Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women

Donnez, Olivier; Donnez, Jacques; Orellana, Renán; Dolmans, Marie-Madeleine

doi:10.1016/j.fertnstert.2016.09.033

Cited by 135 publications

(165 citation statements)

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“…Several case reports, case series and small prospective cohort studies with a maximum of 38 included women and one larger retrospective comparative study ( n = 59) have been reported 5, 12, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35. Eleven articles (including a total of 65 women) reported a reduction or complete resolution of postmenstrual spotting; however, this was mostly not measured in a standardised way 5, 16, 18, 20, 21, 24, 26, 27, 29.…”

Section: Discussionmentioning

confidence: 99%

The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

Vervoort

Vissers

Hehenkamp

et al. 2017

BJOG

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ObjectiveTo evaluate the effectiveness of a laparoscopic niche resection on niche‐related symptoms and/or fertility‐related problems, ultrasound findings and quality of life.DesignProspective cohort study.SettingUniversity hospital.PopulationWomen with a large niche (residual myometrium <3 mm) and complaints of either postmenstrual spotting, dysmenorrhoea, intrauterine fluid accumulation and/or difficulties with embryo transfer due to distorted anatomy.MethodsWomen filled out questionnaires and a validated menstrual score chart at baseline and 6 months after the laparoscopic niche resection. At baseline and between 3 and 6 months follow up niches were evaluated by transvaginal ultrasound.Main outcome measuresThe primary outcome was reduction of the main problem 6 months after the intervention. Secondary outcomes were complications, menstrual characteristics, dysmenorrhoea, niche measurements, intrauterine fluid, surgical outcomes, satisfaction and quality of life.ResultsIn all, 101 women underwent a laparoscopic niche resection. In 80 women (79.2%) the main problem was improved or resolved. Postmenstrual spotting was significantly reduced by 7 days at 6 months follow up compared with baseline. Dysmenorrhoea and discomfort related to spotting was also significantly reduced. The residual myometrium was increased significantly at follow up. The intrauterine fluid was resolved in 86.9% of the women with intrauterine fluid at baseline; 83.3% of women were (very) satisfied. The physical component of quality of life increased, the mental component did not change.ConclusionsA laparoscopic niche resection reduced postmenstrual spotting, discomfort due to spotting, dysmenorrhoea and the presence of intrauterine fluid in the majority of women and increased the residual myometrium.Tweetable abstractLaparoscopic niche resection reduces niche‐related problems and enlarges the residual myometrium.

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Section: Discussionmentioning

confidence: 99%

The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

Vervoort

Vissers

Hehenkamp

et al. 2017

BJOG

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“…15 In 2017, a large prospective study evaluated laparoscopic repair among 38 symptomatic women (TRM <3 mm). 5 The authors found that the A study of transvaginal repair of CSD included 64 patients and reported a mean operative time of 33.6 minutes; a mean blood loss of 37.9 mL; a mean postoperative hospital stay of 6 days; and resolution of postmenstrual bleeding among 86% of participants at the 6-month follow-up. 6 Zhou et al 7 enrolled 121 patients and demonstrated that transvaginal repair of CSD reduced long-term spotting and bleeding from 14.87 days preoperatively to 9.02 days at 6 months after surgery; furthermore, the CSD was corrected by the procedure (anatomically assessed by transvaginal ultrasonography).…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, the TRM had thickened in both the transvaginal repair group and the laparoscopic repair group after surgery; however, the mean recorded TRM (4.41 and 4.68 mm, respectively) was thinner than that previously reported when using laparoscopic repair (9.62 mm). 5 This difference might reflect the fact that the pres- groups. Not all of the women who wished to conceive again had yet met the requirement for 1 year of contraception after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…First, infertility may be caused by abnormal secretions or deposited blood in the niche. Donnez et al 5 reported that 44% of infertile patients with CSD conceived after laparoscopic repair. Second, if the cesarean scar pregnancy happens in the niche, it is extremely dangerous, increasing the likelihood of hysterectomy due to antepartum or postpartum hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…4 Laparoscopic repair was implemented as the gold-standard surgical approach to reduce menstrual bleeding and thicken the TRM. 5 However, this procedure requires suturing to be performed using a laparoscope and hysteroscopic guidance, which increases both the operative time and medical costs. The transvaginal approach offers a novel method for CSD repair.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of transvaginal repair versus laparoscopic repair of lower‐segment cesarean scar defects

