Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single‐ or double‐layer uterotomy closure: a randomized controlled trial

Bamberg, Christian; Hinkson, Larry; Dudenhausen, Joachim W.; Bujak, Verena; Kalache, Karim; Henrich, Wolfgang

doi:10.1111/aogs.13213

Cited by 46 publications

(40 citation statements)

References 22 publications

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“…4,7 Only two studies described CSD prevalence at 6 weeks postpartum, the results were 49.6% (sample size = 263) and 43% (sample size = 53) CSD with TVU. 8,9 Until now, most CSD risk factor studies focused on surgery-related factors of wound healing, such as incision location, adhesions, incomplete uterine closure, uterine suture technique-like single-layer vs double-layer uterine closure, or including vs excluding the endometrial layer at CS. [10][11][12] However, scant attention has been paid to patient-related factors, such as coagulation and presence of infection, which may potentially affect wound healing.…”

Section: Introductionmentioning

confidence: 99%

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The prevalence and risk predictors of cesarean scar defect at 6 weeks postpartum in Shanghai, China: A prospective cohort study

Pan

Zeng

et al. 2018

Acta Obstet Gynecol Scand

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Introduction:The aim of this study was to explore the prevalence and predictors of cesarean scar defect (CSD) at 6 weeks postpartum in Shanghai, China. Material and methods:Women scheduled to receive a cesarean section (CS) were recruited from a university hospital. Surgery-related factors, pregnancy complications, routine examinations, perioperative medications, and physical signs were collected and transvaginal ultrasonography was performed to assess the presence of a CSD at 6 weeks postpartum. Multivariate logistic regression was applied to identify the predictors for CSD. Results:A CSD was detected in 223 of 514 women (43.4%, 95% CI 39.1%-47.7%) by transvaginal ultrasonography. Of women with normal temperature (T < 37.5°C, CSD prevalence 33.9%, 95% CI 28.4%-39.5%), women with postpartum fever (T ≥ 38°C, CSD 44.1%, 95% CI 31.0%-57.1%), and women who were subfebrile in the postpartum (37.5 ≤ T ≤ 38.0°C, CSD 58.3%, 95% CI 50.9%-65.7%), the latter two had significantly increased risk for CSD (adjusted odds ratio [aOR] 2.7, 95% CI 1.3-5.2 and aOR 3.3, 95% CI 2.1-5.3, respectively). In comparison to single-dose antibiotic administration (CSD 49.0%, 95% CI 43.8%-54.3%), multi-dose antibiotic administration (CSD 31.1%, 95% CI 23.8%-38.3%) had a protective effect (aOR 0.4, 95% CI 0.3-0.7).Postpartum fever, intrapartum infection, emergency CS, and cervical dilation ≥ 3 cm were found to be the main predictors of multi-dose antibiotics management. Low platelet count postpartum (defined as ≤ 150 × 10 9 /L) and high fibrinogen pre-CS (defined as ≥ 4.5 g/L) increased CSD risk (aOR 2.0, 95% CI 1.1-3.6 and 1.7, 95% CI 1.1-2.5, respectively). Conclusions:The prevalence of CSD in the Chinese population is high enough to be a concern. Perioperative infection and hypercoagulability should be considered CSD predictors, and multi-dose antibiotics have a protective effect.

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Section: Introductionmentioning

confidence: 99%

“…The wound healing of the uterine cesarean incision is not fully understood and the natural developmental processes of CSD through time are still unclear, so the uterine scar and CSD may change over time. One prospective observational study showed consistence of the CSD from 6 weeks to 6 months and even longer 9.…”

mentioning

confidence: 99%

The prevalence and risk predictors of cesarean scar defect at 6 weeks postpartum in Shanghai, China: A prospective cohort study

