Maternal and neonatal outcomes of patients with ultrasound-diagnosed uterine window

Existing literature is inconsistent regarding the management of uterine window (UW) diagnosed by ultrasound. We assessed whether an antepartum admission for suspected UW conferred maternal or neonatal benefit. This is a single-institution retrospective cohort study that identified subjects from the ultrasound record by querying keywords pertaining to UW from 2013-2019. We included subjects with at least one cesarean delivery (CD) and any LUS measurement. We excluded those where keywords were unrelated to UW and those with no outcome data. Our exposure was antepartum admission (y/n) for any indication. We compared baseline characteristics between groups, and then compared maternal and neonatal outcomes. Our primary outcome was gestational age (GA) at delivery. Secondary outcomes included neonatal birth weight, NICU admission, uterine rupture, and presence of UW at time of CD. Two sensitivity analyses were performed: 1) excluding indicated PTD and 2) including only asymptomatic UW. Of 345 ultrasound records queried, 93 subjects were included. Of these, 27 (29%) had an antepartum admission and 66 (71%) did not. There was no significant difference in demographics. In the analysis including all subjects, there was a significant decrease in GA at delivery (35.7 [34.2-36.2] vs 37.7 [37-39], p< 0.001), mean birth weight (2413 ± 636 vs 3196 ± 464, p< 0.001), and NICU stay (10 (37%) vs 7 (10.7%), p=0.006). There was also a significant difference in GA at delivery in both subgroup analyses of indicated PTD excluded (36 [35.1-36.2] vs 37.7 [37-39], p< 0.001) and asymptomatic UW (35.7 [35.1-36] vs 37.7 [37-39], p=0.002). There was no difference between uterine rupture or in UW at time of CD in any analyses. A minority of admissions for those with suspected UW were for asymptomatic monitoring. In those admitted solely for asymptomatic UW, there was an earlier GA at delivery and lower birth weight. Guidelines surrounding management of antenatal UW are needed to standardize care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)