The B-mode sonographic evaluation of the post-caesarean uter
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There is no doubt that cesarean section (CS) is an important surgical intervention that improves both maternal and fetal obstetrical outcomes given the right circumstances. These circumstances are met when an indication for performing a CS due to either fetal or maternal causes is fulfilled. Even though the immediate postoperative maternal morbidity is decreasing because of improved perioperative management, there are severe long-term risks to a CS including extrauterine pregnancies, subfertility, abnormally invasive placenta (AIP), repeated CS, as well as uterine rupture and hysterectomy. The aim of this study is to utilize the niche measurement guidelines outlined by Jordans et al. in order to establish normal values and accurate description of cesarean section scars in a normal population. After defining the normal distribution, abnormal pregestational scar characteristics will be identified for predicting adverse pregnancy outcomes.

This is a prospective observational multicenter clinical study where women with a history of only one caesarean section and yet open family planning are enrolled. The uterine length, cervical length, niche length, niche depth, niche width, residual myometrial thickness, endometrial thickness, scar to internal os distance, anterior myometrial thickness superior and inferior to the scar and the posterior myometrial thickness opposite the scar, superior and inferior to it are measured in a pregestational uterus. The lower uterine segment is measured over a length of 3-cm during subsequent pregnancy and followed up until delivery.

Data from 500 patients will yield normal distribution curves for all predefined measurements. Establishing a correlation between deviations from the normal measures and adverse events would be instrumental for counseling women regarding subsequent pregnancy and mode of delivery. This study will demonstrate the changes in the post-cesarean scar from a non pregnant uterus until delivery and can confirm the importance of the scar characteristics in predicting pregnancy outcome.

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