Evaluation of Lower Uterine Segment in Women with Previous Cesarean Section by Transabdominal Ultrasonography & its Relation to Feto-Maternal Outcome.

ABSTRACT

The present study was conducted to assess the lower uterine segment with transabdominal sonography (TAS) in women with a previous cesarean section at 36-38 weeks gestation and to study the relationship between various LUS measurements and feto-maternal outcomes. Out of 110 patients enrolled, 10 (9%) with LUS thickness <2 mm were considered as poor healing group and were taken for elective LSCS. Remaining 100 were divided into two groups, 2-3.5 mm group and >3.5 mm group; 92% patients with LUS thickness >3.5 mm and 14% with LUS thickness between 2-3.5 mm delivered vaginally. The fetomaternal outcomes among patients with LUS thickness >3.5 mm were observed to be significant in the form of lower occurrence of puerperal pyrexia (4%), atonic PPH (4%), blood transfusion requirement (2%), less NICU admission (2%), less number of newborns with Apgar score <7 (2%), and with no cases of stillbirth, uterine rupture or uterine dehiscence when compared with LUS thickness 2-3.5 mm. Thus, patients with LUS thickness >3.5 mm had high rate of vaginal deliveries with favourable feto-maternal outcome, resulting in less maternal and perinatal morbidity and mortality. Thus, patients with ultrasonographic LUS thickness >3.5 mm at 36-38 weeks can be selected safely for vaginal birth after cesarean with favourable fetomaternal outcome.