Role of 3 D Ultrasound in Objective Evaluation of Caesarean Scar QC01-QC04
88 B, Vikrant Enclave, Gate 7, Near Swarg Ashram Marg, Hari Nagar, New Delhi, India.
Introduction: The alarming number of caesarean deliveries is a growing concern in India as it has great impact on maternal health. The scar strength can predict performance during Trial of Labour After Caesarean (TOLAC). A 3D ultrasound is a very valuable technique in the scar assessment as it analyses many other volume based parameters apart from just the scar thickness. This adds objectivity in predicting the scar integrity and improves the patient selection for a successful TOLAC.
Aim: To evaluate the most accurate ultrasonographic parameter (2D, 3D USG and colour doppler) for assessing the quality of scar on the uterus.
Materials and Methods: This was an observational prospective study enrolling antenatal women with previous LSCS after 28 weeks of gestation in which after history and antenatal exam, 2D, 3D and colour Doppler were done and scar parameters were analysed. The Pearson's chi-square test was used to determine the relationship between two categorical variables. The sensitivity, specificity, PPV and NPV of each parameter was calculated. ROC analysis was done to determine the optimum cut-off values. The p-value of <0.05 was taken to indicate a significant difference.
Results: Among the 245 patients analysed 160 (65.3%) had a Vaginal Birth After Caesarean section (VBAC) and 85 (34.7%) underwent a repeat Lower Segment Caesarean Section (LSCS). The ultrasonographic parameters which showed a statistically significant difference in affecting the mode of delivery were shape of the scar, thickness of the scar and echostructure of the lower uterine segment. The mean scoring of all the parameters taken together also showed a statistically significant difference affecting the mode of delivery.
Conclusion: The scar parameters analysed in the present study did show a statistically significant difference in affecting the mode of delivery, and the clinical factors analysed, especially induced versus spontaneous mode of delivery, also showed a significant statistical difference in the mode of delivery.