Association between deficient cesarean delivery scar and cesarean scar syndrome

Dosedla, Erik; Gál, Péter; Calda, Pavel

doi:10.1002/jcu.22911

Cited by 15 publications

(16 citation statements)

References 35 publications

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“…Other studies presented prevalence numbers of 45.6% [8], 56% [10] and 69% [14], however, the results provided by Antila-Långsjö et al and Bij de Vaate et al were collected by means of saline-contrast (SIS) or gel instillation sonohysterography (GIS), respectively. Other authors published much lower prevalence numbers [9,15,16] in TVS-guided examinations, indicating that SIS and GIS may ease the detection of isthmoceles. Important distinctions between the studies are the point in time at which the clinical exams were carried out (e.g.…”

Section: Main Findingsmentioning

confidence: 94%

“…Important distinctions between the studies are the point in time at which the clinical exams were carried out (e.g. Dosedla et al chose 6 weeks and 18 months postpartum [16], whereas other authors examined during time periods of 6-12 weeks [11], 6-9 months [14] or 6-12 months postpartum [10] and thus allowed a more heterogeneous time frame) and the individual definitions of a niche. Whilst ours was based on Jordans et al's Delphi study [7] due to their comprehensiveness, Dosedla et al [16] referred to "severe scar defects" based on the thickness of the scar and the adjacent myometrium.…”

Section: Main Findingsmentioning

confidence: 99%

“…Dosedla et al chose 6 weeks and 18 months postpartum [16], whereas other authors examined during time periods of 6-12 weeks [11], 6-9 months [14] or 6-12 months postpartum [10] and thus allowed a more heterogeneous time frame) and the individual definitions of a niche. Whilst ours was based on Jordans et al's Delphi study [7] due to their comprehensiveness, Dosedla et al [16] referred to "severe scar defects" based on the thickness of the scar and the adjacent myometrium. Other studies put more emphasis on the size of the niche [9], using those measurements to detect a relationship with associated symptoms.…”

Section: Main Findingsmentioning

confidence: 99%

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Frequency and associated symptoms of isthmoceles in women 6 months after caesarean section: a prospective cohort study

Gozzi

Hees

Berg

et al. 2022

Arch Gynecol Obstet

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Purpose The purpose of this study was to determine the frequency of detection of isthmoceles by ultrasound 6 months after caesarean section (CS) and which symptoms associated with isthmocele formation occur after CS. Subsequently, it was determined how often the ultrasound finding “isthmocele” coincided with the presence of complaints. Methods A prospective multicentre cohort study was conducted with 546 patients from four obstetric centres in Berlin, who gave birth by primary or secondary CS from October 2019 to June 2020. 461 participants were questioned on symptoms 3 months after CS; 329 participants were included in the final follow-up 6 months after CS. The presence of isthmoceles was determined by transvaginal sonography (TVS) 6 months after CS, while symptoms were identified by questionnaire. Results Of the 329 women, 146 (44.4%) displayed an isthmocele in the TVS. There was no statistically significant difference in the manifestation of symptoms between the two groups of women with and without isthmocele; however, when expressed on a scale from 1 to 10 the intensity of both scar pain and lower abdominal pain was significantly higher in the set of women that had shown to have developed an isthmocele (p = 0.014 and p = 0.031, respectively). Conclusion The prevalence of isthmoceles 6 months after CS was 44.4%. Additionally, scar pain and lower abdominal pain were more pronounced when an isthmocele was also observed in the TVS. Trial registration Trial registration number DRKS00024977. Date of registration 17.06.2021, retrospectively registered.

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Section: Main Findingsmentioning

confidence: 94%

Section: Main Findingsmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Frequency and associated symptoms of isthmoceles in women 6 months after caesarean section: a prospective cohort study

Gozzi

Hees

Berg

et al. 2022

Arch Gynecol Obstet

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“…The natural dynamic contraction of the post-delivery uterus is complicated; post-CS uterine incisions and suturing complicate it even further. Importantly, incomplete closure of the uterine wall is hypothesized to be a surgical factor contributing to CSD pathogenesis, as likely is adhesion formation, which played important role in the biomechanical process and postpartum symptoms related to CSD [22][23][24]. We hypothesize that physical forces and myometrial contraction in the early months postpartum also play an important role in CSD formation.…”

