Comparison of transvaginal repair versus laparoscopic repair of lower‐segment cesarean scar defects

Abstract

Objective To evaluate transvaginal repair versus laparoscopic repair of cesarean scar defects (CSDs). Methods A retrospective cohort study was conducted among 67 symptomatic women with CSDs who attended a tertiary hospital in Beijing, China, between July 1, 2013, and March 31, 2017. The participants underwent either transvaginal repair (n=31) or laparoscopic repair (n=36). Medical costs, perioperative outcomes, and surgical outcomes were compared. Results No statistically significant between‐group differences were found at baseline. The mean thickness of the residual myometrium increased from 1.71 ± 0.67 mm before surgery to 4.41 ± 2.09 mm after surgery in the transvaginal repair group (P<0.001), and from 1.81 ± 0.93 to 4.68 ± 1.96 mm in the laparoscopic repair group (P<0.001). The duration of menses after surgery was less than 10 days in both the transvaginal repair group (n=30, 96.3%) and the laparoscopic repair group (n=30, 83.9%; P=0.113). Operative time and medical costs were both lower in the transvaginal repair group than in the laparoscopic repair group (P<0.001). Conception rates for the two groups were similar among women who desired fertility. Conclusion Transvaginal repair of CSD was associated with reduced operative times and medical costs when compared with laparoscopic repair.

Fertility and pregnancy outcomes after a uterine niche resection in women with and without infertility: a systematic review and meta-analysis

“…None of the studies included a combination of women with and without infertility. An overview of the baseline characteristics, including niche features, is reported for the studies that included women diagnosed with infertility (Table 1) (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) and women without infertility (Table 2) (36)(37)(38)(39)(40). Most studies evaluated HNR (N ¼ 14), and 7, 7, and 2 studies reported on VNR, LSNR, and LTNR, respectively.…”

“…For VNR, all studies used an RMT of <3 mm as the cutoff value. For LSNR, the most frequently reported cutoff value of the RMT was <3 mm (30,36,40). An exception was the study of Tanimura et al (33) who performed HNR in patients with an RMT of R2.5 mm in combination with an anteflexed or straight uterus and LSNR in women with an RMT of <2.5 mm or a uterus in retroflexion.…”

Niche-related outcomes after caesarean section and quality of life: a focus group study and review of literature

“…Reported outcomes, either by patients or clinicians, are summarised in Table 3. The most frequently reported gynaecological outcomes were prolonged menstrual bleeding [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], postmenstrual spotting [5,8,9,25,35,[44][45][46][47][48][49][50], dysmenorrhoea [5,8,9,25,27], dyspareunia [5,27,46] and (chronic) pelvic pain or abdominal pain [5,24,25,27,34,40,46,51,52...…”

“…Prevalence of abnormal adhesive placenta [26,27], successful vaginal birth after CS [27,[53][54][55] and uterine rupture or dehiscence [27,[56][57][58][59][60][61][62][63] were reported as obstetric outcomes. Fertility-related niche therapy studies reported on wish to conceive (secondary subfertility) [26,27,33,52], pregnancy [25,26,33,39,40,42,64] and miscarriage rate [26,27,33,39,42,43], the risk of caesarean scar pregnancy [27,33,40] and live birth rate [26,27,40,43]. Subsequent pregnancies were followed after niche therapy in four studies: mode and timing of delivery [39,42], risk of abnormal adhesive placenta [40] and risk of uterine dehiscence or rupture [39,40,43] were reported.…”

“…Fertility-related niche therapy studies reported on wish to conceive (secondary subfertility) [26,27,33,52], pregnancy [25,26,33,39,40,42,64] and miscarriage rate [26,27,33,39,42,43], the risk of caesarean scar pregnancy [27,33,40] and live birth rate [26,27,40,43]. Subsequent pregnancies were followed after niche therapy in four studies: mode and timing of delivery [39,42], risk of abnormal adhesive placenta [40] and risk of uterine dehiscence or rupture [39,40,43] were reported. Three publications reported on change in HRQoL, assessed using the validated SF-36 questionnaire, after niche therapy (surgical or hormonal) [8,9,24].…”