Clinical and Ultrasound Score for Evaluation of Previous Cesarean Section Scar

September 15, 2021 updated by: Mahmoud Elsaeed Elgohary, Mansoura University
Cesarean delivery rates have increased dramatically worldwide. In the United States, cesarean section (CS) rates increased from 5% of all deliveries in 1970 to a high of 31.9% in 2016.Although efforts were made to reduce the number of CS, it failed to achieve the 15% rate recommended by the World Health Organization (WHO).Repeat CS is the most significant factor contributing to overall increased CS rates. The primary indication of repeat CS is a prior CS. The trial of labor after cesarean (TOLAC) is an attempt to reduce CS rates. Several national medical associations have provided practice guidelines for vaginal birth after cesarean section (VBAC), but these differ across countries.VBAC is relatively safe when compared with repeat CS.However, TOLAC rates have dropped significantly worldwide in recent years.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

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Intervention / Treatment

Intervention / Treatment

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Detailed Description

Brief History taking include: age of patient, gravidity, parity, time interval between previous cesarean sections and current pregnancy, indication for the previous cesarean section, and fetal weight of previous delivery with special emphasis on menstrual history for proper dating and history of previous pregnancy to verify the inclusion or exclusion criteria.Physical examination include : General examination: for exclusion of presence of any medical disorders,Obstetric examination include: Fundal level to correlate with gestational age known by history, Umbilical grip to verify inclusion and exclusion criteria, Scar tenderness and shape in women who had undergone a previous cesarean section and investigations that will be performed including the following:basic routine antenatal investigations of pregnant women including blood group,Rhesus factor, complete blood count, blood sugar, and urine analysis. abdominal and transvaginal ultrasound will be performed for:a complete obstetric assessment at full term using TAS to confirm gestational age, fetal vitality, lie and presentation, amniotic fluid and placental position.Evaluation of the lower uterine segment using TVS, by measuring its thickness and identifying the echo structure for beinghomogenous or not . The LUS will be visualized in the sagittal section in the midline and lateral plane. The measurement will be obtained with the cursors at the urinary bladder wall- myometrium interface and the myometrium chorioamniotic membrane-amniotic fluid interface. Three layers can be identified by ultrasonography in a well-developed LUS in a midline section of sagittal view in a partially filled bladder. They are as follows from inside outwards:Chorioamniotic membrane with decidualized endometrium, a middle layer of myometrium and utero-vesical peritoneal reflection juxtaposed to muscularis and mucosa of the bladder.The lower uterine segment will be visualized in sagittal section in the midline.There after :150 patients will be evaluated using a measurement value of the clinical and ultrasound criteria and Follow up of all participants will be followed up till delivery, the mode of delivery either VBAC or elective repeated lower segment CS according to:History and clinical examination evaluation: Previous complicated CS or not, time interval between previous cesarean sections and current pregnancy(less than one year or more than one year),tender scar or not. US : TAS and TVS include: Lower uterine segment thickness , The echo structure of the lower uterine segment (Homogenous or nonHomogenous). For follow up of patient with previous CS include Initial evaluation: Each of the clinical and US parameters will be scored based on the sum of points is shown in table whatever to complete delivery by natural means or again by cesarean section.If the score is more than 7 out of 10 a vaginal birth will tried. On the other hand,Score 7 or less than 7 will be considered an indication to do repeated elective cesarean section.Careful follow up of patient during trial of labor after CS [TOLAC] for any possible symptoms and signs of uterine rupture that require immediate surgical intervention like : bleeding either intra abdominal or vaginal,cessation of uterine contraction,abnormal uterine contour,abdominal distention,shoulder tip pain,supraoubic pain,sudden severe abdominal pain may decrease after rupture,tender abdomen,rapid materinal pulse, low blood pressure,hypovolomic shock if rupture involve major blood vessels,no fetal presentation on vaginal examination,prolonged fetal bradycardia and absent fetal heart activity during continuous electronic heart rate monitoring.Careful examination of patient after vaginal delivery to detect any maternal complication by: local examination under anesthesia to ensure continuity of cesarean scar and ultrasound evaluation of scar.The parameters that are evaluated by clinical and ultrasound criteria Clinical and ultrasound criteria SCORE (2) SCORE (1)Tender scar Not tender (2) Tender (1)Previous complicated CS Not complicated (2) Complicated (1) ,Echo structure of the LUS Homogenous (2) Non homogenous (1)Lower uterine segment thickness More than or equal 3.65 mm(2) .more than 3mm to less than 3.65 mm(1)Pregnancy time interval after the CS More than 12 months(2) 12 months or less(1)Total Score (10) (5)

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
150

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Mansoura, Egypt
        • Faculty of Medicine - Mansoura University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

17 years to 40 years (Child, Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Previous one cesarean section for non permenant indication.
  • Pregnant women without any medical disorders.
  • Gestational age: 36-40 weeks.
  • Pregnant woman with singleton pregnancy.
  • Clinically adequate pelvis.
  • Normal ultrasonographic findings (gestational age, fetal structures and placental site).
  • Cephalic vertex presentation.
  • Patients not inlabour.

Exclusion Criteria:

  • Previous repair of ruptured uterus.
  • Women with history of long-term treatment for infertility.
  • Multiple pregnancies.
  • Previous operations in uterus rather than cesarean section.
  • Polyhydramnios and Fetal macrosomia.
  • Women with bad obstetric history (previous IUFD or difficult delivery).
  • Disturbance of fetal heart rate (determined with the CTG).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Novel score (Mosbah) score for evaluation of previous cesarean section scar
Time Frame: Baseline
The aim of this study is to use a novel score (Mosbah score) for evaluation of previous cesarean section scar in pregnant women in order to select the best and most safe mode of delivery by using certain measurments based on clinical findings and ultrasound measurements.
Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Mansoura University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

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Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
August 1, 2020

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 1, 2021

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 1, 2021

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
April 14, 2021

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 20, 2021

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
April 23, 2021

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 22, 2021

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 15, 2021

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2021

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • previous cesarean section scar

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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