A systematic review of transvaginal ultrasound assessment of cesarean scar characteristics and prediction of adverse obstetric outcomes
Notice bibliographique
Résumé
OBJECTIVE: This study aimed to investigate the association between preconception and antenatal ultrasound characteristics of cesarean delivery scars and adverse obstetrical outcomes in subsequent pregnancies. DATA SOURCES: Literature searches were performed in MEDLINE, Embase, and Cochrane databases from inception to January 31, 2024. STUDY ELIGIBILITY CRITERIA: Eligible studies included studies that evaluated cesarean delivery scar and niche characteristics using transvaginal ultrasound during preconception and/or antenatally and described subsequent adverse obstetrical outcomes (placenta accreta spectrum, preterm birth, uterine dehiscence/rupture, and unsuccessful vaginal birth after cesarean delivery). METHODS: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews registration number: CRD 42019121523). Of note, 2 reviewers independently screened records and assessed eligible articles. The quality of publication was assessed using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. The data were summarized using descriptive statistics. RESULTS: In 19 included studies, the definition of niche, large niche, and cesarean delivery scar assessment timing varied widely. Scar visibility was reported to be between 78% and 100% in the first trimester of pregnancy and between 68% and 91% in the second trimester of pregnancy. The prevalence rates of niche detection were 65% to 97% before conception and 52% to 58% during pregnancy. Uterine dehiscence/rupture was the most common adverse outcome reported (13 studies) and was associated with a large niche, a higher niche depth-to-residual myometrial thickness ratio (≥0.785), a thin residual myometrial thickness, and a higher average decrease in residual myometrial thickness between the first and second trimesters of pregnancy. Owing to methodological study heterogeneity and insufficient description of definitions, optimal cutoffs could not be defined. Of note, 3 studies evaluated the screening for placenta accreta spectrum using first-trimester cesarean delivery scar characteristics. An exposed cesarean delivery scar above the cervicoisthmic canal with placental implantation over the scar or within the niche had high sensitivity (75.0%-100.0%) and negative predictive value (99.6%-100.0%) for placenta accreta spectrum. Of note, 1 study found that a low scar after full dilatation cesarean delivery (a scar within the cervix or <5.0 mm above the internal cervical os) was associated with an increased risk of shortening cervical length and/or spontaneous preterm birth (adjusted odds ratio, 12.7 [95% confidence interval, 4.5-36.0]; P≤.0001). CONCLUSION: This systematic review found that cesarean delivery scar characteristics are associated with adverse obstetrical outcomes, including uterine rupture/dehiscence, placenta accreta spectrum, and spontaneous preterm birth. Multicenter prospective studies using standardized cesarean delivery scar assessment are needed to establish predictive data for optimal management and pregnancy counseling. El resumen está disponible en Español al final del artículo.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,068 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,012 | 0,013 |
| Bibliométrie | 0,013 | 0,013 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».