Portal de Periódicos da CAPES

Predicting Incomplete Uterine Rupture With Vaginal Sonography During the Late Second Trimester in Women With Prior Cesarean

2000; Lippincott Williams & Wilkins; Volume: 95; Issue: 4 Linguagem: Inglês

10.1097/00006250-200004000-00022

1873-233X

Hideo Gotoh, Hideaki Masuzaki, Atsushi Yoshida, Shuichiro Yoshimura, Tsunetake Miyamura, Tadayuki Ishimaru,

Pregnancy-related medical research

In Brief Objective To evaluate the usefulness of serial transvaginal ultrasonographic measurement of the thickness of the lower uterine segment in the late second trimester for predicting the risk of intrapartum incomplete uterine rupture in women with previous cesarean delivery. Methods Serial transvaginal ultrasonography with full bladder was performed in 374 women without previous cesarean delivery (control group) and 348 women with previous cesarean delivery (cesarean group) from 19 to 39 weeks' gestation. The thickness of the lower uterine segment was measured in the longitudinal plane of the cervical canal. Results The thickness of the lower uterine segment decreased from 6.7 ± 2.4 mm (mean ± standard deviation [SD]) at 19 weeks' gestation to 3.0 ± 0.7 mm at 39 weeks' gestation in the control group, but the thickness was more than 2.0 mm throughout this period in each control subject. In the cesarean group, the thickness decreased from 6.8 ± 2.3 mm at 19 weeks' to 2.1 ± 0.7 mm at 39 weeks' gestation and was significantly thinner than that of the control group after 27 weeks' gestation (P < .05). Eleven of 12 women (91%) with lower uterine segment less than the mean control − 1 SD in the late second trimester had a very thin lower uterine segment at cesarean delivery with fetal hair being visible through the amniotic membrane, ie, incomplete uterine rupture. In 17 of 23 women (74%) with lower uterine segment less than 2.0 mm in thickness within 1 week (4 ± 3 days) before repeat cesarean delivery, intrapartum incomplete uterine rupture developed. Conclusion Transvaginal ultrasonography is useful for measurement of the uterine wall after previous cesarean delivery. The gravid uterus may be at risk of incomplete rupture when the thickness of the lower uterine segment is 2.0 mm or less in the late second trimester as measured by transvaginal ultrasonography.