• Iram Sarwar ATH
  • Faiza Akram AMC
  • Attiya Khan AMC
  • Saqib Malik AMI
  • Ansa Islam AMI
  • Kinza Khan AMI


Background: Caesarean section rate is increasing throughout the world, which increases the risk of complications in subsequent pregnancy with increased maternal and foetal morbidity and mortality. There is risk of uterine rupture in subsequent pregnancy with trial of labour after caesarean section (TOLAC). Therefore, accurate prediction of uterine rupture can be of significant value during the management of subsequent pregnancies after previous caesarean delivery. The aim of this study was to evaluate the accuracy of prenatal transabdominal sonography in determining the lower uterine segment thickness in women with previous caesarean section, to document relevant risk factors in the obstetric history of subjects predisposing to uterine scar rupture and to define a cut-off value of uterine thickness for prediction of uterine rupture. Methods: This cross-sectional validation study was conducted in the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital, Abbottabad from May to October 2017.Transabdominal ultrasound was carried out in all patients before labour for the measurement of uterine scar thickness. Patients were followed till caesarean section and intraoperative findings were recorded. Results: A total of 117 patients were enrolled. Out of these 33% had thin or dehiscence/rupture scar. At the cut-off value of ≤5 mm the sensitivity was 76.9%, specificity 48.7% and accuracy was 58.12%. No significant association was found between clinical features and scar dehiscence/rupture. Conclusion: No definite USG cut-off limit could be established to provide guidance regarding the clinical decision of opting for VBAC or repeat caesarean/section; scar thicknesses ≤5.0 mm should be judged cautiously.Keywords: Caesarean section; ultrasonography; uterine scar thickness; VBAC; TOLAC

Author Biographies

Iram Sarwar, ATH

Department of Gynaecology, Ayub Teaching Hospital, Abbottabad

Faiza Akram, AMC

Radiolog, ATH

Attiya Khan, AMC

Gynae, ATH

Saqib Malik, AMI

Medicine, ATH

Ansa Islam, AMI

Gynae, ATH

Kinza Khan, AMI

gynae, ATH


Pomorski M, Fuchs T, Zimmer M. Prediction of uterine dehiscence using ultrasonographic parameters of caesarean section scar in the non pregnant uterus: a prospective observational study. BMC Pregnancy Childbirth 2014;14:365.

Bano R, Mushtaq A, Adhi M, Saleem MD, Saif A, Siddiqui A, et al. Rates of caesarean section and trials and success of vaginal birth after caesarean sections in secondary care hospital. J Pak Med Assoc 2015;65(1):81–3.

Patah LE, Malik AM. Models of childbirth care and caesarean rates in different countries. Rev Saude Publica 2011;45(1):185–94.

Nahum GG. Uterine Rupture in Pregnancy: Overview, Rupture of the Unscarred Uterus, Previous Uterine Myomectomy and Uterine Rupture [Internet]. [cited 2016 Oct 7]. Available from:

Jastrow N, Vikhareva O, Gauthier RJ, Irion O, Boulvain M, Bujold E. Can third-trimester assessment of uterine scar in women with prior caesarean section predict uterine rupture? Ultrasound Obstet Gynecol 2016;47(4):410–4.

Guise JM, McDonagh MS, Osterweil P, Nygren P, Chan BK, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ 2004;329(7456):19–25.

Cunningham F, Bangdiwala S, Brown S, Dean T, Frederiksen M, Hogue CR, et al. National Institutes of Health Consensus Development Conference Statement: Vaginal Birth After Caesarean Section New Insights March 8–10, 2010. Obstet Anesth Dig 2011;31(3):140–2.

Macones GA, Cahill AG, Stamilio DM, Odibo A, Peipert J, Stevens EJ. Can Uterine Rupture in Patients Atempting Vaginal Birth after Caesarean Delivery be predicted? Am J Obstet Gynecol 2006;195(4):1148–52.

Kok N, Wireman IC, Opmeer BC, De Graaf IM, Mol BW, Pajkrt E. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous caesarean section: a meta- analysis. Ultrasound Obstet Gynecol 2013;42(2):132–9.

Jha NNS, Maheshwari S, Barala S. Ultrasonographic assessment of strength of previous scar during pregnancy.Int J Reprod Contracept Obstet Gynecol 2018;7(4):1458–63.

Society of Obstetricians and Gynaecologists of Canada. SOGC clinical guidelines for vaginal birth after previous caesarean birth. Number 155(Replaces guideline Number 147), February 2005. Int J Gynaecol Obstet 2005;89(3):319–31.

Uharcek P, Brestansky A, Ravinger J, Manova A, Zajacova M. Sonographic assessment of lower uterine segment thickness at term in women with previous caesarean delivery. Arch Gynecol Obstet 2015;292(3):609–12.

Mohammed ABF, Al-Moghazi DA, Hamdy MT, Mohammed EM. Ultrasonographic evaluation of lower uterine segment thickness in pregnant women with previous caesarean section. Middle East Fertil Soc J 2010;15(3):188–93.

Tazion S, Hafeez M, Manzoor R, Rana T. Ultrasound predictability of lower uterine segment caesarean section scar thickness. J Coll Physicians Surg Pak 2018;28(5):361–4.

Sharma C, Suriya M, Soni A, Soni PK, Verma A, Verma S. Sonographic prediction of scar dehiscence in women with previous caesarean section. J Obstet Gynnaecol India 2015;65(2):97–103.

Bujold E, Jastrow N, Simoneau J, Brunet S, Gauthier RJ. Prediction of complete uterine rupture by sonographic evaluation of the lower uteribe segment. Am J Obstet Gynecol 2009;201(3):320.e1–6.

Rozenberg P, Goffinet F, Phillipe HJ, Nisand I. Utrasonographic measurement of lower uterine segment to assess risk of defects of scared uterus. Lancet 1996;347(8997):281–84.

Glavind J, Madsen LD, Uldbjerg N, Dueholm M. Utrasound evaluation of caesarean scar after single- and double -layer uterotomy closure: a cohort study. Ultrasound Obstet Gynecol 2013;42(2):207–12.

Naji O, Wynants L, Smith A, Abdullah Y, Stalder C, Sayasneh A, et al. Predicting successful vaginal birth after caesarean section using a model based on caesarean scar features examined by transvaginal sonography. Ultrasound Obstet Gynaecol 2013;41(6):672–8.

Naji O, Daemen A, Smith A, Abdullah Y, Saso S, Stalder C, et al. Changes in caesarean section scar dimensions during pregnancy: a prospective longitudinal study. Ultrasound Obstet Gynecol 2013;41(5):556–62.

Gizzo S, Zambon A, Saccardi C, Patrelli TS, Di Gangi S, Carrozzini M, et al. Effective anatomical and functional status of the lower uterine segment at term:estimating the risk of uterine dehiscence by ultrasound. Fertil Steril 2013;99(2):496–501.

American College of Obstetrician and Gynecologists. ACOG practice bulletin no. 115: vaginal birth after previous caesarean delivery. Obstet Gynecol 2010;116(2)450–63.



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