Influence of Cesarean Section Scar on the Mean Pulsatility Index of the Uterine Artery Doppler between 20 and 34 Weeks of Gestation

Abstract

Objective

The aim of this study was to assess the influence of the cesarean section scars on the mean pulsatility index (PI) of the uterine artery Doppler between 20 and 34 weeks of gestation. A secondary objective was to assess the association between previous cesarean section and adverse maternal/perinatal outcomes.

Methods

A retrospective cohort study was conducted with pregnant women who had their deliveries between March 2014 and February 2023. PI of the uterine arteries Doppler was performed transvaginally between 20–24 weeks and transabdominally between 28–34 weeks. The following variables were considered adverse perinatal outcomes: birth weight < 10th percentile for gestational age, preeclampsia, premature birth, placental abruption, perinatal death, postpartum hemorrhage, neonatal intensive care unit (NICU) admission.

Results

A total of 479 pregnant women were included in the final statistical analysis, being that 70.6% (338/479) had no (Group I) and 29.4% (141/479) had at least one previous cesarean section (Group II). Pregnant women with a previous cesarean had higher median of mean PI (1.06 vs. 0.97, p = 0.044) and median MoM of mean PI uterine arteries Doppler (1.06 vs. 0.98, p = 0.037) than pregnant women without previous cesarean section at ultrasound 20–24 weeks. Pregnant women with a previous cesarean section had higher median of mean PI (0.77 vs. 0.70, p < 0.001) and mean MoM PI uterine arteries Doppler (1.08 vs. 0.99, p < 0.001) than pregnant women without previous cesarean section at ultrasound 28–34 weeks. Pregnant women with ≥ 2 previous cesarean sections had a higher median of mean PI uterine arteries Doppler than those with no previous cesarean sections (1.19 vs. 0.97, p = 0.036). Group II had a lower risk of postpartum hemorrhage (aPR 0.31, 95% CI 0.13–0.75, p = 0.009) and composite neonatal outcome (aPR 0.66, 95% CI 0.49–0.88, p = 0.006). Group II had a higher risk of APGAR score at the 5th minute < 7 (aPR 0.75, 95% CI 1.49–51.29, p = 0.016).

Conclusion

The number of previous cesarean sections had a significant influence on the mean PI uterine arteries Doppler between 20–24 and 28–34 weeks of gestation. Previous cesarean section was an independent predictor of postpartum hemorrhage and APGAR score at the 5th minute < 7. Pregnancy-associated arterial hypertension and number of previous deliveries influenced the risk of composite neonatal outcome, but not the presence of previous cesarean section alone.

Zusammenfassung

Zielsetzung

Ziel dieser Studie war es, die Auswirkung von Kaiserschnittnarben auf den mittleren Doppler-Pulsatilitätsindex (PI) der A. uterina zwischen der 20. and 34. Schwangerschaftswoche zu beurteilen. Das sekundäre Ziel war, die Assoziation zwischen vorheriger Kaiserschnittentbindung und dem mütterlichen/perinatalen Outcome zu evaluieren.

Methoden

Es wurde eine retrospektive Kohortenstudie durchgeführt mit schwangeren Frauen, die zwischen März 2014 und Februar 2023 entbanden. Die Doppler-Sonografie zur Messung des PI der A. uterina wurde vaginal in den 20. –24. Schwangerschaftswochen und abdominal in den 28.–34. Wochen durchgeführt. Die folgenden Variablen wurden als ungünstiges perinatales Outcome bewertet: Geburtsgewicht < 10. Perzentile in Bezug auf das Gestationsalter, Präeklampsie, Frühgeburt, vorzeitige Plazentalösung, perinataler Tod, postpartale Blutungen, Verlegung auf eine neonatale Intensivstation (NICU).

Ergebnisse

Insgesamt wurden 479 schwangere Frauen in die letzte statistische Analyse eingeschlossen. Davon hatten 70,6% (338/479) keine (Gruppe I) und 29,4% (141/479) mindestens eine (Gruppe II) vorherige Kaiserschnittentbindung. Bei der Ultraschalluntersuchung in den 20.–24. Wochen hatten schwangere Frauen mit vorheriger Kaiserschnittentbindung einen höheren Median des durchschnittlichen PI (1,06 vs. 0,97; p = 0,044) und höheres medianes MoM des durchschnittlichen PI der A. uterina (1,06 vs. 0,98, p = 0,037) verglichen mit schwangeren Frauen ohne vorherige Kaiserschnittentbindung. Bei der Ultraschalluntersuchung in den 28.–34. Schwangerschaftswochen hatten schwangere Frauen mit vorheriger Kaiserschnittentbindung einen höheren Median des durchschnittlichen PI (0,77 vs. 0,70; p < 0,001) und ein höheres durchschnittliches MoM des PI der A. uterina (1,08 vs. 0,99; p < 0,001) verglichen mit schwangeren Frauen ohne vorherige Kaiserschnittentbindung. Schwangere Frauen mit ≥ 2 vorherigen Kaiserschnittentbindungen hatten einen höheren Median des durchschnittlichen PI der A. uterina verglichen mit Frauen ohne vorherige Kaiserschnittentbindung (1,19 vs. 0,97; p = 0,036). Gruppe II hat ein geringeres Risiko für eine postpartale Blutung (aPR 0,31; 95%-KI [0,13–0,75], p = 0,009) und für ein negatives neonatales Outcome (aPR 0,66; 95%-KI [0,49–0,88], p = 0,006). Gruppe II hatte ein höheres Risiko für einen APGAR-Score < 7 nach 5 Minuten (aPR 0,75; 95%-KI [1,49–51,29], p = 0,016).

Schlussfolgerung

Die Anzahl vorhergehender Kaiserschnittentbindungen hatte eine signifikante Auswirkung auf den mittleren Doppler-PI der A. uterina zwischen den 20.–24. und 28.–34. Schwangerschaftswochen. Eine vorherige Kaiserschnittentbindung war ein unabhängiger Prädiktor für eine postpartale Blutung und einen APGAR-Score < 7 nach 5 Minuten. Schwangerschaftsassoziierter Bluthochdruck und die Anzahl vorheriger Entbindungen haben Auswirkungen auf das Risiko eines negativen neonatalen Outcomes, nicht aber eine vorherige Kaiserschnittentbindung an sich.

Keywords

sonography - uterus - cesarean section scar - uterine artery Doppler - perinatal outcomes - influence

Schlüsselwörter

Sonografie - Gebärmutter - Kaiserschnittnarbe - Doppler-Sonografie der Arteria uterina - perinatales Outcome - Auswirkung

Publikationsverlauf

Eingereicht: 03. April 2024

Angenommen nach Revision: 17. Juni 2024

Artikel online veröffentlicht:
09. Juli 2024

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