Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography.

Thurmond, Amy S.; Harvey, W. J.; Smith, Susan A.

doi:10.7863/jum.1999.18.1.13

Cited by 191 publications

(139 citation statements)

References 7 publications

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“…Long‐term complaints after caesarean section, such as postmenstrual spotting, dysmenorrhea, dyspareunia, or chronic pelvic pain, are frequently described in relation to the presence of a niche 1, 2, 3, 4, 5, 6, 7, 8…”

Section: Introductionmentioning

confidence: 99%

“…Two independent prospective cohort studies reported that the presence of a niche after caesarean section increases the risk of postmenstrual spotting for more than 2 days from 15 to 30% 1, 3. Postmenstrual spotting may be caused by a mechanical outflow problem, with the retention of menstrual blood in a niche,4, 5, 7, 8 or by the accumulation of blood because of impaired uterine contractions at the site of the niche 5. Additionally, newly formed fragile vessels in the niche may play a role in the formation of blood or fluid in the niche and uterine cavity.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Vervoort

Voet

Hehenkamp

et al. 2017

BJOG

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ObjectiveTo compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect.DesignMulticentre randomised controlled trial.SettingEleven hospitals collaborating in a consortium for women's health research in the Netherlands.PopulationWomen reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3 mm, measured during sonohysterography.MethodsWomen were randomly allocated to hysteroscopic niche resection or expectant management for 6 months.Main outcome measuresThe primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of life, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation.ResultsWe randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2–7 days) in the intervention group and 7 days (IQR 3–10 days) in the control group (P = 0.04); on a scale of 0–10, discomfort as a result of spotting had a median score of 2 (IQR 0–7) in the intervention group, compared with 7 (IQR 0–8) in the control group (P = 0.02).ConclusionsIn women with a niche with a residual myometrium of ≥3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting‐related discomfort.Tweetable abstractA hysteroscopic niche resection is an effective treatment to reduce niche‐related spotting.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Vervoort

Voet

Hehenkamp

et al. 2017

BJOG

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“…Bleeding or spotting after menstruation decreases the fertility due to changes in follicular-phase mucus quality, decreasing sperm motility in cervical canal or inhibiting implantation process [8]. Abnormal uterine spotting is probably caused by impaired contractility of muscle fibers surrounding the niche [5,9].…”

Section: Symptomsmentioning

confidence: 99%

When and how should we treat cesarean scar defect — isthmocoele?

Futyma

Gałczyński

Romanek³

et al. 2016

Ginekol Pol

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The reported number of cesarean sections in Poland is approximately 30% and is associated with increasing number of early and late complications. The myometrial discontinuity at the site of previous cesarean section is known in the literature as "isthmocoele", "niche", "pouch" or cesarean scar defect. In most cases presence of isthmocoele has no clinical significance, but in some patients it may cause abnormal uterine bleeding, dysmenorrhea, dyspareunia, pelvic pain or be associated with secondary infertility. This defect may be treated by laparoscopy, hysteroscopy or vaginal surgery.

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“…In the seventies, hysterography had a major role in showing defective scarification (presence of scar niche), recently replaced by hysterosonography, hysteroscopy and magnetic resonance, also performed outside the gestational period. [7][8][9] Ultrasonography, a safe, noninvasive method, 10 has been used to that end during pregnancies since the eighties; 2;11 however, subjective assessment of the resulting ultrasonograms are a drawback, since visuals are not enough to determine the precise echogenicity of the tissues. Hence, quantitative and computerized analysis provided by gray-level histograms from an area of interest provide the opportunity to perform minute studies of uterine scars from previous Cesarean sections, since they enable us to compare the same region in different patients.…”

Section: Original Article Introductionmentioning

confidence: 99%

Estudo da cicatriz uterina de cesariana avaliada pelo histograma escala-cinza

Filho

Nardozza

Araújo

et al. 2010

Rev. Assoc. Med. Bras.

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Evaluation of Cesarean uterine scar by the gray-level histogram Objective. To evaluate the Cesarean uterine scar by the gray-level histogram (GLH) in women with a previous Cesarean section, performed either during or before labor (elective Cesarean). MethOds. A prospective study was conducted with 40 women between 11 and 14 weeks of gestation, who were divided into three groups: 15 pregnant women with a previous elective Cesarean section (group A); 9 with a previous Cesarean section performed during labor (group B); and 16 with a single previous vaginal delivery (group C). The pregnant women were examined by transvaginal ultrasound, to obtain an image corresponding to the "shadow" formed by the uterine scar in groups A and B. In group C, GLH was accomplished in the region of the uterine isthmus. After capturing the image, the region of interest (ROI) was delimited and the option "histogram" was activated, automatically obtaining graphic representation. The mean, median and standard deviation (SD) were calculated for each study group. Means, medians and standard deviations (SD) were computed for each study group. The mean average for the control group's histogram values was the normal parameter to which other groups were compared. The ANOVA test was used to compare averages of the three groups. A (p) value of < 0.05 was considered statistically significant. Results. GLHs for group A ranged from 7 to 40.5 (mean: 24.8; SD: 11.2); from 23.1 to 47.2 (mean: 34.1; SD: 9.6) for group B, and from 21.6 to 58.8 (mean: 40.3; SD: 11.3) for group C. Conclusion. There was a significant difference for GLH in the uterine scar region of previous Cesarean sections when the surgery was elective and when performed during labor, suggesting greater tissue change in elective Cesarean sections.

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Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography.

Cited by 191 publications

References 7 publications

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

When and how should we treat cesarean scar defect — isthmocoele?

Estudo da cicatriz uterina de cesariana avaliada pelo histograma escala-cinza

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