American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"The Process of Developing a Comprehensive Maternal-Fetal Surgery Center.","authors":"Andrew H Chon, Amanda J H Kim, Roya Sohaey, Leonardo Pereira, Aaron B Caughey, Amy C Hermesch, Alireza A Shamshirsaz, Gretchen McCullough, Mounira A Habli, Stephanie E Dukhovny, Mubeen Jafri, Ramesha Papanna, Kenneth Azarow, Monica Rincon, Eryn Hughey, Erin J Madriago, Mary Beth Martin, Mariaelena Galie, Ramen H Chmait, Raphael C Sun","doi":"10.1016/j.ajogmf.2024.101557","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101557","url":null,"abstract":"<p><p>The scope of fetal therapy has evolved over the last several decades to include interventions intended to treat or mitigate morbidities of complex fetal disorders. As a result, maternal-fetal surgery centers have been established across the country to better meet the needs of this patient population. Centers offering fetal interventions need to utilize a multidisciplinary approach to optimally balance the pregnant patient's autonomy and safety while striving to optimize fetal health. Although there is literature highlighting the components that an experienced maternal-fetal surgery center should contain, there are limited publications illustrating the process of creating a maternal-fetal surgery center. The journey of building a maternal-fetal surgery center is often as complex as the care delivered. The convergence of resources from both adult and pediatric medicine along with extensive hospital executive support are necessary. As a group of centers with diverse experience and geographic locations, we present a staged approach to building a comprehensive maternal-fetal surgery center and the lessons learned along the way.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101557"},"PeriodicalIF":3.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening tests for preeclampsia: in search of clinical utility.","authors":"Yossi Bart, Rebecca Horgan, George Saade, Baha M Sibai","doi":"10.1016/j.ajogmf.2024.101554","DOIUrl":"10.1016/j.ajogmf.2024.101554","url":null,"abstract":"<p><p>The research and implementation process for a new screening test should involve two steps. First, one has to demonstrate that the test can predict a certain outcome or appropriately stratify the patients based on risk for the outcome. The second step requires evidence of clinical utility. The Food and Drug Administration has approved screening tests for risk stratification or progression of preeclampsia despite the absence of data on clinical utility. Introduction into clinical practice and eventual integration into the standard of care might follow quickly, making a clinical utility trial challenging to accomplish. This manuscript provides an overview of the research and regulatory pathways used for screening and diagnostic tests in medicine in general and obstetrics in particular. For illustration purposes, we review the relevant data gathered so far regarding tests that are promoted for prediction, risk stratification, and progression of preeclampsia. We then discuss the importance of proving clinical utility before introducing tests into clinical practice and the potential unintended consequences of adoption prior to proving clinical utility. VIDEO ABSTRACT.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101554"},"PeriodicalIF":3.8,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based Cesarean Delivery: Postoperative Care (Part 10).","authors":"A D Mackeen, M V Sullivan, W Bender, D Di Mascio, V Berghella","doi":"10.1016/j.ajogmf.2024.101549","DOIUrl":"10.1016/j.ajogmf.2024.101549","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The following review focuses on routine postoperative care after cesarean delivery (CD), including specific Enhanced Recovery After Cesarean (ERAS) recommendations as well as important postpartum counseling points. Following CD, there is insufficient evidence to support administration of prophylactic multi-dose antibiotics to all patients. Additional antibiotic doses are indicated for the following scenarios: patients with obesity, CD lasting ≥ 4 hours since prophylactic dose, blood loss &gt;1,500 mL, or those with an intra-amniotic infection. An oxytocin infusion for prevention of postpartum hemorrhage should be continued post-CD. While initial measures to prevent postoperative pain occur in the intraoperative period, with the consideration of 1g intravenous (IV) acetaminophen and IV or intramuscular (IM) non-steroidal anti-inflammatory medications (e.g., 30mg IV ketorolac), the focus postoperatively continues with this multimodal approach with scheduled acetaminophen per os (PO, 650mg every 6 hours) and non-steroidal agents (ketorolac 30mg IV every 6 hours for 4 doses followed by ibuprofen 600mg PO every 6 hours) being recommended. Short-acting opioids should be reserved for breakthrough pain. Low-risk patients should receive mechanical thromboprophylaxis until ambulation with chemoprophylaxis being reserved for patients with additional risk factors. When an indwelling bladder catheter was placed intraoperatively for scheduled CD, it should be removed immediately