scholarly journals Cesarean Scar Hysterotomy: Assessment by Three-dimensional Transvaginal Ultrasound Scan

2017 ◽  
Vol 11 (1) ◽  
pp. 82-87
Author(s):  
MT Clavijo ◽  
José Bajo-Arenas ◽  
JM Troyano ◽  
I Martinez-Wallin ◽  
A Molina Betancor ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Recovery Period ◽  
Three Dimensional ◽  
Wound Dehiscence ◽  
Well Being ◽  
Background Information ◽  
Ultrasound Scan ◽  
Cesarean Scar ◽  
Uterine Scar ◽  
Transvaginal Ultrasound Scan

ABSTRACT Objective The combined study of two-dimensional (2D) and three-dimensional (3D) sonographic records may be useful to diagnose wound dehiscence from hysterotomy and forecast the well-being of future gestations. In that respect, irregular cicatrization patterns can be identified from the early puerperium over the whole postparturition recovery period, and may encourage the need for further cesarean in new pregnancies to come. Subjects and Methods A random sample of 42 female patients were subjected to transvaginal sonographic exploration at three sampling times, namely 4 days, 4 months, and 1 year following hysterotomy. All of these women recovered successfully from their cesarean and were discharged from hospital 5 days after parturition.  The 2D and 3D surveys were subsequently undertaken at each of the three study times. Four days after surgery, the 2D ultrasound scan aimed at evaluating the early evolution of the uterine scar. On the contrary, 3D echographies were implemented frame-to-frame, in a transverse direction, from the right to left sides of the uterus. Results The 3D sonographic records from those dehiscent wounds displayed at this time a wide, irregular hypoechogenic area crossed over by linear structures representing the suture material (Vycril). Such a record was called a “shark bite” pattern.  The latter puerperal dehiscence pattern persisted in the isthmic region for 4 months and 1 year after delivery. It consistently featured a notch between the scar borders that run perpendicular to the complete extent of the internal myometrium layer and bordered the anterior uterine wall.  By considering the length of the hysterotomy-derived notch over the whole study period, two types of scars could be differentiated through 2D sonographic surveys, scar notches >2/3 (n=9) or ≤1/3 (n=4) of the total scar lengt. Six of the 13 wound-dehiscent women monitored in this study became pregnant within 2 years after their former cesarean.  All were subjected to a second hysterotomy, before which an in situ examination of the previous uterine scar could be made.  Early puerperal ultrasound scan focusing on hypoechogenic areas across the borders of hysterotomy-derived scars under suturing pressure must be undertaken by means of 2D transvaginal ultrasound scan, with the bonus that such exploration can be extended through several months to a 1 year period after surgery. The extent of dehiscent myometrium areas and the depth of the notch remaining between the serose and the cervical channel of the stigma can be used as reliable indicators for defective cicatrization processes and should be used as background information aiding in future gestations.  The 3D transvaginal ultrasound scan provides the practitioner with thorough records of myometrial failure and enhances the morphological study of iatrogenic pathologies originating from cesarean surgery.  The state and extent of healed vs failing cicatrization areas can be easily assessed by means of 3D transvaginal ultrasound scan. How to cite this article Troyano JM, Clavijo MT, Martinez-Wallin I, Molina-Betancor A, Alvarez-de-la-Rosa M, Padilla AI, Bajo-Arenas J. Cesarean Scar Hysterotomy: Assessment by Three-dimensional Transvaginal Ultrasound Scan. Donald School J Ultrasound Obstet Gynecol 2017;11(1):82-87.

scholarly journals OP10.03: Three dimensional transvaginal ultrasound scan: is cervical length longer?

2011 ◽  
Vol 38 (S1) ◽  
pp. 84-84
Author(s):  
L. Alabi-isama ◽  
L. Sykes ◽  
V. Khullar ◽  
R. Rai ◽  
P. Bennett ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Three Dimensional ◽  
Cervical Length ◽  
Ultrasound Scan ◽  
Transvaginal Ultrasound Scan

scholarly journals Various Types of Niche Imaging by Sonohysterography: A Pictorial Review

2014 ◽  
Vol 8 (3) ◽  
pp. 311-315 ◽  
Author(s):  
Firoozeh Ahmadi ◽  
Farnaz Akhbari ◽  
Fatemeh Niknejad
Keyword(s):  
Cesarean Section ◽  
Transvaginal Ultrasound ◽  
Subsequent Pregnancy ◽  
Previous Cesarean Section ◽  
Cesarean Section Delivery ◽  
Cesarean Scar ◽  
Pictorial Review ◽  
Scar Region ◽  
Uterine Scar ◽  
Previous Cesarean

ABSTRACT Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. Recently cesarean section delivery has been raised around the world markedly; therefore women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual Spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy. Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs have been used as a powerful tool for detecting the uterine scar of a previous cesarean section. Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently. How to cite this article Ahmadi F, Akhbari F, Niknejad F. Various Types of Niche Imaging by Sonohysterography: A Pictorial Review. Donald School J Ultrasound Obstet Gynecol 2014;8(3):311-315.

