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Comparison of the lower uterine segment in pregnant women with and without previous cesarean section in 3 T MRI

BACKGROUND: Prenatal risk stratification of women with previous cesarean section (CS) by ultrasound thickness measurement of the lower uterine segment (LUS) is challenging. There is a wide range of proposed cutoff values and a valuable algorithm for selection before birth is not available. Using 3 T...

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Autores principales: Hoffmann, Janine, Exner, Marc, Bremicker, Kristina, Grothoff, Matthias, Stumpp, Patrick, Stepan, Holger
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505214/
https://www.ncbi.nlm.nih.gov/pubmed/31068180
http://dx.doi.org/10.1186/s12884-019-2314-7
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author Hoffmann, Janine
Exner, Marc
Bremicker, Kristina
Grothoff, Matthias
Stumpp, Patrick
Stepan, Holger
author_facet Hoffmann, Janine
Exner, Marc
Bremicker, Kristina
Grothoff, Matthias
Stumpp, Patrick
Stepan, Holger
author_sort Hoffmann, Janine
collection PubMed
description BACKGROUND: Prenatal risk stratification of women with previous cesarean section (CS) by ultrasound thickness measurement of the lower uterine segment (LUS) is challenging. There is a wide range of proposed cutoff values and a valuable algorithm for selection before birth is not available. Using 3 T magnetic resonance imaging (MRI), we aimed to identify possible shortcomings of the current protocols used for birth selection after CS. Therefore, we evaluated anatomic and morphologic differences of the LUS and its thickness in patients with CS and those without. Possible impact factors on LUS thickness were studied. METHODS: We retrospectively analyzed 3 T MRI scans of 164 pregnant women in their second or third trimester, with (patient group, n = 60) and without previous CS (control group, n = 104). Sagittal T2-weighted images were studied. Normal findings of the LUS in MRI, reliability of MRI measurements, as well as factors influencing LUS thickness were assessed. MRI findings were compared to intraoperative findings. RESULTS: MRI provided good intra- (ICC 0.872) and fair inter-rater reliability (ICC 0.643). The relationship of the LUS and the cesarean scar to the surrounding anatomical structures and also its morphology varied strongly in patients and controls. Scar identification was possible in only 9/60 (15.0%) patients. The LUS was thinner in patients (1.9 ± 0.7 mm) than in controls (2.7 ± 1.3 mm). An LUS thinning up to 1 mm was observed in 23% of women without a previous CS and in 34% of women with normal intraoperative findings. Suspicion of a uterine dehiscence (LUS thickness < 1 mm) was only found in the patient group (5/59 (8.5%)) and was intraoperatively confirmed. In controls, LUS thickness was influenced by fetal weight, gestational age and amniotic fluid amounts. CONCLUSION: Variability in anatomy, thickness and morphology seem to limit common prenatal LUS imaging diagnostics. Therefore, we consider that diagnostic protocols must be re-evaluated and imaging should be adjusted to the individual patient conditions. Due to its independency of ultrasound limitations, an additional MRI might be useful for altered anatomy and impaired ultrasound conditions. An LUS thinning up to 1 mm might be a normal finding and should be further investigated as reference value.
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spelling pubmed-65052142019-05-10 Comparison of the lower uterine segment in pregnant women with and without previous cesarean section in 3 T MRI Hoffmann, Janine Exner, Marc Bremicker, Kristina Grothoff, Matthias Stumpp, Patrick Stepan, Holger BMC Pregnancy Childbirth Research Article BACKGROUND: Prenatal risk stratification of women with previous cesarean section (CS) by ultrasound thickness measurement of the lower uterine segment (LUS) is challenging. There is a wide range of proposed cutoff values and a valuable algorithm for selection before birth is not available. Using 3 T magnetic resonance imaging (MRI), we aimed to identify possible shortcomings of the current protocols used for birth selection after CS. Therefore, we evaluated anatomic and morphologic differences of the LUS and its thickness in patients with CS and those without. Possible impact factors on LUS thickness were studied. METHODS: We retrospectively analyzed 3 T MRI scans of 164 pregnant women in their second or third trimester, with (patient group, n = 60) and without previous CS (control group, n = 104). Sagittal T2-weighted images were studied. Normal findings of the LUS in MRI, reliability of MRI measurements, as well as factors influencing LUS thickness were assessed. MRI findings were compared to intraoperative findings. RESULTS: MRI provided good intra- (ICC 0.872) and fair inter-rater reliability (ICC 0.643). The relationship of the LUS and the cesarean scar to the surrounding anatomical structures and also its morphology varied strongly in patients and controls. Scar identification was possible in only 9/60 (15.0%) patients. The LUS was thinner in patients (1.9 ± 0.7 mm) than in controls (2.7 ± 1.3 mm). An LUS thinning up to 1 mm was observed in 23% of women without a previous CS and in 34% of women with normal intraoperative findings. Suspicion of a uterine dehiscence (LUS thickness < 1 mm) was only found in the patient group (5/59 (8.5%)) and was intraoperatively confirmed. In controls, LUS thickness was influenced by fetal weight, gestational age and amniotic fluid amounts. CONCLUSION: Variability in anatomy, thickness and morphology seem to limit common prenatal LUS imaging diagnostics. Therefore, we consider that diagnostic protocols must be re-evaluated and imaging should be adjusted to the individual patient conditions. Due to its independency of ultrasound limitations, an additional MRI might be useful for altered anatomy and impaired ultrasound conditions. An LUS thinning up to 1 mm might be a normal finding and should be further investigated as reference value. BioMed Central 2019-05-08 /pmc/articles/PMC6505214/ /pubmed/31068180 http://dx.doi.org/10.1186/s12884-019-2314-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hoffmann, Janine
Exner, Marc
Bremicker, Kristina
Grothoff, Matthias
Stumpp, Patrick
Stepan, Holger
Comparison of the lower uterine segment in pregnant women with and without previous cesarean section in 3 T MRI
title Comparison of the lower uterine segment in pregnant women with and without previous cesarean section in 3 T MRI
title_full Comparison of the lower uterine segment in pregnant women with and without previous cesarean section in 3 T MRI
title_fullStr Comparison of the lower uterine segment in pregnant women with and without previous cesarean section in 3 T MRI
title_full_unstemmed Comparison of the lower uterine segment in pregnant women with and without previous cesarean section in 3 T MRI
title_short Comparison of the lower uterine segment in pregnant women with and without previous cesarean section in 3 T MRI
title_sort comparison of the lower uterine segment in pregnant women with and without previous cesarean section in 3 t mri
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505214/
https://www.ncbi.nlm.nih.gov/pubmed/31068180
http://dx.doi.org/10.1186/s12884-019-2314-7
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