Section: Discussionmentioning

confidence: 95%

Postpartum Changes in Uterine Position and Occurrence of Cesarean Scar Defects: A Retrospective Observational Study

Pan¹,

Gu²,

Yu³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: Over the past several decades, rates of cesarean delivery have increased considerably worldwide. As cesarean section (CS) may also result in changes to uterine position, the relationship between delivery modes, postpartum uterine position and cesarean scar defect (CSD) warrants elucidation. Materials & Methods: Here, we conducted a retrospective observational study evaluating 921 women (482 underwent vaginal delivery and 439 underwent CS) who had undergone transvaginal ultrasonography (TVU) early in their pregnancy (<8 weeks). Subsequent ultrasonography was performed 3-6 months postpartum to evaluate uterine position for all women and saline infusion sonohysterography (SIS) for women who underwent CS. The outcome was the uterine position for all of the women and the CSD for women underwent CS. Results: A total of 716 women (371 of whom underwent vaginal delivery and 345 of whom underwent CS) were concluded in the study. Postpartum uterine position was found to be significantly changed from anteflexion (81.9% for vaginal delivery and 82.0% for CS) to retroflexion (29.1% for vaginal delivery and 46.7% for CS) after both vaginal (p < 0.001) and CS (p < 0.001) deliveries. CSD was diagnosed by SIS in 146 of 345 (42.3 95% CI 37.1-47.6) women that underwent CS. CSD prevalence among anteflexed and retroflexed uterus were 46.7% (95% CI 39.5%-54.0%) and 37.3% (95% CI 29.7%-44.8%), respectively (p = 0.08). Conclusions: This study revealed that uterus became retroflexed in patients who underwent either CS or vaginal deliveries. CS resulted in a significantly greater proportion of retroflexed uterus than did vaginal delivery. CSD prevalence among women with retroflexed uterus in the postpartum has no difference with those with anteflexed uterus.

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“…Osser et al (2010) also showed that a longer labour with a duration of ≥ 5 hours was also associated with larger defects. A recent prospective cohort study of 200 women showed an increased incidence of defects diagnosed by TVUS after emergency CS compared to elective (Dosedla et al, 2020). There appears to be inconsistency with results however, as some other studies have shown an increased risk of niche formation at less cervical dilatation, with presence of labour or emergency CS not being shown as risk factors (Yazicioglu et al, 2006;Hayakawa et al, 2006).…”

Section: Aetiology and Risk Factorsmentioning

confidence: 99%

Fantastic niches and where to find them: the current diagnosis and management of uterine niche

Gowan¹,

Goumalatsou²,

Kent³

2022

Facts Views Vis ObGyn

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Background: Caesarean section (CS) scar niche is a well recognised complication of caesarean delivery and is defined as an indentation at the site of the CS scar with a depth of at least 2mm. Objectives: To review systematically the medical literature regarding the current diagnosis and management of uterine niche Materials and Methods: We carried out a systematic review using MeSH terms ‘niche’ OR ‘sacculation’ OR ‘caesarean scar defect’ OR ‘caesarean section scar’ OR ‘uterine defect’ OR ‘isthmocele.’ Articles included were peer-reviewed and in English language. Main Outcome Measures: Prevalence, symptoms, diagnosis, pathophysiology and management of uterine niche. Results: CS scar niche is common and, in a subgroup, produces a range of symptoms including post-menstrual bleeding, dyspareunia and subfertility. It may be linked to use of locked sutures during CS closure. Niche repair can be achieved laparoscopically or hysteroscopically and appears to improve symptoms, although solid conclusions regarding fertility outcomes cannot be drawn. Conclusions: CS scar niche is associated with a range of symptoms. Repair may aid subfertile patients and those with post-menstrual spotting. The presence of a niche is probably irrelevant in the absence of symptoms. What is New? LNG-IUS and surgical repair appear to improve symptoms in those with a niche.

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Association between deficient cesarean delivery scar and cesarean scar syndrome

Cited by 15 publications

References 35 publications

Frequency and associated symptoms of isthmoceles in women 6 months after caesarean section: a prospective cohort study

Frequency and associated symptoms of isthmoceles in women 6 months after caesarean section: a prospective cohort study

Postpartum Changes in Uterine Position and Occurrence of Cesarean Scar Defects: A Retrospective Observational Study

Fantastic niches and where to find them: the current diagnosis and management of uterine niche

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