Laparoscopic Repair of Post-Cesarean Section Uterine Scar Defects Diagnosed in Nonpregnant Women

Marotta, Maria-Laura; Donnez, Jacques; Squifflet, Jean; Jadoul, Pascale; Darii, Natalia; Donnez, Olivier

doi:10.1016/j.jmig.2012.12.006

Cited by 131 publications

(151 citation statements)

References 23 publications

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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%

“…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. Pelvic pain and/or dysmenorrhoea was reported to be resolved after laparoscopic niche resection in 36 women 5, 18, 21, 29. The residual myometrial thickness was increased after laparoscopic niche resection in all studies, but only three studies compared the outcomes with baseline measurements 15, 16, 17.…”

Section: Discussionmentioning

confidence: 99%

“…Niches are reported to be associated with postmenstrual spotting 1, 2, 3. Other symptoms include dysmenorrhoea and chronic pelvic pain 4, 5. It has been postulated that the accumulation of fluid and mucus in a large niche may impair fertility due to reduced implantation and penetration of spermatozoa 6.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

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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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“…12 Considering the published data concerning the diagnosis and treatment of the cesarean section scar defects, there is no dehiscence case among nonpregnant women included into the studies. 13,14 Therefore, we believe that in our case the separation occurred during the pregnancy.…”

Section: Discussionmentioning

confidence: 73%

“…15 While the number of the cases in women who become pregnant after the repair of post-growing niches, is limited, previa and dehiscence wasn't reported. 13 As the repair of the niches presenting abnormal uterine bleeding symptoms, is being suggested, the pre-pregnancy repair should also be considered in terms of pregnancy complications in larger niches.…”

Section: Discussionmentioning

confidence: 99%

Repair of a First Trimester Uterine Dehiscence with Continuation of Pregnancy: Case Report

Sanverdi¹,

Ayvaci²,

Temizkan³

et al. 2017

Turkiye Klinikleri J Case Rep

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pontaneous uterine rupture and dehiscence are rare complications of pregnancy. While uterine rupture refers to full thickness disruption of the uterine wall, uterine dehiscens is an incomplete separation of the uterine wall with intact serosa.The dehiscence of a uterus in fetal viability limit creates a dilemma because there is not any clear treatment approach.1 Although rare, pregnancy continuation with the expectant approach or defect repair in the second trimester has been published. 2,3 Also, there are few reported cases of first trimester uterine dehiscence associated with surgical abortion or following incomplete abortion. While uterine rupture refers to full thickness disruption of the uterine wall, uterine dehiscens is an incomplete separation of the uterine wall with intact serosa. The dehiscence of a uterus in fetal viability limit creates a dilemma because there is not any clear treatment approach. Although rare, pregnancy continuation with the expectant approach or defect repair in the second trimester has been published. We report a first trimester uterine scar dehiscence. Ultrasound examination during valsalva maneuver and synchronous elevation of uterus by manual examination helped us in correct diagnosis. The dehiscence has been repaired with laparotomy and the pregnancy continued until 32 weeks of gestation.K Ke ey yw wo or rd ds s: : Pregnancy trimester, first; uterine rupture Ö ÖZ ZE ET T Uterus ruptürü ve dehisensi gebeliğin nadir komplikasyonlarındandır. Uterin ruptürde uterusa ait tüm katlar ayrışırken, uterus dehisensinde seroza bütünlüğünü korumakta ve bu duruma kısmi bir ayrışma eşlik etmektedir. Fetal viabilite için sınır olan haftalar ve öncesinde ortaya çıkan bir uterus dehisensi tedavi yaklaşımında netlik olmadığı için gebeliğin takibinde ikilem yaratmaktadır. Nadir olsa da, ikinci trimester dehisens olgularında beklemenin tercih edilmesi ya da uterusun onarımı sonrasında devam eden gebelik olguları bildirilmişir. Bu olguda birinci trimester bir gebelikte uterin dehisens olgusu sunduk . 31 yaşında, geçirilmiş 2 sezaryen öyküsü olan hastanın ultrasonografi eşliğinde yapılan muayenesinde, valsalva manevrası esnasında amniyotik kesenin eski insizyon hattından mesaneye doğru protrude olduğu izlendi. Dehisens laparotomi ile onarıldı, gebelik 32 haftaya dek devam etti.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Gebelik trimesteri, birinci; uterus rüptürü

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The effect of surgery on subsequent pregnancy outcomes among patients with cesarean scar diverticulum

Cheng

et al. 2018

Intl J Gynecology & Obste

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Laparoscopic Repair of Post-Cesarean Section Uterine Scar Defects Diagnosed in Nonpregnant Women

Cited by 131 publications

References 23 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

Repair of a First Trimester Uterine Dehiscence with Continuation of Pregnancy: Case Report

The effect of surgery on subsequent pregnancy outcomes among patients with cesarean scar diverticulum

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