология. 2021; 6: 66-72. [Savelyeva G.M., Kurtzer M.A., Breslav I.Yu., Karaganova E.Ya., Neklyudova Yu.G. Non-penetrating rupture of the uterus along the scar after cesarean section and spreading/ scar aneurysm on the uterus in the second half of pregnancy and childbirth. Obstetrics and Gynecology. 2021; 6: 66-72. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.6.66-72.
- Agha R.A., Sohrabi C., Mathew G., Franchi T., Kerwan A., O’Neill N.; PROCESS Group. The PROCESS 2020 guideline: updating consensus preferred reporting of CasE series in surgery (PROCESS) guidelines. Int. J. Surg. 2020; 84: 231-5. https://dx.doi.org/10.1016/ j.ijsu.2020.11.005.
Received 02.03.2022
Accepted 01.06.2022
About the Authors
Natalya B. Kuznetsova, Dr. Med. Sci., Professor at the Center for Simulation Training, Rostov State Medical University, Ministry of Health of Russia, 344022, Russia,Rostov-on-Don, Nakichevanskiy str., 29; Chief Physician, Clinic of Professor Bushtyreva, 344011, Russia, Rostov-on-Don, Sobornyi str., 58/7, +7(928)770-97-62,
lauranb@inbox.ru, https://orcid.org/0000-0002-0342-8745
Gulmira M. Ilуasova, post-graduate student, Rostov State Medical University, Ministry of Health of Russia, +7(989)613-04-03, gulmirka666@mail.ru,
344022, Russia, Rostov-on-Don, Nakhichevansky str., 29.
Irina O. Bushtyreva, Dr. Med. Sci., Professor, Director of the Clinic of Professor Bushtyreva, +7(928)296-15-97, kio4@mail.ru,
344011, Russia, Rostov-on-Don, Sobornyi str., 58/7.
Sergey S. Todorov, Dr. Med. Sci., Associate Professor, Head of the Department Pathological Anatomy, Head of the Morphological Department of the Clinic, Rostov State Medical University, Ministry of Health of Russia, +7(918)508-37-89, sertodorov@gmail.com, 344022, Russia, Rostov-on-Don, Nakhichevansky str., 29.
Viktoriya V.Barinova, PhD, Assistant Professor at the Department of Obstetrics and Gynecology No. 1, Rostov State Medical University, Ministry of Health of Russia,
344022, Russia, Rostov-on-Don, Nakhichevanskiy str., 29; Head of the Obstetric Department, Clinic of Professor Bushtyreva,
344011, Russia, Rostov-on-Don, Soborniy str., 58/7, +7(928)909-55-68, victoria-barinova@yandex.ru, https://orcid.org/0000-0002-8584-7096
Corresponding authors: Natalya B. Kuznetsova, lauranb@inbox.ru; Gulmira M. Ilyasova, gulmirka666@mail.ru
Authors' contributions: Kuznetsova N.B., Ilyasova G.M., Bushtyreva I.O. – concept and design of the investigation; Kuznetsova N.B., Ilyasova G.M. – material collection and processing; Kuznetsova N.B., Ilyasova G.M., Todorov S.S. – writing the text; Kuznetsova N.B., Todorov S.S., Barinova V.V. – editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Rostov State Medical University, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data and associated images.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Kuznetsova N.B., Ilyasova G.M., Bushtyreva I.O., Todorov S.S., Barinova V.V. Ultrasound assessment of uterine scar competence during labor.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 6: 114-121 (in Russian)
https://dx.doi.org/10.18565/aig.2022.6.114-121
Similar Articles
