Evidence map›Paper›PMID 39893267›Full record

Observational studyArchives of gynecology and obstetrics2025

The prospective sonographic assessment of the lower uterine segment after cesarean section and its clinical utility.

Stephan Spahn, Alex Horky, Dianita Sugiyo, Franz Bahlmann, Ammar Al Naimi

Abstract readObservational Study
In one paragraph

Observational study in Archives of gynecology and obstetrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Stephan SpahnDepartment of Obstetrics and Gynecology, Buergerhospital - Dr. Senckenberg Foundation, Frankfurt Am Main, 60318, Frankfurt, Hessen, Germany.
Alex HorkyDepartment of Obstetrics and Gynecology, Buergerhospital - Dr. Senckenberg Foundation, Frankfurt Am Main, 60318, Frankfurt, Hessen, Germany.
Dianita SugiyoClinic for Gynecology and Obstetrics, Medical Faculty, Philipps University of Marburg, Marburg, Germany.
Franz BahlmannDepartment of Obstetrics and Gynecology, Buergerhospital - Dr. Senckenberg Foundation, Frankfurt Am Main, 60318, Frankfurt, Hessen, Germany.
Ammar Al NaimiDepartment of Obstetrics and Gynecology, Buergerhospital - Dr. Senckenberg Foundation, Frankfurt Am Main, 60318, Frankfurt, Hessen, Germany. ammar.alnaimi@uclmail.net.ORCID 0000-0001-5345-4688

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis study aims to investigate the sonographic features of the lower uterine segment (LUS) and their association with successful vaginal birth after a cesarean section (VBAC).

methodsThis is a prospective observational cohort study of women who underwent a first cesarean section (CS). Inclusion criteria were age over 18 years and open family planning. Women with a history of any additional uterine surgery, as well as a vertical or inverted T uterotomy during the CS were excluded. A pregestational transvaginal sonography, followed by serial transabdominal ultrasound examinations at the first, second, and third trimesters upon starting a new pregnancy were performed. Each intra-gestational examination involved measuring the LUS on a sagittal plane over a length of 3 cm starting from the most inferior identifiable part of the myometrium behind a full bladder. Logistic regression was performed to test the association between measures of the LUS and successful vaginal birth after CS.

results96 women with a follow-up pregnancy within 2 years of the initial CS were included in the analysis. The pregestational RMT ratio was 62% and 38 (39%) women had a niche. The median thickness of the lower uterine segment was 8.34 mm (5.57-9.77), 4.75 mm (4.02-5.95), and 2.55 mm (2.01-3.55) at the first, second and third trimester, respectively. 70 women attempted VBAC and the risk of unplanned repeat CS was 37.1%. One millimeter increase in LUS thickness in the first trimester increased the odds of VBAC by 50-120% depending on the used measure (p < 0.05). This association weakened with increasing gestational age and the p values increased above 0.05.

conclusionThere is a good chance of successful VBAC for women attempting it. The sonographic assessment of the lower uterine segment during pregnancy could be helpful in counseling these women, albeit it seems that performing ultrasound during the first trimester is more informative than second and third trimesters.

Indexed as

Ultrasonography, PrenatalUterusVaginal Birth after CesareanAdultCesarean SectionFemaleHumansPregnancyProspective StudiesUltrasonographyCesarean sectionLower uterine segmentSonographyVaginal birth after cesarean

Identifiers

PMID39893267
PMCPMC12177004

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.