Charles Adu-Takyi, Rafique Munazzah, Yaw Gyanteh Owusu, Atta Owusu-Bempah, Bernard Arhin, Henry Sakyi Opare-Addo, Amponsah Peprah, Sally L. Collins, Theophilus Adu-Bredu
{"title":"在资源有限的环境中，剖腹产后超声下段厚度和阴道分娩预测的准确性；前瞻性研究。","authors":"Charles Adu-Takyi, Rafique Munazzah, Yaw Gyanteh Owusu, Atta Owusu-Bempah, Bernard Arhin, Henry Sakyi Opare-Addo, Amponsah Peprah, Sally L. Collins, Theophilus Adu-Bredu","doi":"10.1111/1471-0528.17872","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To assess the accuracy of ultrasound measurement of the lower uterine segment (LUS) thickness against findings at laparotomy, and to investigate its correlation with the success rate of vaginal birth after one previous caesarean delivery (CD) in a resource-limited setting.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Prospective study.</p>\n </section>\n \n <section>\n \n <h3> Setting</h3>\n \n <p>Obstetrics and Gynaecology department in a tertiary hospital in Ghana.</p>\n </section>\n \n <section>\n \n <h3> Population</h3>\n \n <p>Women with one previous CD undergoing either a trial of labour (TOLAC) or elective CD.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Myometrial lower uterine segment thickness (mLUS) and full lower uterine segment thickness (fLUS) were measured with transvaginal ultrasound (TVUS). The women were managed according to local protocols with the clinicians blinded to the ultrasound measurements. The LUS was measured intraoperatively for comparison with ultrasound measurements.</p>\n </section>\n \n <section>\n \n <h3> Main outcome measures</h3>\n \n <p>Lower uterine segment findings at laparotomy, successful vaginal birth.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 311 pregnant women with one previous CD were enrolled; 147 women underwent elective CD and 164 women underwent a TOLAC. Of the women that underwent TOLAC, 96 (58.5%) women had a successful vaginal birth. The mLUS was comparable to the intraoperative measurement in the elective CD group with LUS thickness <5 mm (bias of 0.01, 95% CI −0.10 to 0.12 mm) whereas fLUS overestimated LUS <5 mm (bias of 0.93, 95% CI 0.80–1.06 mm). Successful vaginal birth rate correlated with increasing mLUS values (odds ratio 1.30, 95% CI 1.03–1.64). Twelve cases of uterine defect were recorded. LUS measurement ≤2.0 mm was associated with an increased risk of uterine defects with a sensitivity of 91.7% (95% CI 61.5–99.8%) and specificity of 81.8% (95% CI 75.8–86.8%).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Accurate TVUS measurement of the LUS is technically feasible in a resource-limited setting. This approach could help in making safer decisions on mode of birth in limited-resource settings.</p>\n </section>\n </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1771-1779"},"PeriodicalIF":4.7000,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17872","citationCount":"0","resultStr":"{\"title\":\"Accuracy of sonographic lower segment thickness and prediction of vaginal birth after caesarean in a resourced-limited setting; Prospective study\",\"authors\":\"Charles Adu-Takyi, Rafique Munazzah, Yaw Gyanteh Owusu, Atta Owusu-Bempah, Bernard Arhin, Henry Sakyi Opare-Addo, Amponsah Peprah, Sally L. Collins, Theophilus Adu-Bredu\",\"doi\":\"10.1111/1471-0528.17872\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>To assess the accuracy of ultrasound measurement of the lower uterine segment (LUS) thickness against findings at laparotomy, and to investigate its correlation with the success rate of vaginal birth after one previous caesarean delivery (CD) in a resource-limited setting.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Design</h3>\\n \\n <p>Prospective study.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Setting</h3>\\n \\n <p>Obstetrics and Gynaecology department in a tertiary hospital in Ghana.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Population</h3>\\n \\n <p>Women with one previous CD undergoing either a trial of labour (TOLAC) or elective CD.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Myometrial lower uterine segment thickness (mLUS) and full lower uterine segment thickness (fLUS) were measured with transvaginal ultrasound (TVUS). The women were managed according to local protocols with the clinicians blinded to the ultrasound measurements. The LUS was measured intraoperatively for comparison with ultrasound measurements.