Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment.
OBJECTIVE
The purpose of this study was to establish the validity of sonographic evaluation of lower uterine segment (LUS) thickness for complete uterine rupture.


METHODS
A prospective cohort study of women with previous cesarean delivery was conducted. LUS thickness (full thickness and myometrial thickness only) was measured between 35 and 38 weeks gestation, and the thinnest measurement was considered to be the dependent variable. Receiver operating curve analyses and logistic regression were used.


RESULTS
Two hundred thirty-six women were included in the study. Nine uterine scar defects (3 cases of complete rupture during a trial of labor and 6 cases of dehiscence) were reported. Receiver operating curve analyses showed that full thickness of <2.3 mm was the optimal cutoff for the prediction of uterine rupture (3/33 vs 0/92; P = .02). Full thickness was also identified as an independent predictor of uterine scar defect (odds ratio, 4.66; 95% confidence interval, 1.04-20.91)


CONCLUSIONS
Full LUS thickness of <2.3 mm is associated with a higher risk of complete uterine rupture.
Bujold
Emmanuel
E
Department of Obstetrics and Gynaecology, Faculty of Medicine, Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Québec, QC, Canada. emmanuel.bujold@crchul.ulaval.ca
Jastrow
Nicole
N
Simoneau
Jessica
J
Brunet
Suzanne
S
Gauthier
Robert J
RJ
D000328:Adult; D005260:Female; D006801:Humans; D009215:Myometrium; D011247:Pregnancy; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D014597:Uterine Rupture / Q000000981:diagnostic imaging*