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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award

Poster Session 2

(394) Impact of antenatally suspected uterine window on maternal and neonatal outcomes

Thursday, January 30, 2025
4:00 PM - 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Alexa L. Cohen, MD

    University of Miami Health System
    Miami, Florida, United States

    • Coauthor(s)

  • CP

    Carly Pickett, MD, MSc

    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

  • TD

    Taylor Douglas, MD

    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

  • GL

    Grace M. Lee, MD

    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

  • CP

    Chloe Porigow

    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

  • Pe'er Dar, MD

    Professor and Director, Division of Fetal Medicine
    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

  • Georgios Doulaveris, MD

    Assistant Professor
    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, New York, United States

Objective:

Prenatal sonographic suspicion for uterine window at a prior cesarean scar niche may impact mode and timing of delivery. We aimed to investigate maternal and neonatal outcomes in patients with prenatal suspicion of uterine window.

Study Design:

Retrospective cohort study of all patients with a sonographic diagnosis of a uterine window at a tertiary referral academic institution from 2014-2024. Uterine window was defined as lower uterine myometrial segment >10mm in length and thickness < 2mm on 2nd trimester transvaginal ultrasound. Patients were compared to controls with a history of cesarean delivery (CD) without a uterine window, electing a repeat CD. All study patients were planned for repeat CD at early term (37 weeks). Primary outcome was a composite adverse maternal outcome (uterine rupture, blood loss >1.5L, transfusion, intensive care unit (ICU) admission, need for vasopressors and hysterectomy). Secondary outcomes included APGAR < 7, NICU admission and a composite neonatal morbidity outcome (sepsis, respiratory distress, and IVH or NEC). Multivariable logistic regression analysis was performed.

Results:

Study included 103 patients with mid-gestation suspicion of uterine window and 103 matched controls. There was no significant difference in age, race/ethnicity, BMI, or parity between groups. Uterine rupture occurred in two (1.94%) study patients and one (0.9%) control. Delivery on the planned date was similar between groups (67.0% vs 69.9%, p=0.6). Actual delivery occurred earlier for study patients (36.3 ±0.2 weeks vs 38.2 ±0.2 weeks, p< 0.01). Maternal composite adverse outcome was higher in study patients (22.3% vs 11.7%, p=0.04). Study neonates had similar APGAR scores, but were more likely to be admitted to NICU (20.4% vs 9.7%, p=0.03) and had higher morbidity (16.5% vs 6.8%, p=0.02), compared with controls. 

Conclusion:

Patients with 2nd trimester sonographic suspicion for uterine window are at increased risk for iatrogenic earlier delivery, and higher maternal and neonatal morbidity. Possible benefits of earlier scheduled repeat CD should be weighed against the increased neonatal risks.