title: Sonographic prediction of scar dehiscence in women with previous cesarean section.
abstract: OBJECTIVE
  To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS).
  
  
  METHODS
  In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I-IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I-IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I-IV).
  
  
  RESULTS
  Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS (p = 0.440) and inter-delivery interval (p = 0.062) had no statistically significant correlation with thickness of LUS.
  
  
  CONCLUSIONS
  Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.
authors.affiliation: Dr. RPGMC Kangra, Tanda, 176001 HP India.
authors.forename: Chanderdeep
authors.initials: C
authors.lastname: Sharma
authors.affiliation: Dr. RPGMC Kangra, Tanda, 176001 HP India.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Surya
authors.affiliation: Dr. RPGMC Kangra, Tanda, 176001 HP India.
authors.forename: Anjali
authors.initials: A
authors.lastname: Soni
authors.affiliation: Dr. RPGMC Kangra, Tanda, 176001 HP India.
authors.forename: Pawan Kumar
authors.initials: PK
authors.lastname: Soni
authors.affiliation: Dr. RPGMC Kangra, Tanda, 176001 HP India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Verma
authors.affiliation: Dr. RPGMC Kangra, Tanda, 176001 HP India.
authors.forename: Suresh
authors.initials: S
authors.lastname: Verma
keywords: Cesarean scar; Cesarean section; Pregnancy; Transabdominal ultrasonography; Transvaginal ultrasonography