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Inter- and intraobserver variability in sonographic measurement of the lower uterine segment after a previous
N Jastrow1, E Antonelli, R Robyr
1Obstetrics and Gynecology Department, University Hospital of Geneva, Switzerland. nijw@bluewin.ch
Objective:
To evaluate the reproducibility of sonographic measurement of the lower uterine segment in pregnant women at term.
Methods:
Two independent observers performed transabdominal sonography on 129 women between 36 and 38 weeks of gestation who had had a previous Cesarean section. Sonography was performed when the patients had a full and a half-full bladder; in 100 patients, the measurements were also performed transvaginally, with the patients having an empty bladder. Agreement was quantified by the intraclass correlation coefficient and, using a cut-off of 3.5 mm, by the kappa coefficient.
Results:
The intraobserver agreement was generally high (intraclass correlation coefficient > 0.90). The interobserver agreement was higher on transvaginal (intraclass correlation coefficient, 0.94) compared with transabdominal (0.70 and 0.84, with full and half-full bladder, respectively) ultrasound. The kappa coefficient was 0.75 transvaginally, compared with 0.34 and 0.54 using the transabdominal approach, with full and half-full bladder, respectively.
Conclusion:
The agreement between two observers for sonographic transvaginal measurement of the lower uterine segment can be considered good, compared with poor to moderate agreement using the transabdominal approach.
