Association between ultrasonographic parameters of Cesarean scar defect and outcome of early termination of pregnancy

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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.

Original languageEnglish
Pages (from-to)506-510
Number of pages5
JournalUltrasound in Obstetrics and Gynecology
Volume47
Issue number4
DOIs
Publication statusPublished - Apr 1 2016

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Cicatrix
Pregnancy
Ultrasonography
Misoprostol
Mifepristone
Pregnancy Rate
Gestational Sac
Myometrium
Counseling
Odds Ratio

Keywords

  • Cesarean delivery
  • Cesarean scar defect
  • medical abortion
  • mifepristone
  • misoprostol
  • transvaginal ultrasound

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine

Cite this

@article{9edf501c3e004d8e8b35b013a51459ba,
title = "Association between ultrasonographic parameters of Cesarean scar defect and outcome of early termination of pregnancy",
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.",
keywords = "Cesarean delivery, Cesarean scar defect, medical abortion, mifepristone, misoprostol, transvaginal ultrasound",
author = "Au, {H. K.} and Liu, {C. F.} and Tzeng, {C. R.} and Chien, {L. W.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1002/uog.14877",
language = "English",
volume = "47",
pages = "506--510",
journal = "Ultrasound in Obstetrics and Gynecology",
issn = "0960-7692",
publisher = "John Wiley and Sons Ltd",
number = "4",

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TY - JOUR

T1 - Association between ultrasonographic parameters of Cesarean scar defect and outcome of early termination of pregnancy

AU - Au, H. K.

AU - Liu, C. F.

AU - Tzeng, C. R.

AU - Chien, L. W.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - 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.

AB - 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.

KW - Cesarean delivery

KW - Cesarean scar defect

KW - medical abortion

KW - mifepristone

KW - misoprostol

KW - transvaginal ultrasound

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U2 - 10.1002/uog.14877

DO - 10.1002/uog.14877

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VL - 47

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