ABSTRACT
BACKGROUND: The aim of this study is to evaluate accuracy of transvaginal sonographic examination of the lower uterine segment in pregnant women with previous cesarean section. METHODS: Sixty-one pregnant women between 37 and 40 weeks of gestation, with previous cesarean section underwent transvaginal ultrasonography. Wall thickness of the lower uterine segment, the length of cervix, dilation of the isthmus uteri were measured. On the basis of the surgical findings (in 53 patients) and outcome of the trial of labor (in 8 patients) a Score was assigned to the pregnant women: Score 1 to the women who had good healing or a trial of labor without complications; Score 2 to the women with a thin or discontinued scar and in case of threatened rupture of the uterus in the trial of labor. RESULTS: The mean thickness of the lower uterine segment is 3.82 mm +/- 0.99 mm. The Score 1 group shows a mean thickness of 4.2 mm +/- 2.5 mm, and the Score 2 group a mean thickness of 2.8 mm +/- 1.06 mm. The transvaginal sonographic examination provides a sensitivity and a specificity respectively of 100 and 75%, for a thickness cut-off of 3.5 mm, and a positive and negative predictive values of 60.7% and 100% respectively. CONCLUSIONS: The transvaginal sonographic evaluation of the lower uterine segment improves therefore the obstetrical decision-making regarding the trial of labor in women with previous cesarean section.
Subject(s)
Ultrasonography, Prenatal , Uterus/diagnostic imaging , Adult , Cesarean Section , Female , Humans , PregnancyABSTRACT
The plasma levels and urinary excretions of (+/-) alpha-(benzoylamino)-4-[2-(diethylamino)ethoxy]-N, N-dipropyl-benzenepropanamide (tiropramide) and of some of its metabolites were studied in healthy volunteers after the following single-dose administrations of tiropramide hydrochloride: a) i.v. 50 mg, oral 100 mg or rectal 200 mg; b) i.v. 50 mg or i.m. 50 mg; c) oral 100, 200 or 400 mg. After i.v. bolus the plasma levels of tiropramide are consistent with a three-compartment open pharmacokinetic model. The steady-state volume of distribution is 221 l. The terminal elimination constant is 0.279 h-1 (t1/2 = 2.5 h). After i.m. injection the plasma levels increase rapidly (invasion t1/2 = 2 min) and then are similar to those found after i.v. bolus. After oral administration appreciable plasma levels are found after lag times of 18-27 min. They increase with an invasion t1/2 of 14-22 min. The peak is reached 1-1.7 h after administration and the elimination occurs with a constant of 0.20-0.23 h-1. After rectal administration appreciable plasma levels are found after a lag time of 11 min and increase with an invasion t1/2 of 6 min. The peak is reached at 2.2 h. The elimination constant is 0.21 h-1. Tiropramide and some of its metabolites can be determined in the urine by gas-liquid chromatography. The following percentages of the administered dose of tiropramide and tiropramide-related substances can be found in the 24-h urines. After i.v. bolus: 16.2; after i.m. injection: 17.0; after oral administration: 19.6; after rectal administration 13.1.(ABSTRACT TRUNCATED AT 250 WORDS)
