Three-Dimensional Volume Ultrasound Assessment of Cesarean Scar Niche and Cervix in Pregnant Women

Objective: To assess the reproducibility of standardized 3-dimensional (3D) ultrasound volume analysis of the dimensions and the position of cesarean birth (CB) scar niche relative to the cervix in pregnant women. // Methods: This prospective single-center study in women with 1 previous CB ≥8 cm cervical dilatation acquired ultrasound volumes between 11 and 24 weeks' gestation in a mid-sagittal plane. Two experienced operators processed the volumes using virtual organ computer-aided analysis. A CB scar niche was defined as an indentation at the scar site of ≥2 mm in depth. Niche and cervix volumes were calculated using manual contouring. Agreement for categorical variables was expressed using intraclass correlation coefficient (ICC). The Bland–Altman method was used to assess numerical variable reproducibility. // Results: To achieve the desired statistical power, 52 participants were included. The intraobserver agreement on niche classification relative to the internal os was 100%, with an interobserver kappa coefficient of 0.98 (95% confidence interval [CI] 0.97–0.99, P < .05). The intraobserver ICC for niche volume was 0.94 (95% CI 0.90–0.96; P < .001), with a mean difference of −15.32 mm3 (±109.32). The interobserver ICC was 0.78 (95% CI 0.62–0.87; P < .001), with a mean difference of −21.57 mm3 (±202.01). The ICC for niche/cervix volume ratio were 0.94 (95% CI 0.90–0.96; P < .001) and 0.79 (95% CI 0.63–0.87; P < .001) for intra- and interobserver reproducibility, respectively. // Conclusions: This study demonstrates that 3D CB scar sonographic features are highly reproducible in pregnant women with a history of advanced labor CB. The validated protocol can guide future research on the association with subsequent adverse pregnancy outcomes.