TY  - JOUR
A1  - Al Naimi, Ammar
A1  - Wolnicki, Bartosch
A1  - Mouzakiti, Niki
A1  - Reinbach, Tiana
A1  - Louwen, Frank
A1  - Bahlmann, Franz
T1  - Anatomy of the sonographic post-cesarean uterus
T2  - Archives of gynecology and obstetrics
N2  - Purpose: We aim to describe the sonographic uterine anatomy after a cesarean section (CS), test the reproducibility of predefined measurements from the BSUM study, and report the distribution of these measurements. Methods: This is a descriptive observational study where 200 women with a history of only one CS were recruited 12–24 months postoperatively. A 5–13 MHz micro-convex transvaginal transducer was used for the acquisition of volumetric datasets for evaluating the CS scars. We defined 15 distinct measurements including the residual myometrial thickness (RMT). RMT ratio was calculated as a percentage of RMT to the assumed pre-cesarean anterior uterine wall thickness. A P value below 0.05 is utilized for significant statistical analysis. Results: Patients were included on average 18.5 months post-cesarean. The uterus was anteflexed in 82.5% and retroflexed in 17.5%. Myometrial defects at the site of CS manifest in two forms, either as a niche or as fibrosis. Patients are classified into four groups: those with isolated niches (45%), combined niches and fibrosis (38.5%), isolated fibrosis (11%), and lacking both (5%). The median RMT ratio for these groups was 63.09, 40.93, 59.84, and 100% with a standard deviation of 16.73, 12.95, 16.59, and 0, respectively. The interclass correlation coefficient (ICC) remained above 0.9 for all distinct measurements among these groups except for those of RMT, where ICC varied between 0.47 and 0.96. The RMT ratio shows a constant ICC at 0.94 regardless of the group. Conclusion: The post-cesarean uterus is often anteflexed, and a myometrial loss of about 50% is normally expected. The pattern of this loss is in the form of a predominantly sharp-edged and echogenic niche, fibrosis, or a combination of both. The proposed RMT ratio takes these changes into consideration and results in a reproducible quantification. We hypothesize that different adverse outcomes could be attributed to the different scar patterns.
KW  - Post-cesarean
KW  - Uterus
KW  - Niche
KW  - Cesarean section
KW  - Ultrasound
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/63773
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-637732
SN  - 1432-0711
N1  - This work was supported by the Dr. Senckenberg Foundation
N1  - Open Access funding enabled and organized by Projekt DEAL.
VL  - 304
IS  - 6
SP  - 1485
EP  - 1491
PB  - Springer
CY  - Berlin ; Heidelberg
ER  -