postoperatively. Chewing gum to aid in return of bowel function and early oral intake of solid food can occur immediately after CD and within 2 hours, respectively. For prevention of postoperative nausea and vomiting, administration of 5HT&lt;sub&gt;3&lt;/sub&gt; antagonists in recommended with the addition of either a dopamine antagonist or a corticosteroid as needed based on non-cesarean data. Early ambulation after CD starting 4 hours postoperatively is encouraged and should be incentivized by pedometer. For patients that receive a dressing over the CD skin incision, there is limited evidence regarding when best to remove it. Adjunct non-pharmacologic interventions for postoperative recovery discussed in this review are acupressure, acupuncture, aromatherapy, coffee, ginger, massage, reiki and TENS. In the low-risk patient, hospital discharge may occur as early as 24-28 hours if close (i.e., 1-2 days) outpatient neonatal follow up is available due to the potential for neonatal jaundice; otherwise, patients should be discharged at 48-72 hours postoperatively. Upon discharge, the multimodal pain control recommendations of acetaminophen and ibuprofen should be continued. If short-acting opioids are necessary, the prescribing practices should be individualized based upon the inpatient opioid requirements. Other portions of postoperative/postpartum counseling during the inpatient stay include the optimal interpregnancy interval of 18 to 23 months, encouraging exclusive breastfeeding for at least ","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101549"},"PeriodicalIF":3.8,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of obstetrics and gynecology journal podcasts on the dissemination of featured articles.","authors":"Christina Maxey, John Hayden, Rebecca Schneyer, Kacey M Hamilton, Gabriel Levin, Matthew T Siedhoff, Kelly N Wright, Raanan Meyer","doi":"10.1016/j.ajogmf.2024.101533","DOIUrl":"10.1016/j.ajogmf.2024.101533","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101533"},"PeriodicalIF":3.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does combining warm perineal compresses with perineal massage during the second stage of labor reduce perineal trauma? A randomized controlled trial.","authors":"Raneen Abu Shqara, Aya Binenbaum, Sari Nahir Biderman, Inshirah Sgayer, Riva Keidar, Nadir Ganim, Lior Lowenstein, Susana Mustafa Mikhail","doi":"10.1016/j.ajogmf.2024.101547","DOIUrl":"10.1016/j.ajogmf.2024.101547","url":null,"abstract":"<p><strong>Background: </strong>Various interventions have been applied to reduce perineal trauma and obstetric anal sphincter injuries (OASIS). The efficacy of warm compresses during the second stage of labor for reducing the occurrence of perineal tears is controversial.</p><p><strong>Objective: </strong>We aimed to compare rates of spontaneous perineal tears requiring suturing, between women who received warm compresses plus perineal massage vs perineal massage alone.</p><p><strong>Study design: </strong>Women admitted to a single tertiary university-affiliated hospital between June 2023 and January 2024 were randomized to receive warm compresses and perineal massage (n=206) or perineal message only (n=206) during the second stage of labor. Excluded were women with a history of third-degree perineal tear, nut allergy, fetal death, Crohn's disease with perineal involvement, or delivery number >5. Participant allocation was concealed until the second stage of labor. The allocated perineal management was implemented at the time of active fetal descent and when the participant felt the need to push. During active maternal pushing, gentle perineal massage with almond oil was performed in both study groups. In 1 group, warm compresses were applied between contractions, for a minimum of 10 minutes and a maximum of 30. The temperature of the warm compresses was kept in the range of 45°C to 59°C. The perineum was protected during delivery with a hands-on technique. After delivery, the perineum was assessed by an intervention-blinded senior midwife and rectal examination was performed for ruling out OASIS. The primary outcome was the rate of perineal tears requiring suturing. Secondary outcomes included the rates of OASIS and episiotomies. A sub-analysis according to parity and an intention-to-treat analysis were performed.</p><p><strong>Results: </strong>Similar proportions of women treated and not treated with warm compresses had spontaneous perineal tears requiring suturing: 43.7% vs 45.1%, P value=.766. The groups did not differ in the proportions with first-degree tears, 22.8% vs 21.4%, P value=.722; second-degree tears, 21.4% vs 23.8%, P value=.566; and OASIS rates, 0.5% in each. In a sub-analysis according to parity, the proportion with perineal tears did not differ between the 2 groups.</p><p><strong>Conclusion: </strong>For women treated during the second stage of labor with warm compresses and perineal massage, compared to perineal massage alone, the rate of spontaneous perineal tears requiring suturing was similar.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101547"},"PeriodicalIF":3.