title: Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment.
abstract: 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.
authors.affiliation: 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
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
authors.forename: Nicole
authors.initials: N
authors.lastname: Jastrow
authors.forename: Jessica
authors.initials: J
authors.lastname: Simoneau
authors.forename: Suzanne
authors.initials: S
authors.lastname: Brunet
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gauthier
mesh_terms: 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*