Association between ultrasonographic parameters of Cesarean scar defect and outcome of early termination of pregnancy. (April 2016)

• Record Type: Journal Article
• Authors: Au, H.‐K.; Liu, C.‐F.; Tzeng, C.‐R.; Chien, L.‐W.
• Is Part Of: Ultrasound in obstetrics & gynecology. Volume 47:Number 4(2016)
• Page Start: 506
• Page End: 510
• Publication Date: 2016-04
• Subjects: Cesarean delivery -- Cesarean scar defect -- medical abortion -- mifepristone -- misoprostol -- transvaginal ultrasound; Ultrasonics in obstetrics -- Periodicals; Generative organs, Female -- Diseases -- Diagnosis -- Periodicals; Diagnosis, Ultrasonic -- Periodicals; Genital Diseases, Female -- ultrasonography -- Periodicals; Ultrasonography, Prenatal -- Periodicals; 618.047543
• DOI: 10.1002/uog.14877
• Languages: English
• ISSNs: 0960-7692

Abstract

Abstract : Linked Comment: Ultrasound Obstet Gynecol 2016; 47: 416–416 ABSTRACT: Objective: To determine whether Cesarean scar defect (CSD) parameters assessed by transvaginal sonography (TVS) might affect the outcome of early termination of pregnancy (TOP) with mifepristone–misoprostol. Methods: This was a retrospective review of 183 women with previous Cesarean delivery who received oral mifepristone and misoprostol for TOP. A successful TOP was defined by the absence of an intrauterine gestational sac, with no need for surgical intervention. CSD was diagnosed by TVS in the presence of a hypoechogenic indentation within the myometrium of the lower uterine segment at the site of a previous Cesarean incision. Women were analyzed in three subgroups according to size of defect (ratio of residual myometrial thickness over the defect to adjacent myometrial thickness < 30%, 30%–70% and > 70%). Results: Of the 183 women, 43 (23.5%) had failure of TOP. Fifty‐nine (32.2%) had CSD detectable at TVS, and these women had a higher failure rate of TOP than did those without CSD (38.9% vs 16.1%; P = 0.001). CSD was associated significantly with failure of TOP (odds ratio, 3.32 (95% CI, 1.64–6.75)). The TOP failure rates in relation to defect size in the myometrial thickness ratio < 30%, 30%–70% and > 70% subgroups were 57.1%, 25.0% and 18.2%, respectively. There was a linear trend in failure rate across these ratios (Cochran–Armitage trend test; P = 0.015). Conclusions: Women with CSD are at increased risk of failed TOP. Women with a defect in which the residual myometrial thickness was < 30% of the adjacent myometrial thickness tended to have a greater chance of failed TOP. CSD detected at TVS is of clinical relevance in counseling women with a history of Cesarean delivery who are considering TOP. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.