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The two-hour second stage rule: the 1817 labor of the Princess of Wales.","authors":"Valentina Frusone, Vincenzo Berghella","doi":"10.1016/j.ajogmf.2024.101537","DOIUrl":"10.1016/j.ajogmf.2024.101537","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101537"},"PeriodicalIF":3.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based Cesarean Delivery: Intraoperative management following placental delivery until skin closure (Part 9): Evidence based care during cesarean delivery.","authors":"A D Mackeen, M V Sullivan, V Berghella","doi":"10.1016/j.ajogmf.2024.101548","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2024.101548","url":null,"abstract":"<p><p>This expert review provides recommendations for the cesarean technique after placental delivery to skin closure. Following placental delivery during cesarean, sponge curettage may be omitted as it has not been shown to decrease the risk of retained products of conception. Uterine irrigation and mechanical cervical dilation cannot be recommended. Either intra-abdominal or extra-abdominal repair of the hysterotomy is acceptable with some possible benefits with decreased postoperative pain and nausea/vomiting with intra-abdominal repair. There is insufficient evidence to recommend one uterine closure technique over the other with regards to suture type, continuous versus interrupted, locking or non-locking, one versus two-layer closure. Double layer uterine closure has been shown to be more beneficial with regards to residual myometrial thickness and full thickness bites (including endometrium) should be considered. Glove change by the surgical team is recommended after placental delivery and prior to closure of the abdominal wall. The following techniques are not recommended: intra-abdominal irrigation, use of adhesion-prevention barriers, peritoneal closure, and rectus muscle re-approximation. Based on non-cesarean evidence, fascial closure bites should be at least 5 × 5 mm with monofilament suture for vertical incisions. As an adjunct to postoperative pain control, surgeons may consider wound infiltration with local anesthesia either supra- or sub-fascial. Prior to closure, subcutaneous irrigation may be performed with saline, and routine use of subcutaneous drains is not recommended. Though closure of the subcutaneous layer can be considered in all patients, it should occur when the depth is ≥ 2cm. A monofilament absorbable suture, such as poliglecaprone, should be used to close the CD skin incision. There is no level 1 evidence evaluating the potential benefit of additional skin adhesive or sterile strips after suture skin closure. If a dressing is preferred over the skin incision the following may be considered: a DACC-impregnated dressing if available, otherwise a standard gauze dressing is appropriate. Prophylactic negative pressure would therapy can be considered in patients with obesity. Vaginal seeding at CD is not recommended.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101548"},"PeriodicalIF":3.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness Analysis of a Randomized Clinical Trial of Outpatient vs Inpatient Cervical Ripening Using Synthetic Osmotic Dilators","authors":"Elenir B. C. Avritscher MD, PhD, MBA,&nbsp;Antonio F. Saad MD, MBA ,&nbsp;Xiao Han MS,&nbsp;George R. Saade MD","doi":"10.1016/j.ajogmf.2024.101546","DOIUrl":"10.1016/j.ajogmf.2024.101546","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 1","pages":"Article 101546"},"PeriodicalIF":3.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of prophylactic intravenous calcium in prevention of postspinal hypotension among women with preeclampsia undergoing cesarean delivery: a placebo controlled randomized clinical trial","authors":"Navin Kumar Yadav MBBS ,&nbsp;Suman Lata MBBS, MD ,&nbsp;Nivedita Jha MBBS, MS ,&nbsp;Deepak Chakravarthy MBBS, MD ,&nbsp;Ajay Kumar Jha MD, DM","doi":"10.1016/j.ajogmf.2024.101541","DOIUrl":"10.1016/j.ajogmf.2024.101541","url":null,"abstract":"<div><h3>Background</h3><div>Preeclamptic women, in addition to traditional antihypertensive medications, often receive magnesium supplementation and are at increased risk of postspinal hypotension Postspinal hypotension increases the risk of fetomaternal morbidity. Calcium is a physiological antagonist of magnesium in vascular smooth muscle. Therefore, the study hypothesized that calcium is better suited for preserving systemic vascular resistance and preventing postspinal hypotension during cesarean delivery.</div></div><div><h3>Objectives</h3><div>The study aimed to evaluate the effect of prophylactic calcium administration on postspinal hypotension in preeclamptic women receiving magnesium supplementation.</div></div><div><h3>Methods</h3><div>This prospective, randomized, placebo-controlled, double-blinded, two-arm parallel trial was conducted in preeclamptic women receiving magnesium sulfate supplementation undergoing cesarean delivery. The women were randomized to receive intravenous calcium or a placebo (normal saline) before spinal anesthesia. The study drug (calcium gluconate 500 mg or normal saline) was administered over 15 minutes and ended immediately before spinal anesthesia. The primary outcome measure was the incidence of postspinal hypotension, and secondary outcome measures were postpartum blood loss and maternal and neonatal outcomes.