Effect of closure versus nonclosure of peritoneum at cesarean section on adhesions: a prospective randomized study

Kapustian, Viki; Anteby, Eyal Y.; Gdalevich, Michael; Shenhav, Simon; Lavie, Ofer; Gemer, Ofer

doi:10.1016/j.ajog.2011.07.032

Cited by 60 publications

(40 citation statements)

References 19 publications

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“…Cerclage reduces the risk of sPTB by about 30% in women with a history of sPTB and short cervix, although at least one in three of these women still delivers preterm [35]. Progesterone supplementation (intramuscular 17α-hydroxyprogesterone caproate) for women with a history of sPTB is recommended by the American College of Obstetricians and Gynecologists (ACOG) [21] and the Society for Maternal–Fetal Medicine (SMFM) [36] because it reduces the risk of recurrent sPTB. The SMFM additionally supports adjunctive cerclage in those who develop cervical shortening because of a trend toward benefit [36].…”

Section: Treating Cervical Insufficiencymentioning

confidence: 99%

“…Progesterone supplementation (intramuscular 17α-hydroxyprogesterone caproate) for women with a history of sPTB is recommended by the American College of Obstetricians and Gynecologists (ACOG) [21] and the Society for Maternal–Fetal Medicine (SMFM) [36] because it reduces the risk of recurrent sPTB. The SMFM additionally supports adjunctive cerclage in those who develop cervical shortening because of a trend toward benefit [36]. Also, both societies recommend progesterone (vaginal suppositories) for risk reduction of sPTB in women with an incidental short cervix (no prior sPTB) [22,36].…”

Section: Treating Cervical Insufficiencymentioning

confidence: 99%

See 1 more Smart Citation

Cervical etiology of spontaneous preterm birth

Vink

Feltovich

2016

Seminars in Fetal and Neonatal Medicine

108

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SUMMARY The cervix functions as a barrier between the uterus and vagina and keeps the uterus closed until term so that the fetus can develop. For delivery the cervix must soften and dilate, and finally reconstitute to close the uterus. This complex process involves precisely timed activation of molecular and microstructural events. Spontaneous preterm birth (sPTB) can result from aberrant timing of these events in the cervix. Unfortunately, the pathophysiology of sPTB due to cervical causes remains unclear and thus our treatment options remain limited – even if all appropriate candidates were identified and correctly treated with currently available interventions, the rate of sPTB would only be reduced by 5%. Very recent molecular and microstructural investigation is challenging prevailing concepts about cervical remodeling in pregnancy. We believe that progress toward novel, targeted solutions for the diverse pathways to sPTB entails a paradigm shift in which the overlapping and complex interactions between the cervix, uterus, membranes, fetus, placenta, and surrounding (structural and molecular) environment are suitably honored.

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Section: Treating Cervical Insufficiencymentioning

confidence: 99%

Section: Treating Cervical Insufficiencymentioning

confidence: 99%

Cervical etiology of spontaneous preterm birth

Vink

Feltovich

2016

Seminars in Fetal and Neonatal Medicine

108

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“…Subsequent to these publications another large controlled trial including over 500 women found no significant differences in adhesions on inspection at the repeat CS (n ¼ 97) (Kapustian et al, 2012). However, verification bias cannot be excluded, as scar evaluation was not an outcome and especially patients with large niches might have had fertility problems.…”

Section: Hypothesis 2: Incomplete Closure Of the Uterine Wallmentioning

confidence: 99%

Why Do Niches Develop in Caesarean Uterine Scars? Hypotheses on the Aetiology of Niche Development

Vervoort

Uittenbogaard

Hehenkamp

et al. 2016

Obstetrical &Amp; Gynecological Survey

108

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Caesarean section (CS) results in the occurrence of the phenomenon 'niche'. A 'niche' describes the presence of a hypoechoic area within the myometrium of the lower uterine segment, reflecting a discontinuation of the myometrium at the site of a previous CS. Using gel or saline instillation sonohysterography, a niche is identified in the scar in more than half of the women who had had a CS, most with the uterus closed in one single layer, without closure of the peritoneum. An incompletely healed scar is a long-term complication of the CS and is associated with more gynaecological symptoms than is commonly acknowledged. Approximately 30% of women with a niche report spotting at 6-12 months after their CS. Other reported symptoms in women with a niche are dysmenorrhoea, chronic pelvic pain and dyspareunia. Given the association between a niche and gynaecological symptoms, obstetric complications and potentially with subfertility, it is important to elucidate the aetiology of niche development after CS in order to develop preventive strategies. Based on current published data and our observations during sonographic, hysteroscopic and laparoscopic evaluations of niches we postulate some hypotheses on niche development. Possible factors that could play a role in niche development include a very low incision through cervical tissue, inadequate suturing technique during closure of the uterine scar, surgical interventions that increase adhesion formation or patient-related factors that impair wound healing or increase inflammation or adhesion formation.

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“…Lyell, 37 on the other hand, in a review of 173 women who had undergone CD, reported fewer dense adhesions in those with peritoneal closure after CD. Contrary to both groups, Kapustian and colleagues, 41 in a review of 533 women with closure and nonclosure of the peritoneum after CD, did not show a significant difference in adhesion rates between the 2 groups.…”

Section: Pelvic Adhesionsmentioning

confidence: 77%