Evaluation of uterine scar healing by transvaginal ultrasound in 607 nonpregnant women with a history of cesarean section

2020 ◽  
Author(s):  
Xingchen Zhou ◽  
Tao Zhang ◽  
Huayuan Qiao ◽  
Yi Zhang ◽  
Xipeng Wang
Keyword(s):  
Cesarean Section ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Cesarean Scar ◽  
Female Reproductive Health ◽  
Position Detection ◽  
The Difference ◽  
Uterine Scar ◽  
Group B ◽  
Scar Healing

Abstract Background: Caesarean scar defect (CSD) seriously affects female reproductive health. In this study, we aim to evaluate uterine scar healing by transvaginal ultrasound（TVS）in nonpregnant women with cesarean section（CS）history and to build a predictive model for cesarean section defects is very necessary. Methods: A total of 607 nonpregnant women with previous CS who have transvaginal ultrasound measurements of the thickness of the lower uterine segment . The related clinical data were recorded and analyzed. Results: All patients were divided into two groups according to their clinical symptoms: Group A (N=405) who had no cesarean scar symptoms, and Group B (N=141) who had cesarean scar symptoms. The difference in frequency of CS, uterine position, detection rate of CSD and the the residual muscular layer (TRM) of the CSD were statistically significant between groups; the TRM measurements of the two groups were (mm) 5.39±3.34 vs 3.22±2.33, P<0.05.All patients were divided into two groups according to whether they had CSDs: Group C (N=337) who had no CSDs , Group D (N=209) who had CSDs on ultrasound examination. The differences in frequency of CS, uterine position, TRM between groups were statistically significant (P<0.05). In the model predicting CSDs by TRM with TVS, the area under the ROC curve was 0.771, the cut-off value was 4.15 mm. The sensitivity and specificity were 87.8% and 71.3%,respectively.Conclusions: Patients with no clinical symptoms had a mean TRM on transvaginal ultrasonography of 5.39 ± 3.34 mm, which could be used as a good reference to predict the recovery of patients with CSDs after repair surgery.

scholarly journals Clinical relevance of routine transvaginal ultrasound in women referred with pelvic organ prolapse

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lone Pedersen ◽  
Marianne Glavind-Kristensen ◽  
Pinar Bor
Keyword(s):  
Pelvic Organ Prolapse ◽  
Incidental Findings ◽  
Transvaginal Ultrasound ◽  
Pelvic Organ ◽  
University Hospital ◽  
Ultrasound Scan ◽  
Ultrasound Findings ◽  
Gynaecological Examination ◽  
Prolapse Symptoms ◽  
Transvaginal Ultrasound Scan

Abstract Background The aim of this study was to investigate the prevalence of incidental findings on transvaginal ultrasound scan in women referred with pelvic organ prolapse by a general practitioner and to investigate which further examinations and treatments were performed as a result of these findings. Methods This was a retrospective cohort study that investigated women with pelvic organ prolapse referred to the outpatient urogynaecological clinics at Randers Regional Hospital and Aarhus University Hospital, Denmark. Results A total of 521 women were included and all of them were examined with a routine transvaginal ultrasound scan and a gynaecological examination. Prolapse symptoms only and no specific indication for transvaginal ultrasound scan were seen in 507 women (97.3%), while 14 women (2.7%) received scans on indication. Among the latter women, five (35.7%) had cancer. In the women with solely prolapse symptoms, 59 (11.6%) had incidental findings on transvaginal ultrasound scan, but all were benign. However, two patients were later diagnosed with cancer unrelated to the initial ultrasound findings. The treatment was extended with further examinations not related to POP in 19 of the women (32.2%) with incidental ultrasound findings. Conclusion The prevalence of incidental ultrasound findings was not high in the women referred with pelvic organ prolapse and no additional symptoms, and all these findings were benign. However, it should be considered that these findings resulted in further investigations and changes to the patients’ initial treatment plans. A meticulous anamnesis and digital vaginal examination are crucial to rule out the need for vaginal ultrasound.

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