Presence of intrauterine fluid in women with a large niche is not associated with a difference in endometrial thickness

Meuleman, Saskia.J.M. Klein; Post, Britt.; Vissers, Jolijn; Leeuw, Robert de; Uiterweer, Emiel D. Post; Huirne, Judith A F

doi:10.1016/j.fertnstert.2022.11.004

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…A prospective cohort study performed in the Amsterdam University Medical Center attempted to elucidate the mechanism behind the negative effects of intracavitary fluid accumulation and hypothesized that niche-related intrauterine fluid compromises the endometrial thickness, which could be an intermediate factor for the negative impact of a niche on fertility. While their study showed no significant effect of intrauterine fluid on endometrial thickness in women with a niche, they did note a longer duration of infertility at baseline in women with a niche when intracavitary fluid was present [40].…”

Section: Fertility Implications Of Treatmentmentioning

confidence: 85%

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Emerging data on diagnosis and management of uterine isthmoceles: a rapid review

Cook,

Jesse,

Harvey

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review With a rising number of cesarean sections, the prevalence of uterine isthmoceles is increasing. We performed a rapid review to assess the most recent data on the diagnosis and management of uterine isthmoceles over the past 18 months to identify current trends and directions for continued research. Recent findings A comprehensive search was conducted in PubMed (NLM), Embase (Ovid), CINAHL (EBSCOhost) to find English written articles discussing the diagnosis or management of uterine isthmoceles published in the previous 18 months. Data extraction was performed on one hundred articles that met inclusion criteria. Summary This rapid review highlights agreement regarding diagnostic methods, symptoms, and recommended treatment paths for patients with symptomatic uterine niches. However, the diversity in definitions hampers the capacity to formulate detailed conclusions regarding the features of uterine niches and their impact on women's health.

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Section: Fertility Implications Of Treatmentmentioning

confidence: 85%

“…&,20]; 18 retrospective cohort studies[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]; nine prospective cohort studies[39][40][41][42][43][44]45 & ,46,47]; four case controls[48][49][50][51]; three cross-sectional[52- 54]; five editorials[55][56][57][58][59]; two expert opinion articles [60 & ,61 &&…”

mentioning

confidence: 99%

Emerging data on diagnosis and management of uterine isthmoceles: a rapid review

Cook,

Jesse,

Harvey

2024

Current Opinion in Obstetrics &Amp; Gynecology

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“…From a recent study we know that in approximately 60% of all niche patients one or more adenomyosis signs can be observed 1 . Currently, there is no consensus yet on how many signs of the Morphological Uterus Sonographic Assessment (MUSA) criteria need to be present to diagnose clinical relevant adenomyosis 27 . In addition, we started this study in 2011, at which time the MUSA criteria had not yet been formulated or defined.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Currently, there is no consensus yet on how many signs of the Morphological Uterus Sonographic Assessment (MUSA) criteria need to be present to diagnose clinical relevant adenomyosis. 27 In addition, we started this study in 2011, at which time the MUSA criteria had not yet been formulated or defined. However, we previously reported a strong reduction in dysmenorrhea NRS score after a laparoscopic niche resection at the 6‐month follow‐up.…”

Section: Discussionmentioning

confidence: 99%

Reproductive outcomes after laparoscopic resection of symptomatic niches in uterine cesarean scars: Long‐term follow‐up on the prospective LAPNICHE study

Vissers,

Hehenkamp,

Brölmann

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionAfter incomplete healing of the uterine cesarean section scar, a niche can be observed; 24% of the women develop large niches with a residual myometrial thickness <3 mm. In these cases a laparoscopic resection is possible. The effect of this new treatment on fertility outcome is not known yet. This paper describes reproductive outcomes 2 years after a laparoscopic niche resection and compares women with or without secondary infertility at baseline.Material and methodsA prospective cohort study was performed, with consecutive inclusion of women between 2011 and 2019. Women with a niche in the uterine cesarean scar, with a residual myometrial thickness of <3 mm and with a desire to become pregnant, were scheduled to undergo a laparoscopic niche resection because of one or more of the following problems (1) postmenstrual spotting; (2) midcycle intrauterine fluid accumulation diagnosed during the fertility workup or (3) difficulties with a previous embryo transfer and preferring a surgical therapy. The study is registered in the ISRCTN register (ref. no. ISRCTN02271575) on April 23, 2013.ResultsThere were 133 (62%) women included with a desire to become pregnant, 88 with secondary infertility. In all, 83 had an ongoing pregnancy at the 2‐year follow‐up. The ongoing pregnancy rate in patients with previous fertility problems was 60.2% compared with 66.7% in patients without infertility (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.32–1.7). The OR for live births was 0.57 (95% CI 0.02–1.2). Overall, 8.3% of the pregnancies resulted in miscarriages by the 2‐year follow‐up.ConclusionsThe reproductive outcomes in women with and without previous fertility problems undergoing resection of a large niche are very promising and quite comparable in both groups. These results suggest, but do not prove, a beneficial effect of this therapy for these indications. The results support the design of future randomized controlled trials to evaluate the effect of niche resection vs expectant management to assess its additional value in women with or without fertility problems who desire pregnancy.

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“…The patients were recruited at various phases of the menstrual cycle without correction for this variable. Therefore, further studies are needed to identify the most opportune time during the menstrual cycle for endometrial evaluation [75]. A retrospective study conducted on 1793 patients undergoing assisted reproductive treatments showed a lower pregnancy rate in women with previous cesarean section compared to women with prior vaginal delivery and an even lower pregnancy rate was observed in patients with isthmocele [76].…”

Section: Infertilitymentioning

confidence: 99%

Isthmocele and Infertility

Baldini,

Lot,

Malvasi

et al. 2024

JCM

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Isthmocele is a gynecological condition characterized by a disruption in the uterine scar, often associated with prior cesarean sections. This anatomical anomaly can be attributed to inadequate or insufficient healing of the uterine wall following a cesarean incision. It appears that isthmocele may impact a woman’s quality of life as well as her reproductive capacity. The incidence of isthmocele can range from 20% to 70% in women who have undergone a cesarean section. This review aims to sum up the current knowledge about the effect of isthmocele on fertility and the possible therapeutic strategies to achieve pregnancy. However, currently, there is not sufficiently robust evidence to indicate the need for surgical correction in all asymptomatic patients seeking fertility. In cases where surgical correction of isthmocele is deemed necessary, it is advisable to evaluate residual myometrial thickness (RMT). For patients with RMT >2.5–3 mm, hysteroscopy appears to be the technique of choice. In cases where the residual tissue is lower, recourse to laparotomic, laparoscopic, or vaginal approaches is warranted.

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Presence of intrauterine fluid in women with a large niche is not associated with a difference in endometrial thickness

Cited by 5 publications

References 6 publications

Emerging data on diagnosis and management of uterine isthmoceles: a rapid review

Emerging data on diagnosis and management of uterine isthmoceles: a rapid review

Reproductive outcomes after laparoscopic resection of symptomatic niches in uterine cesarean scars: Long‐term follow‐up on the prospective LAPNICHE study

Isthmocele and Infertility

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