title: Effective anatomical and functional status of the lower uterine segment at term: estimating the risk of uterine dehiscence by ultrasound.
abstract: OBJECTIVE
  To define the role of lower uterine segment (LUS) evaluation at term.
  
  
  METHODS
  Observational case-control study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Ninety-four patients were divided into two groups. Group A consisted of 45 multiparous single fetus pregnant women with up to two previous cesarean sections (CS). Group B consisted of 49 multiparous pregnant women with up to three vaginal deliveries and no uterine scars.
  
  
  METHODS
  Total LUS and myometrial thickness were measured by sonogram in all patients before undergoing a CS.
  
  
  METHODS
  The primary outcome is a correlation between echographic measurements and features of the LUS at the time of CS. The secondary outcome is a definition of a correlation between the number of previous CS, interdelivery interval time, and features of the LUS (grades I-IV).
  
  
  RESULTS
  Sonographic measurements revealed significant differences in LUS size and myometrial thickness between the two groups. Grades III and IV of LUS were only observed in group A. An interdelivery interval <18 months, LUS thickness ≤ 3.0 mm, and myometrial thickness < 1.5 mm were statistically significant predictors of LUS grades III and IV. Number of previous CS showed no correlation with surgical LUS status.
  
  
  CONCLUSIONS
  Sonographic evaluation of the LUS may be a noninvasive, reproducible, and safe technique for defining the risk of uterine dehiscence, with a sensitivity of 100% and specificity of 85% (positive predictive value, 45%; negative predictive value, 100%).
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy. ginecologia_padova@libero.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Zambon
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
authors.forename: Tito Silvio
authors.initials: TS
authors.lastname: Patrelli
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Gangi
authors.forename: Monica
authors.initials: M
authors.lastname: Carrozzini
authors.forename: Anna
authors.initials: A
authors.lastname: Bertocco
authors.forename: Giampiero
authors.initials: G
authors.lastname: Capobianco
authors.forename: Donato
authors.initials: D
authors.lastname: D'Antona
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging* / Q000209:etiology*; D014463:Ultrasonography; D014591:Uterine Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D016064:Vaginal Birth after Cesarean; D055815:Young Adult