The definition, diagnosis, and symptoms of the uterine niche – A systematic review

Meuleman, Saskia.J.M. Klein; Min, Nan; Hehenkamp, Wouter J.K.; Uiterweer, Emiel D. Post; Huirne, Judith A F; Leeuw, Robert de

doi:10.1016/j.bpobgyn.2023.102390

Cited by 8 publications

(5 citation statements)

References 118 publications

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“…In this context, we emphasize that no niches were found by TVS but only by contrast HSG in our study. This fact makes our data even more reliable as it is known from previous studies that HSG examination results in a higher prevalence of niches, increased niche depth and significantly smaller residual myometrium in comparison with native TVS [6]. Therefore, HSG seems to be the method with the highest sensitivity in niche detection and was used for this reason in our study.…”

Section: Discussionsupporting

confidence: 63%

“…In summary, no patient suffered from Caesarean Scar Disorder (according to [1]) and thus all niches were clinically not relevant. In a recently published review including 19 studies, the prevalence of a niche was 13-75 %, measured by native TVS and 42-84 %, using HSG in a random population of women with a history of at least one CS [6]. Definition of a niche was identical to the protocol of this study with a depth of at least 2 mm.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a large scar defect was defined when the residual myometrium thickness (RMT) was < 2.5 mm using contrast hysterosonography (HSG) or 2.2 mm using native transvaginal sonography (TVS) [4,5]. Prevalence of a niche varies greatly depending on niche definition, symptomatology and imaging technique [6]. Various studies propose HSG as the gold standard in niche diagnostic [3,4,7].…”

Section: Introductionmentioning

confidence: 99%

“…As seen in various studies, using TVS without contrast agent, niche prevalence is much lower than using HSG (46.4 % vs 69.1 % [4] or 49.6 % vs. 64.5 % [8]). Within a recently published systematic review [6], prevalence detected by HSG varied between 42 % [9] and 84 % [7]. Prevalence of large defects with residual myometrium < 2.2 mm or niche depth of 50-80 % of the myometrium has been seen between 11 % [10] and 45 % [11] in a random population.…”

Section: Introductionmentioning

confidence: 99%

“…Niches result in a variety of symptoms associated with them, highlighting the importance of a correct diagnosis explaining the patient's complaints. Typical symptoms include bleeding disorders, especially postmenstrual spotting, dysmenorrhea, dyspareunia, chronic lower and abdominal/pelvic pain [6,8,12]. Niches can cause endometriosis, secondary infertility and complications of gynecological procedures like embryo transfer [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Contrast Hysterosonographic Evaluation of Niche Prevalence Following a Standardized Suturing Technique for Caesarean Sections

Hafner,

Pohle,

Rauh

et al. 2024

Geburtshilfe Frauenheilkd

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After caesarean section a uterine niche can be detected in 42–84% of all women and in 11–45% large defects with a residual myometrium < 2.2 mm occur. If the niche compromises > 50% of myometrial thickness, risk of uterine rupture during birth increases. The suturing technique might contribute substantially on pathogenesis of niches. The objective of this study is to investigate the effect of the suturing technique on niche prevalence by using a standardized two-layer surgical technique.Women with one previous caesarean section were examined within 6–23 months after caesarean section using contrast medium-supported transvaginal sonography regarding the prevalence, sonomorphological aspect and clinical symptoms of a uterine niche. The surgical technique used was: dilatation of the cervix, interrupted suture of the first layer (excluding the endometrium), continuous closure of the visceral and parietal peritoneum.Using native vaginal sonography, no niches were visible in the whole cohort. In three cases, there was a small niche detectable with a depth between 2.3 and 3.9 mm by contrast hysterosonography. Regarding the total myometrial thickness, the niche depth compromised less than 50%. All patients were symptom-free.In our study population, there were only three cases (9.1%) with a small uterine niche. Residual myometrium and niche percentage on myometrial thickness were excellent in all three cases. Thus, our results show that the uterotomy closure technique used in the study cohort might be superior with respect to the development of uterine niches compared with the expected prevalence.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Contrast Hysterosonographic Evaluation of Niche Prevalence Following a Standardized Suturing Technique for Caesarean Sections

Hafner,

Pohle,

Rauh

et al. 2024

Geburtshilfe Frauenheilkd

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Looking back to look forward: Has the time arrived for active management of obstetricians in placenta accreta spectrum?

Bartels,

Downey,

Brennan

2024

Intl J Gynecology & Obste

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Placenta accreta spectrum (PAS) is a relatively new obstetric condition which, until recently, was poorly understood. The true incidence is unknown because of the poor quality and heterogeneous diagnostic criteria. Classification systems have attempted to provide clarity on how to grade and diagnose PAS, but these are no longer reflective of our current understanding of PAS. This is particularly true for placenta percreta, which referred to extrauterine disease, as recent studies have demonstrated that placental villi associated with PAS have minimal potential to invade beyond the uterine serosa. It is accepted that PAS is a direct consequence of previous iatrogenic uterine injury, most commonly a previous cesarean section. Here, we “look back to look forwards”—starting with the primary predisposing factor for PAS, an iatrogenic uterine injury and subsequent wound healing. We then consider the evolution of definitions and diagnostic criteria of PAS from its first description over a century ago to current classifications. Finally, we discuss why modifications to the current classifications are needed to allow accurate diagnosis of this rare but life‐threatening complication, while avoiding overdiagnosis and potential patient harm.

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Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study)

Verberkt,

Stegwee,

Van der Voet

et al. 2024

American Journal of Obstetrics and Gynecology

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The definition, diagnosis, and symptoms of the uterine niche – A systematic review

Cited by 8 publications

References 118 publications

Contrast Hysterosonographic Evaluation of Niche Prevalence Following a Standardized Suturing Technique for Caesarean Sections

Contrast Hysterosonographic Evaluation of Niche Prevalence Following a Standardized Suturing Technique for Caesarean Sections

Looking back to look forward: Has the time arrived for active management of obstetricians in placenta accreta spectrum?

Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study)

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