</div></div><div><h3>Results</h3><div>A total of 100 women (50 each calcium and placebo arm) completed the study. The baseline demographic variables, mean blood pressure and heart rate were comparable. The incidence of postspinal hypotension was significantly lower in the calcium arm compared to the placebo arm (32% vs 60%; Relative risk [95% CI]; 1.87 [1.18–2.97]; <em>P=</em>.007). The mean phenylephrine requirement (5.60±14.59 vs 14.80±22.42 mcg; <em>P=</em>.01) and mephentermine requirement (3.30±5.11 mg vs 5.82±4.97 mg; <em>P=</em>.008) was significantly lower in the calcium group. Furthermore, the calcium group's mean postpartum blood loss was significantly lower (406.90±94.34 vs 472.20±122.49 ml, <em>P=</em>.004). However, the Neonatal Intensive Care Unit admission rate, Apgar score, umbilical artery PH, and maternal serum calcium were comparable.</div></div><div><h3>Conclusion</h3><div>Prophylactic calcium infusion significantly reduces the incidence of postspinal hypotension during cesarean delivery in preeclamptic women receiving magnesium supplementation. Furthermore, the effect of prophylactic calcium in decreasing postpartum blood loss is encouraging. However, large trials are required to validate the findings of this study.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 1","pages":"Article 101541"},"PeriodicalIF":3.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower uterine segment thickness to predict uterine rupture: a secondary analysis of PRISMA cluster randomized trial","authors":"Emmanuel Bujold MD, MSc ,&nbsp;Eric Dubé MSc ,&nbsp;Mario Girard RT ,&nbsp;Nils Chaillet PhD","doi":"10.1016/j.ajogmf.2024.101543","DOIUrl":"10.1016/j.ajogmf.2024.101543","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Third-trimester lower uterine segment thickness (LUST) is associated with uterine rupture during trial of labor after cesarean (TOLAC) but threshold values vary according to the approach used (lower values with vaginal ultrasound, higher values with abdominal ultrasound).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To estimate the optimal LUST cut-off value combining vaginal and abdominal ultrasound to predict uterine rupture during TOLAC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;We performed a secondary analysis of PRISMA cluster randomized trial including women with a single previous cesarean who underwent ultrasound LUST measurement at 34–38 weeks using the thinnest measurement obtained by combining transvaginal and transabdominal measurements. Participants in the intervention group were informed about the risk of uterine rupture according to LUST reported in 3 categories (≥2.5 mm: low risk—TOLAC is safe; 2.0–2.4 mm: intermediate-risk—TOLAC is safe under specific conditions (e.g., Grobman estimate of vaginal delivery of at or above 70% and/or having a history of vaginal delivery; estimated fetal weight below 4000 grams; interdelivery interval≥18 months); &lt;2.0 mm: high-risk for uterine rupture). Delivery outcomes including uterine rupture were compared using nonparametric analyses and receiver operating characteristics (ROC) curves.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 3460 participants, 2809 (81%); 385 (11%); and 266 (8%) were identified at low-; intermediate-; and high-risk for uterine rupture, respectively. As expected, low-risk participants were more likely to undergo TOLAC (49% vs 46% vs 13%; &lt;em&gt;P=.&lt;/em&gt;001) and more likely to undergo labor induction (16% vs 12% vs 3%, respectively; &lt;em&gt;P=.&lt;/em&gt;001) than intermediate-risk and high-risk participants. Four (0.3%) cases of uterine rupture during TOLAC occurred among 1382 low-risk participants but none among the intermediate-risk (0/178) and high-risk (0/35) participants (&lt;em&gt;P=.&lt;/em&gt;73). Among low-risk participants, uterine rupture was associated with LUST combining vaginal and abdominal ultrasound (area under the ROC curve: 0.93; 95% confidence interval: 0.86%–0.99%; &lt;em&gt;P=.&lt;/em&gt;001) with all cases occuring among women with LUST between 2.5 and 3.0 mm (4/371 or 1.1%) compared to none (0/1011) among those with LUST≥3.0 mm (&lt;em&gt;P=.&lt;/em&gt;01).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Third-trimester LUST measurement influences the rates of TOLAC and uterine rupture. TOLAC appears to be associated with a low risk of uterine rupture with a LUST between 2.0 and 2.4 mm under specific conditions. However, these conditions should perhaps be extended to patients with a LUST of less than 3.0 mm, as we found an increase in uterine ruptures in this subgroup (between 2.5 and 3.0 mm) who had no special conditions to comply with. LUST≥3.0 mm combining vaginal and abdominal ultrasound was associated with a very low risk for uterine rupture. A large-scale study using these new","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 12","pages":"Article 101543"},"PeriodicalIF":3.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}