<scp>OC</scp>14.07: Lower uterine segment thickness for prevention of uterine rupture and prediction of uterine scar dehiscence: a multicentre prospective study
Bibliographic record
Abstract
To estimate the impact of third-trimester lower uterine segment (LUS) thickness measurement on the rate of uterine rupture and to compare abdominal and vaginal measurements for the prediction of uterine scar dehiscence. Women with a prior single low-transverse Caesarean were recruited at 34–38 weeks of gestation. LUS thickness was measured by transabdominal and transvaginal ultrasounds and the thinnest measurement was considered as the primary independent variable. Participants and health care providers were kept blinded except when LUS thickness was below 2.5 mm: they were informed about the risk of uterine rupture during trial of labour (TOL). Our primary outcomes were symptomatic uterine rupture that required urgent Caesarean during TOL and complete uterine scar dehiscence at the time of elective repeat Caesarean (ERC). Receiver-operating characteristics (ROC) area under the curve (AUC) were used to compare the predictive values of each technique. We recruited 1853 women at a mean gestational age of 36.7 ± 1.2 weeks and we obtained 99% (n = 1839) complete follow-up. LUS thickness was below 2.5 mm in 410 (22%). Successful VBAC occurred in 685 (67%) out of 987 TOL while no symptomatic uterine rupture was observed. Out of 852 women who underwent ERC, we found a significant correlation between LUS thickness and uterine scar defect (p < 0.001) with the highest AUC observed when vaginal and abdominal measurements were combined (0.85; 95%CI 0.79 - 0.91), followed by vaginal (0.82; 95%CI 0.75- 0.89), and abdominal (0.78; 95%CI 0.70 - 0.88) measurements only. LUS below 2.3 mm was associated with sensitivity of 86%, specificity of 74%, positive predictive value of 8%, and negative predictive value of 99.5%. Performing third-trimester measurement of LUS thickness is efficient to prevent symptomatic uterine rupture. The optimal prediction of uterine scar dehiscence is achieved by the combination of abdominal and vaginal ultrasound.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".