Assessing lateral uterine wall defects and residual myometrial thickness after cesarean section

Ammar Al Naimi; Niki Mouzakiti; Bartosch Wolnicki; Frank Louwen; Franz Bahlmann

doi:10.1016/j.ejogrb.2021.01.033

Assessing lateral uterine wall defects and residual myometrial thickness after cesarean section

Eur J Obstet Gynecol Reprod Biol. 2021 Mar:258:391-395. doi: 10.1016/j.ejogrb.2021.01.033. Epub 2021 Jan 22.

Authors

Ammar Al Naimi¹, Niki Mouzakiti², Bartosch Wolnicki², Frank Louwen³, Franz Bahlmann²

Affiliations

¹ Department of Obstetrics and Gynecology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Hessen, Germany; Department of Obstetrics and Gynecology, Buergerhospital - Dr. Senckenbergische Stiftung, Frankfurt, Hessen, Germany. Electronic address: ammar.alnaimi@uclmail.net.
² Department of Obstetrics and Gynecology, Buergerhospital - Dr. Senckenbergische Stiftung, Frankfurt, Hessen, Germany.
³ Department of Obstetrics and Gynecology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Hessen, Germany.

PMID: 33540191
DOI: 10.1016/j.ejogrb.2021.01.033

Abstract

Objective: Lateral wall ruptures in women with a history of cesarean section are less common but more complicated than anterior wall ruptures. Residual myometrial thickness (RMT) is believed to be valuable for assessing the probability of ruptures. This study aimed to assess the utility of OmniView (a sonographic reslicing technique) in evaluating the lateral uterine wall after cesarean section and evaluate the relationship between lateral and anterior wall RMT using OmniView and sagittal two-dimensional ultrasound.

Study design: This cross-sectional study examined changes in both the anterior and lateral uterine wall in women with a history of cesarean section in the past 12-18 months. OmniView with volume contrast imaging with a 2-mm slice thickness was used to generate coronal planes, and the OmniView RMT (OV-RMT) was calculated as a percentage. Blinded to the OV-RMT results, sonographic multiplanar views were used to acquire the optimum sagittal plane for evaluating the RMT, and the sagittal RMT (S-RMT) was calculated as a percentage. The reproducibility of OV-RMT and S-RMT between two observers was tested using interclass correlation (ICC). The relationship between two variables was tested using Spearman's rank correlation.

Results: In 208 recruited patients, the prevalence of lateral uterine wall defects was 79 %. The interobserver and intraobserver reproducibility of S-RMT and OV-RMT had ICC coefficients over 0.9 with a p-value <0.001. S-RMT and OV-RMT did not follow a normal distribution, and the medians were significantly different (55.5 and 85.7, respectively). Spearman's rank correlation between OV-RMT and S-RMT had a rho (ρ) value of 0.24 (p < 0.05). Passing-Bablok regression had an intercept of 47.95 and a slope of 0.65.

Conclusion: OmniView can be used to assess lateral uterine wall defects, and OV-RMT is a reproducible and reliable method for quantifying this assessment. The RMT on the coronal plane was independently more intact than that on the sagittal plane, which might account for the lower incidence of lateral ruptures. Further studies could reveal a critical OV-RMT value that is safe for a trial of labor.

Keywords: Cesarean scar; Cesarean section; OmniView; RMT; Uterine wall.

MeSH terms

Cesarean Section* / adverse effects
Cicatrix / diagnostic imaging
Cross-Sectional Studies
Female
Humans
Pregnancy
Reproducibility of Results
Ultrasonography
Uterine Rupture* / diagnostic imaging
Uterine Rupture* / etiology
Uterus / diagnostic imaging
Uterus / pathology