Intraoperative ultrasound during repeat cesarean delivery facilitates sampling of uterine scar tissue
Author:
Paping Alexander12ORCID, Basler Clara2, Melchior Kerstin2, Ehrlich Loreen2, Thiele Mario3, Duda Georg N.3, Henrich Wolfgang1, Braun Thorsten12ORCID
Affiliation:
1. Department of Obstetrics , Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin , Germany 2. Division of ‘Experimental Obstetrics’ , Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin , Germany 3. Julius Wolff Institute and Center for Musculoskeletal Surgery , Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin , Germany
Abstract
Abstract
Objectives
Histological examination of uterine scars provides insight into uterine wound healing and helps to develop prevention methods of uterine wall rupture after previous uterine surgery. Therefore, exact intraoperative scar identification is needed for specimen collection from the actual scar tissue. The aim of this study was to correlate pre- and intraoperative ultrasound measurements of the lower uterine segment (LUS) with histological findings of scar tissue and to evaluate the relevance of intraoperative ultrasound.
Methods
In a prospective observational study, preoperative and intraoperative sonographic measurements of the LUS thickness were performed in 33 women with a history of at least one cesarean delivery. Intraoperative ultrasound with a linear transducer placed directly on the uterus identified the scar area and uterotomy was performed 2 cm cranially. Tissue samples were taken after extraction of the fetus, embedded in paraffin wax, and stained according to Gomori Trichrome to identify scar tissue. Collagen content was evaluated with imaging software Fiji (NIH, Bethesda, USA). Preoperative and intraoperative sonographic measurements were correlated with histologic evidence of scar tissue.
Results
Histological evidence of scar tissue was found in 11 out of 33 samples with significantly lower ultrasonographic thickness of the lower uterine segment compared to the other 22 samples, both antepartum (1.4 mm [1.3–1.9] vs. 2.0 mm [1.6–2.6], p=0.03) and intrapartum (1.6 mm [1.3–1.9] vs. 3.7 mm [2.0–4.7], p<0.01). Intraoperative ultrasound had a significantly higher predictive power (AUC difference 0.18 [0.03–0.33], p=0.01).
Conclusions
Intraoperative sonography identifies the uterine wall area with histologically confirmable scar tissue far better than preoperative sonography.
Funder
University research fund of Charité Universitätsmedizin Berlin Deutsche Forschungsgemeinschaft
Publisher
Walter de Gruyter GmbH
Subject
Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health
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