Systematic Review of Cesarean Scar Assessment in the Nonpregnant State: Imaging Techniques and Uterine Scar Defect

Stéphanie Roberge; Amélie Boutin; Nils Chaillet; Lynne Moore; Nicole Jastrow; Suzanne Demers; Emmanuel Bujold

doi:10.1055/s-0032-1304829

American Journal of Perinatology, Table of Contents

Am J Perinatol 2012; 29(06): 465-472
DOI: 10.1055/s-0032-1304829

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Systematic Review of Cesarean Scar Assessment in the Nonpregnant State: Imaging Techniques and Uterine Scar Defect

Stéphanie Roberge

¹Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada

²Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada

³Centre de recherche, Centre hospitalier universitaire de Québec (CRCHUQ), Quebec, Canada

,

Amélie Boutin

¹Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada

²Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada

³Centre de recherche, Centre hospitalier universitaire de Québec (CRCHUQ), Quebec, Canada

,

Nils Chaillet

⁴Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada

,

Lynne Moore

²Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada

⁵Centre hospitalier affilié universitaire de Québec, Hôpital Enfant-Jésus, Quebec, Canada

,

Nicole Jastrow

⁶Department of Obstetrics and Gynecology, Faculty of Medicine, Hôpitaux Universitaire de Genève (HUG), Université de Genève, Geneva, Switzerland

,

Suzanne Demers

¹Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada

,

Emmanuel Bujold

¹Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada

²Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada

³Centre de recherche, Centre hospitalier universitaire de Québec (CRCHUQ), Quebec, Canada

› Author Affiliations

Abstract

Objective To review the ability of imaging techniques to predict incomplete healing of uterine cesarean scars before the next pregnancy.

Study Design A systematic literature review searched for studies on women who underwent previous low-transverse cesarean, evaluated by hysterography, sonohysterography (SHG), or transvaginal ultrasound (TVU). The median prevalence of scar defects was computed with 95% confidence intervals (95% CIs). Odds ratio (OR, 95% CI) identified risk factors of incomplete healing.

Results The analysis included 21 studies. The proportions of suspected scar defects detected by hysterography, SGH, and TVU were 58% (33 to 70), 59% (58 to 85), and 37% (20 to 65), respectively. Two studies found that women with a large uterine scar defect had a higher risk of uterine rupture or uterine scar dehiscence than those with no scar defect or small scar defect (OR: 26.05 [2.36 to 287.61], p <0.001). The only reported risk factor for scar defect was the occurrence of more than one previous cesarean (OR: 2.24 [1.13, 4.45], p = 0.02).

Conclusion Hysterography, SGH, and TVU can detect uterine scar defects in ~50% of women with previous cesarean.

Keywords

scar defects - cesarean - imaging techniques - ultrasound

Full Text

References

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