First-trimester uterine scar assessment by transvaginal ultrasound

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• 作者：Julien J. Stirnemann ; MD^a ; Gihad E. Chalouhi ; MD^a ; Sylvana Forner ; MD^a ; Yasmine Saidji^b ; Laurent J. Salomon ; MD ; PhD^a ; Jean-Pierre Bernard ; MD^a ; Yves Ville ; MD^a ; ^{ville.yves@gmail.com}
• 关键词：cesarean ; first trimester screening ; reproducibility ; scar
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2011
• 出版时间：December, 2011
• 年：2011
• 卷：205
• 期：6
• 页码：551.e1-551.e6
• 全文大小：1094 K

文摘

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Objective

The objective of the study was to describe the assessment of lower segment uterine scar (LSCS) by transvaginal ultrasound (TVUS) during a first-trimester scan.

Study Design

Patients with a history of LSCS were prospectively enrolled over a 6 month period. Four groups were defined: type 1A, thin scar within cervicoisthmic canal (CIC); type 1B, thin above the internal os (IO); type 2A, dehiscent within the CIC; type 2B, dehiscent above the IO. Accuracy of first-trimester TVUS was investigated by blind testing a panel of 14 operators over a web-based dataset.

Results

The scar was visualized in 122 of 123 patients enrolled. Types 1A, 1B, 2A, and 2B occurred in 49.2 % , 3.3 % , 38.3 % , and 9.2 % , respectively. When blind tested, fetal medicine specialists achieved a median sensitivity of 82 % and specificity of 100 % for the detection of a scar. These were 83 % and 87 % for nonspecialists.

Conclusion

First-trimester uterine scar assessment may become a valuable tool in early recognition of patients at risk of subsequent perinatal complications.