Title: The visibility and measurement of Caesarean section scars in pregnancy: an interobserver variability study
Authors: Naji, O ×
Daemen, Anneleen
Smith, A
Abdallah, Y
Saso, S
Stalder, C
Sayasneh, A
McIndoe, A
Ghaem-Maghami, S
Timmerman, Dirk
Bourne, Tom #
Issue Date: Nov-2012
Publisher: Blackwell Science
Series Title: Ultrasound in Obstetrics & Gynecology vol:40 issue:5 pages:549-556
Article number: 10.1002/uog.11132
Abstract: OBJECTIVES: To evaluate the visibility of Caesarean section (CS) scars by Transvaginal Sonography (TVS) in the pregnant state, to apply agreed methods and nomenclature for measuring Caesarean scars and to test their reproducibility throughout the course of pregnancy. METHODS: In this observational cohort study, 320 consecutive pregnant women with a previous Caesarean delivery were examined to assess scar visibility by two independent examiners. TVS was carried out at 11-13, 19-21 and 34-36 weeks gestation. A scar was defined visible when a hypoechoic shadow representing myometrial discontinuity at the anterior wall of the lower uterine segment was identified. In a subset of patients (n = 111), visible scars were measured by two independent examiners in three dimensions: scar width, depth and length as well as the residual myometrial thickness (RMT). Descriptive analysis was used to assess scar visibility, and Intraclass Correlation Coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners on scar measurements, using RMT cut-off of 2.4 mm by the Kappa Coefficient. RESULTS: The scar was visible in 284/320 cases (89%). Visible scars were significantly associated with anteverted uteri (p-value <0.0001). Both examiners had 100% agreement on scar visibility at 12 and 20 weeks gestation, while the agreement was 96% at 34 weeks. The intra and inter-observer agreement for scar measurements were generally good (ICC 0.86 and 0.89) respectively. The Kappa coefficient for the RMT was 0.26 in the first trimester, compared with 0.51 and 0.71 in the second and third trimester, respectively. CONCLUSION: CS scars remain visible in the majority of women throughout pregnancy. CS scars can be reproducibly measured in three dimensions when assessed by TVS in all phases of pregnancy. The agreement between two observers for CS scar measurements can be considered good in the second trimester, compared with moderate agreement in the first and third trimesters. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
ISSN: 0960-7692
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Department of Development and Regeneration - miscellaneous (+)
× corresponding author
# (joint) last author

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