Transvaginal Sonographic Assessment of Previous Cesarean Section Scar in Late Pregnancy in correlation with Intra operative Scar condition

Bendary, Ali Ahmed; Aboelezz, Shreen Naguib; Elsayed, Labiba Kasem

doi:10.21608/svuijm.2025.407108.2220

Transvaginal Sonographic Assessment of Previous Cesarean Section Scar in Late Pregnancy in correlation with Intra operative Scar condition

Document Type : Original research articles

Authors

Department of Obstetrics & Gynecology, Faculty of Medicine, Benha University, Benha, Egypt.

10.21608/svuijm.2025.407108.2220

Abstract

Background: Cesarean section (CS) rates have risen significantly over the past decades, exceeding 29% in some regions. The rate of CS in Egypt is very high, with recent studies and reports indicating a rate of over 50% and even reaching 72.2%. This makes Egypt one of the countries with the highest CS rates globally, particularly when compared to WHO recommendations and other countries in the region. Accurate assessment of the uterine scar is essential for selecting candidates for VBAC.
Objectives: This study investigates the role of transvaginal sonography (TVS) in evaluating lower uterine segment (LUS) thickness in late pregnancy and its correlation with intraoperative scar findings.
Patients and methods: TVS was performed due to its superior resolution and proximity to the cesarean scar. LUS thickness was measured from the bladder wall (muscularis and mucosa) to the chorioamniotic membrane, including the myometrium.
Results: All cases with thick LUS were classified intraoperatively as Class I. Among thin LUS cases, 41.9% were Class II, and 6.5% were Class IV. A significant association was found between the number of previous CS and scar classification. At a cut-off of 4.5 mm, TVS showed 100% specificity and positive predictive value, with 66.7% sensitivity and 61.3% negative predictive value.
Conclusion: TVS-measured LUS thickness correlates with intraoperative scar quality. At a 4.5 mm threshold, TVS is a specific tool for identifying well-formed scars and can aid in selecting candidates for a trial of labor after cesarean.

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