Sezaryen Skarına Yönelik Yapılan Shear Wave Elastosonografinin Etkinliği ve Doğum Planlamasına Katkısı

Öz

Amaç: Bu çalışmanın amacı, sezaryen doğumun miyometriyum üzerindeki etkisini gri skala ultrasonografi ve shear wave elastografi tekniklerini kullanarak değerlendirmek ve sezaryen öyküsü bulunan gebelerde doğum şeklinin belirlenmesine yönelik karar sürecine katkı sağlamaktır. Gereç ve Yöntemler: Bu prospektif çalışmaya, 28-32. gebelik haftaları arasında olan toplam 120 gebe dahil edildi. Gebelerin 60’ı geçirilmiş sezaryen, 60’ı vajinal doğum öyküsüne sahipti. Her iki grupta da olguların yarısının bir doğum , diğer yarısının ise iki doğum öyküsü mevcuttu. Sezaryen doğum yapmış gebeler, önceki doğumundan elastografi ölçümlerine kadar geçen zamana göre iki yıldan az, iki-beş yıl arası ve beş yıldan fazla olmak üzere üç gruba ayrıldı. Sezaryen skarlarının değerlendirilmesinde ultrasonografi ve shear wave elastografi ölçümleri kullanıldı. Bulgular: Vajinal doğum yapmış gebelerde ortalama myometrium elastisite değerleri 9,6 ± 3,22 kPa, sezaryen doğum yapmış gebelerde ise 21,33 ± 9,18 kPa ölçülmüş olup iki grup arasında istatistiksel olarak anlamlı fark mevcuttu (p<0,001). 1 sezaryen ile 1 vajinal doğum öyküsü bulunan gebeler arasında miyometriyal sertlik farkı (sırasıyla 21,86 ± 10,54 kPa, 10,07 ± 3,24 kPa, p<0,001) ve 2 sezaryen ile 2 vajinal doğum öyküsü bulunan gebeler arasında miyometriyal sertlik farkı istatistiksel olarak anlamlıydı (sırasıyla 20,80 ± 7,74 kPa, 9,14 ± 3,19 kPa, p<0,001). Sezaryen sonrası geçen süreye göre elastisite değerleri iki yıldan az olan grupta 28,9 ± 10,42 kPa, 2-5 yıl arası olan grupta 24,01 ± 6,98 kPa ve 5 yıldan fazla olan grupta 14,45 ± 5,46 kPa olarak ölçüldü. Tüm gruplar arasındaki fark istatistiksel olarak anlamlı bulundu (p<0,001). Sonuç: Önceki sezaryen öyküsü 2 yıldan az olan grupta miyometriyal elastisite değeri daha yüksek bulunurken, sezaryen öyküsü 5 yıl ve daha fazla olan grupta gebelerin miyometriyal elastisite değerleri normal doğum yapmış gebelerin değerlerine yaklaşmaktadır. Bu bulgu, sezaryen geçirmiş gebeleri normal doğuma yönlendirmek için elastosonografinin önemli bir parametre olarak kullanılabileceğini göstermektedir.

Anahtar Kelimeler

• Ultrasonografi
• Shear Wave Elastografi
• Sezaryen skarı
• Vajinal doğum

The Effectiveness of Shear Wave Elastosonography for the Evaluation of Cesarean Scar and Its Contribution to Delivery Planning

Öz

Objective: This study aims to evaluate the impact of cesarean section on the myometrium using gray-scale ultrasonography and shear wave elastography techniques, and to contribute to the decision-making process regarding the mode of delivery in pregnant women with a history of cesarean delivery. Material and method: This prospective study included 120 pregnant women between 28 and 32 weeks of gestation. Of these, 60 had a history of cesarean delivery and 60 had a history of vaginal delivery. In both groups, half of the cases had a history of one birth, and the other half had a history of two births. Ultrasonography and shear wave elastography measurements were used to evaluate cesarean scars. Additionally, the cesarean delivery group was divided into three subgroups based on the time since the previous birth: less than two years, between two and five years, and more than five years. Results: The mean myometrial elasticity value was 9.6 ± 3.22 kPa in pregnant women with a history of vaginal delivery and 21.33 ± 9.18 kPa in those with a history of cesarean delivery, showing a statistically significant difference between groups (p < 0.001). The difference in myometrial stiffness was also statistically significant between women with one cesarean and those with one vaginal delivery (21.86 ± 10.54 kPa vs. 10.07 ± 3.24 kPa, p < 0.001), as well as between women with two cesareans and those with two vaginal deliveries (20.80 ± 7.74 kPa vs. 9.14 ± 3.19 kPa, p < 0.001). According to the time elapsed after cesarean delivery, the mean elasticity values were 28.9 ± 10.42 kPa in women less than two years post-cesarean, 24.01 ± 6.98 kPa in those 2–5 years post-cesarean, and 14.45 ± 5.46 kPa in those more than five years post-cesarean. The differences among all groups were statistically significant (p < 0.001). Conclusion: Myometrial elasticity values were higher in women whose previous cesarean section had occurred less than two years earlier, whereas in those with a cesarean history of five years or more, elasticity values approached those of women who had vaginal deliveries. This finding suggests that elastosonography may serve as an important parameter in guiding pregnant women with a history of cesarean section toward vaginal delivery.

Anahtar Kelimeler

• Ultrasonography
• Shear Wave Elastography
• Cesarean scar
• Vaginal delivery

Kaynakça

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