Zhang

Liang

Zhu

2019

Intl J Gynecology & Obste

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Objective To evaluate transvaginal repair versus laparoscopic repair of cesarean scar defects (CSDs). Methods A retrospective cohort study was conducted among 67 symptomatic women with CSDs who attended a tertiary hospital in Beijing, China, between July 1, 2013, and March 31, 2017. The participants underwent either transvaginal repair (n=31) or laparoscopic repair (n=36). Medical costs, perioperative outcomes, and surgical outcomes were compared. Results No statistically significant between‐group differences were found at baseline. The mean thickness of the residual myometrium increased from 1.71 ± 0.67 mm before surgery to 4.41 ± 2.09 mm after surgery in the transvaginal repair group (P<0.001), and from 1.81 ± 0.93 to 4.68 ± 1.96 mm in the laparoscopic repair group (P<0.001). The duration of menses after surgery was less than 10 days in both the transvaginal repair group (n=30, 96.3%) and the laparoscopic repair group (n=30, 83.9%; P=0.113). Operative time and medical costs were both lower in the transvaginal repair group than in the laparoscopic repair group (P<0.001). Conception rates for the two groups were similar among women who desired fertility. Conclusion Transvaginal repair of CSD was associated with reduced operative times and medical costs when compared with laparoscopic repair.

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Association Between Mode of First Delivery and Subsequent Fecundity and Fertility

et al. 2020

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IMPORTANCE More than 20% of births globally are by cesarean delivery, including more than 30% in the US. Prior studies have reported lower rates of childbearing after cesarean delivery, but it is not clear if this is due to maternal choice or lower conception rates. OBJECTIVE To investigate the association between mode of first delivery and subsequent conceptions and live births. DESIGN, SETTING, AND PARTICIPANTS The First Baby Study was a multicenter prospective cohort study of women aged 18 to 35 years with singleton pregnancies, enrolled and interviewed before first childbirth, who delivered in Pennsylvania from 2009 to 2011 and were followed up for 36 months after delivery (until April 2014). Data analysis for this study took place between May and July 2019 and in January 2020. EXPOSURES Mode of first delivery (cesarean or vaginal). MAIN OUTCOMES AND MEASURES Rates of subsequent conceptions and live births. Discrete-time Cox proportional hazard regression models were used to compare the rate of subsequent conception (vaginal vs cesarean) among those who completed the 36-month survey, accounting for reported months of unprotected intercourse during the follow-up period and adjusting for relevant covariates. A log binomial regression was used to compare the age-adjusted rate of subsequent live birth (vaginal vs cesarean) among those who completed the 36-month survey. RESULTS The study population consisted of 2423 women who were retained to the 36-month survey (mean [SD] age at baseline was 27.2 [4.4] years and 712 [29.4%] delivered by cesarean). There were 2046 women who had unprotected intercourse during the follow-up period, 2021 of whom provided data on months of unprotected intercourse. Cesarean delivery was associated with lower rates of conception after unprotected intercourse during the follow-up period (413 of 599 [68.9%]) compared with vaginal delivery (1090 of 1422 [76.7%]) (adjusted hazard ratio, 0.85; 95% CI, 0.74-0.96). Cesarean delivery was also associated with reduced likelihood of a subsequent live birth (305 women [42.8%]) compared with vaginal delivery (857 women [50.1%]), with an age-adjusted risk ratio of 0.83 (95% CI, 0.75-0.92). CONCLUSIONS AND RELEVANCE In the 3 years following first childbirth, women who delivered their first child by cesarean had lower rates of conception after unprotected intercourse, and fewer of these women had a second child than those who delivered vaginally.

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Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women

Abstract: In symptomatic women with residual myometrial thickness of less than 3 mm who wish to conceive, laparoscopic repair could be considered an appropriate approach.

Cited by 135 publications

References 34 publications

The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

Comparison of transvaginal repair versus laparoscopic repair of lower‐segment cesarean scar defects

Association Between Mode of First Delivery and Subsequent Fecundity and Fertility

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