Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound

Klemm, P.; Koehler, Christhardt; Mangler, Mandy; Schneider, Uwe; Schneider, Achim

doi:10.1515/jpm.2005.058

Cited by 82 publications

(63 citation statements)

References 41 publications

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“…Several case reports, case series and small prospective cohort studies with a maximum of 38 included women and one larger retrospective comparative study ( n = 59) have been reported 5, 12, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35. Eleven articles (including a total of 65 women) reported a reduction or complete resolution of postmenstrual spotting; however, this was mostly not measured in a standardised way 5, 16, 18, 20, 21, 24, 26, 27, 29.…”

Section: Discussionmentioning

confidence: 99%

“…Eleven articles (including a total of 65 women) reported a reduction or complete resolution of postmenstrual spotting; however, this was mostly not measured in a standardised way 5, 16, 18, 20, 21, 24, 26, 27, 29. Pelvic pain and/or dysmenorrhoea was reported to be resolved after laparoscopic niche resection in 36 women 5, 18, 21, 29. The residual myometrial thickness was increased after laparoscopic niche resection in all studies, but only three studies compared the outcomes with baseline measurements 15, 16, 17.…”

Section: Discussionmentioning

confidence: 99%

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The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

Vervoort

Vissers

Hehenkamp

et al. 2017

BJOG

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ObjectiveTo evaluate the effectiveness of a laparoscopic niche resection on niche‐related symptoms and/or fertility‐related problems, ultrasound findings and quality of life.DesignProspective cohort study.SettingUniversity hospital.PopulationWomen with a large niche (residual myometrium <3 mm) and complaints of either postmenstrual spotting, dysmenorrhoea, intrauterine fluid accumulation and/or difficulties with embryo transfer due to distorted anatomy.MethodsWomen filled out questionnaires and a validated menstrual score chart at baseline and 6 months after the laparoscopic niche resection. At baseline and between 3 and 6 months follow up niches were evaluated by transvaginal ultrasound.Main outcome measuresThe primary outcome was reduction of the main problem 6 months after the intervention. Secondary outcomes were complications, menstrual characteristics, dysmenorrhoea, niche measurements, intrauterine fluid, surgical outcomes, satisfaction and quality of life.ResultsIn all, 101 women underwent a laparoscopic niche resection. In 80 women (79.2%) the main problem was improved or resolved. Postmenstrual spotting was significantly reduced by 7 days at 6 months follow up compared with baseline. Dysmenorrhoea and discomfort related to spotting was also significantly reduced. The residual myometrium was increased significantly at follow up. The intrauterine fluid was resolved in 86.9% of the women with intrauterine fluid at baseline; 83.3% of women were (very) satisfied. The physical component of quality of life increased, the mental component did not change.ConclusionsA laparoscopic niche resection reduced postmenstrual spotting, discomfort due to spotting, dysmenorrhoea and the presence of intrauterine fluid in the majority of women and increased the residual myometrium.Tweetable abstractLaparoscopic niche resection reduces niche‐related problems and enlarges the residual myometrium.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

Vervoort

Vissers

Hehenkamp

et al. 2017

BJOG

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show abstract

“…Klemm and colleagues suggested that transvaginal sonography could be performed under laparoscopic vision if the scar piercing can not be immediately seen after cutting the bladder peritoneum and dissection of the uterovascular layer [9]. In our case, we used uterine manipulator porcelain to distinguish the bladder border.…”

Section: Discussionmentioning

confidence: 95%

A New Problem Arising After the Cesarean, Cesarean Scar Defect (Isthmocele) a Case Report

Nazık¹,

Nazik²

2017

OGIJ

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Background: Cesarean rates continue to increase all over the world. This has led to a particularly rapid increase in placenta-induced complications. A definition has emerged which is now called the new name istmosel, also called cesarean scar defect. Globally, the frequency is between 6.2% and 36%. Scar tissue in the old cesarean section causes problems such as menometrorrhagia, staining and infertility in patients. There are laparoscopic and hysteroscopic treatment approaches. Since there is a new terminology, there is no comprehensive publication in the literature to provide a general view on diagnosis and treatment. The primary treatment approach we offer in this case is laparoscopic surgery.Case Presentaion: A 37-year-old patient with gravida 2, parity 2, two previous cesarean section stories had complaints of continuing intermenstrual bleeding for 2 years. When the patient's examination and radiological evaluation is done, there was fluid accumulation in the old cesarean section.In the ultrasonographic examination; a dome-shaped fluid collection of about 2.3x1.4 cm was observed in the uterine lower segment anterior Wall. As a result, laparoscopic approach was decided for istmosel treatment. Conclusion:There is no consensus in the literature as to what type of suture or energy modality should be used to repair the isthmocele. In addition, there is no consensus on the superiority of double-layer suturing and superiority of the laparoscopic or hysteroscopic approach in cesarean scar repair.

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“…These include conditions such as scar pregnancy, placenta accreta, placenta previa, and uterine rupture in subsequent pregnancies [2,3]. The CSD is also associated with abnormal bleeding, dysmenorrhea, pelvic pain, adenomyosis, infertility, abscess formation, post-coital bleeding during the non-pregnant state [4][5][6]. Of note, the most common clinical symptom is abnormal bleeding, and the correlation with CSDs has been well established.…”

Section: Short Communicationmentioning

confidence: 99%

A Growing Concern: Cesarean Scar Defect and Massive Uterine Bleeding

Hu¹

2015

J Clin Case Rep

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Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound

Cited by 82 publications

References 41 publications

The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

A New Problem Arising After the Cesarean, Cesarean Scar Defect (Isthmocele) a Case Report

A Growing Concern: Cesarean Scar Defect and Massive Uterine Bleeding

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