Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;39(3):655-661.
doi: 10.1007/s00381-022-05642-0. Epub 2022 Aug 8.

Ultrasound evaluation of uterine scar thickness after open fetal surgery for myelomeningocele

Alexandre Kim Sangalan Sasaoka  1 , Antonio Fernandes Moron  1   2   3 , Edward Araujo Júnior  4 , Adriana Sañudo  5 , Mauricio Mendes Barbosa  2   3 , Herbene José Figuinha Milani  1   2   3 , Stephanno Gomes Pereira Sarmento  2   3 , Sergio Cavalheiro  2   3   6
Affiliations

Ultrasound evaluation of uterine scar thickness after open fetal surgery for myelomeningocele

Alexandre Kim Sangalan Sasaoka et al. Childs Nerv Syst. 2023 Mar.

Abstract

Purpose: This study aimed to analyse the evolution of uterine scar thickness after open fetal surgery for myelomeningocele (MMC) by ultrasonography, and to establish a cut-off point for uterine scar thickness associated with high-risk of uterine rupture.

Methods: A prospective longitudinal study was conducted with 77 pregnant women who underwent open fetal surgery for MMC between 24 and 27 weeks of gestation. After fetal surgery, ultrasound follow-up was performed once a week, and the scar on the uterine wall was evaluated and its thickness was measured by transabdominal ultrasound. At least five measurements of the uterine scar thickness were performed during pregnancy. A receiver operating characteristics (ROC) curve was constructed to obtain a cut-off point for the thickness of the scar capable of detecting the absence of thinning. Kaplan-Meier curves were constructed to evaluate the probability of thinning during pregnancy follow-up.

Results: The mean ± standard deviation of maternal age (years), gestational age at surgery (weeks), gestational age at delivery (weeks), and birth weight (g) were 30.6 ± 4.5, 26.1 ± 0.8, 34.3 ± 1.2 and 2287.4 ± 334.4, respectively. Thinning was observed in 23 patients (29.9%). Pregnant women with no thinning had an average of 17.1 ± 5.2 min longer surgery time than pregnant women with thinning. A decrease of 1.0 mm in the thickness of the uterine scar was associated with an increased likelihood of thinning by 1.81-fold (95% confidence interval [CI]: 1.32-2.47; p < 0.001). The area below the ROC curve was 0.899 (95% CI: 0.806-0.954; p < 0.001), and the cut-off point was ≤ 3.0 mm, which simultaneously presented greater sensitivity and specificity. After 63 days of surgery, the probability of uterine scarring was 50% (95% CI: 58-69).

Conclusion: A cut-off point of ≤ 3.0 mm in the thickness of the uterine scar after open fetal surgery for MMC may be used during ultrasonography monitoring for decision-making regarding the risk of uterine rupture and indication of caesarean section.

Keywords: Cut-off point; Dehiscence; Fetal surgery; Myelomeningocele; Uterine scar.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. Mitchell LE, Adzick NS, Melchionne J, Pasquariello PS, Sutton LN, Whitehead AS (2004) Spina bifida. Lancet 364:1885–1895 - DOI - PubMed
    1. Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GN, Shaw GM (2015) Spina bífida Nat Rev Dis Primers 1:15007 - DOI - PubMed
    1. Adzick NS, Thom EA, Spong CY, Brock JW, Burrows PK, Johnson MP et al (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993–1004 - DOI - PubMed - PMC
    1. American College of Obstetricians and Gynecologists (2013) ACOG Committee opinion no. 550: maternal-foetal surgery for myelomeningocele. Obstet Gynecol 121:218–219
    1. Varner M (2012) Cesarean scar imaging and prediction of subsequent obstetric complications. Clin Obstet Gynecol 55:988–996 - DOI - PubMed

LinkOut - more resources