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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
1   Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
2   Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
3   Centre de recherche, Centre hospitalier universitaire de Québec (CRCHUQ), Quebec, Canada
,
Amélie Boutin
1   Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
2   Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
3   Centre de recherche, Centre hospitalier universitaire de Québec (CRCHUQ), Quebec, Canada
,
Nils Chaillet
4   Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Canada
,
Lynne Moore
2   Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
5   Centre hospitalier affilié universitaire de Québec, Hôpital Enfant-Jésus, Quebec, Canada
,
Nicole Jastrow
6   Department of Obstetrics and Gynecology, Faculty of Medicine, Hôpitaux Universitaire de Genève (HUG), Université de Genève, Geneva, Switzerland
,
Suzanne Demers
1   Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
,
Emmanuel Bujold
1   Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
2   Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
3   Centre de recherche, Centre hospitalier universitaire de Québec (CRCHUQ), Quebec, Canada
› Author Affiliations
Further Information

Publication History

23 September 2011

31 October 2011

Publication Date:
07 March 2012 (online)

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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
 

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