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Main outcome measures</h3>\\n \\n <p>Lower uterine segment findings at laparotomy, successful vaginal birth.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 311 pregnant women with one previous CD were enrolled; 147 women underwent elective CD and 164 women underwent a TOLAC. Of the women that underwent TOLAC, 96 (58.5%) women had a successful vaginal birth. The mLUS was comparable to the intraoperative measurement in the elective CD group with LUS thickness <5 mm (bias of 0.01, 95% CI −0.10 to 0.12 mm) whereas fLUS overestimated LUS <5 mm (bias of 0.93, 95% CI 0.80–1.06 mm). Successful vaginal birth rate correlated with increasing mLUS values (odds ratio 1.30, 95% CI 1.03–1.64). Twelve cases of uterine defect were recorded. LUS measurement ≤2.0 mm was associated with an increased risk of uterine defects with a sensitivity of 91.7% (95% CI 61.5–99.8%) and specificity of 81.8% (95% CI 75.8–86.8%).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Accurate TVUS measurement of the LUS is technically feasible in a resource-limited setting. This approach could help in making safer decisions on mode of birth in limited-resource settings.</p>\\n </section>\\n </div>\",\"PeriodicalId\":50729,\"journal\":{\"name\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"volume\":\"131 13\",\"pages\":\"1771-1779\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2024-06-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17872\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/1471-0528.17872\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bjog-An International Journal of Obstetrics and Gynaecology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1471-0528.17872","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Accuracy of sonographic lower segment thickness and prediction of vaginal birth after caesarean in a resourced-limited setting; Prospective study
Objectives
To assess the accuracy of ultrasound measurement of the lower uterine segment (LUS) thickness against findings at laparotomy, and to investigate its correlation with the success rate of vaginal birth after one previous caesarean delivery (CD) in a resource-limited setting.
Design
Prospective study.
Setting
Obstetrics and Gynaecology department in a tertiary hospital in Ghana.
Population
Women with one previous CD undergoing either a trial of labour (TOLAC) or elective CD.
Methods
Myometrial lower uterine segment thickness (mLUS) and full lower uterine segment thickness (fLUS) were measured with transvaginal ultrasound (TVUS). The women were managed according to local protocols with the clinicians blinded to the ultrasound measurements. The LUS was measured intraoperatively for comparison with ultrasound measurements.
Main outcome measures
Lower uterine segment findings at laparotomy, successful vaginal birth.
Results
A total of 311 pregnant women with one previous CD were enrolled; 147 women underwent elective CD and 164 women underwent a TOLAC. Of the women that underwent TOLAC, 96 (58.5%) women had a successful vaginal birth. The mLUS was comparable to the intraoperative measurement in the elective CD group with LUS thickness <5 mm (bias of 0.01, 95% CI −0.10 to 0.12 mm) whereas fLUS overestimated LUS <5 mm (bias of 0.93, 95% CI 0.80–1.06 mm). Successful vaginal birth rate correlated with increasing mLUS values (odds ratio 1.30, 95% CI 1.03–1.64). Twelve cases of uterine defect were recorded. LUS measurement ≤2.0 mm was associated with an increased risk of uterine defects with a sensitivity of 91.7% (95% CI 61.5–99.8%) and specificity of 81.8% (95% CI 75.8–86.8%).
Conclusion
Accurate TVUS measurement of the LUS is technically feasible in a resource-limited setting. This approach could help in making safer decisions on mode of birth in limited-resource settings.
期刊介绍：
BJOG is an editorially independent publication owned by the Royal College of Obstetricians and Gynaecologists (RCOG). The Journal publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. Its aim is to publish the highest quality medical research in women''s health, worldwide.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
