VP52.15: Caesarean section (CS) scar location and preterm birth following full dilatation CS

Le résumé fourni par la source

To evaluate the Caesarean section (CS) scar characteristics by transvaginal ultrasound (TVUS) in pregnant women with previous full dilatation Caesarean section (FDCS) and its association with subsequent spontaneous preterm birth (SPTB). In this single centre prospective cohort study, singleton pregnant women with previous term FDCS (2017-2019) underwent serial TVUS assessment of cervical length (CL) and the distance of previous CS scar to the internal cervical os (14-24 weeks gestation). The internal os was identified using colour Doppler as the level where the uterine artery reaches the uterus. SPTB prophylactic interventions (cervical cerclage or vaginal progesterone) were offered for CL <25mm or in women with a previous history of SPTB/late miscarriage after FDCS. Primary outcome was prediction of SPTB <37 weeks. Secondary outcomes included CL <25 mm and need for prophylactic intervention. In logistic regression analysis we adjusted for SPTB risk factors (ethnicity, previous SPTB, late miscarriage and cervical surgery). CS scar was identified in 128/147 (87.0%) women. 14/128 (10.9%) CS scars were located below the internal os; 26/128 (20.3%) were between 0-5mm above the internal os and 88/128 (68.8%) were ≥5mm from the internal os. Mean CS scar distance was 7.3mm above the internal os (range -13.4 to 30.5mm). The SPTB rate was 5.5% (7/128). SPTB was more common when the CS scar was located <5mm above the internal os or within the cervix compared to >5mm above the internal os (5 of 40, 12.5% vs 2 of 88, 2.3%, RR 5.5, 95% CI 1.1-27.2; p = 0.03). History or ultrasound indicated cerclage was performed in 10/128 (7.8%) women, of whom only one woman delivered preterm. A higher position of the CS scar was associated with a significantly reduced the risk of CL <25mm (aOR 0.71; 95% CI, 0.60-0.85; p = 0.0001). In the next pregnancy after FDCS, CS scar located within the cervix or <5mm above the internal os predicts CL, risk of SPTB and the potential need for intervention.

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