Pan

Zeng

et al. 2018

Acta Obstet Gynecol Scand

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“…One prospective observational study showed that CSD occurred from 6 weeks to 6 months or longer after surgery 30. Another prospective study reported that the statuses of some women with or without CSD showed a reversal between 6 weeks and 6 months after surgery (90.7% at 6 weeks and 93.1% at 6 months (OR 0.96 (0.61 to 1.49), p=0.91)) 31. This trial is based on our previous cohort study in which CSD was observed at 6 weeks postpartum.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of adjunctive azithromycin versus single-dose cephalosporin prophylaxis for caesarean scar defect: study protocol for a randomised controlled trial

et al. 2020

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IntroductionPerioperative infections may be considered predictors of caesarean scar defect (CSD), and multidose antibiotics have a protective effect against CSD. However, the ability of adjunctive azithromycin combined with cephalosporin to reduce the prevalence of CSD remains unclear. The planned study aims to clarify the protective effect of antibiotics against CSD and to assess the effectiveness of adjunctive azithromycin prophylaxis for CSD.Methods and analysisThis study is a double-blind, parallel-control randomised clinical trial that will be carried out at the International Peace Maternity and Child Health Hospital. A total of 220 eligible patients will be randomised (1:1) to receive either adjunctive azithromycin or single-dose cephalosporin 30 min before the incision. The evaluation criteria are the prevalence and characteristics of CSD as assessed by transvaginal ultrasound (TVU) and saline infusion sonohysterography (SIS) at 42 days, 6 months and 12 months after delivery. The primary outcome will be the prevalence of CSD, and the characteristics of CSD will be assessed by TVU and SIS 42 days after delivery; all other outcomes are secondary.Ethics and disseminationThis protocol received authorisation from the Medical Research Ethics Committee of International Peace Maternity and Child Health Hospital on 25 April 2018 (approval no. GKLW2017-84). The findings will be reported in peer-reviewed publications and presentations at international scientific meetings.Trial registration numberChiCTR-INR-17013272.

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“…A recent research also observed that the incidence of cesarean scar formation and niche depth was independent of the hysterotomy closure technique used. 20 In a recent meta-analysis, Di Spiezio Sardo et al 7 reported that women who received a single-layer uterine closure had a similar incidence of uterine scar defects as women who received a double-layer closure.…”

Section: Surgery Technique Factorsmentioning

confidence: 99%

Isthmocele: From Risk Factors to Management

Iannone

Nencini

Bonaccorsi

et al. 2019

Rev Bras Ginecol Obstet

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Objective The aim of the present study was to perform a comprehensive review of the literature to provide a complete and clear picture of isthmocele-a hypoechoic area within the myometrium at the site of the uterine scar of a previous cesarean section-by exploring in depth every aspect of this condition. Methods A comprehensive review of the literature was performed to identify the most relevant studies about this topic. Results Every aspect of isthmocele has been studied and described: pathophysiology, clinical symptoms, classification, and diagnosis. Its treatment, both medical and surgical, has also been reported according to the actual literature data. Conclusion Cesarean section is the most common surgical procedure performed worldwide, and one of the consequences of this technique is isthmocele. A single and systematic classification of isthmocele is needed to improve its diagnosis and management. Further studies should be performed to better understand its pathogenesis. Palavras-chave ResumoObjetivo O objetivo do presente estudo foi realizar uma revisão abrangente da literatura a fim de fornecer um quadro completo e claro da istmocele-uma área hipoecoica dentro do miométrio no local da cicatriz uterina de uma cesariana anterioraprofundando todos os aspectos desta condição Métodos Uma revisão abrangente da literatura foi realizada para identificar os estudos mais relevantes sobre este tema. Resultados Todos os aspectos da istmocele foram estudados e descritos: fisiopatologia, sintomas clínicos, classificação e diagnóstico. Os tratamentos médico e cirúrgico também foram relatados de acordo com os dados reais da literatura. Conclusão A cesárea é o procedimento cirúrgico mais comum realizado em todo o mundo, e uma das consequências desta técnica é a istmocele. Uma classificação única e sistemática da istmocele é necessária para melhorar seu diagnóstico e manejo. Novos estudos devem ser realizados para melhor entender sua patogênese.ORCID ID is https://orcid.org/0000-0001-9485-0126.

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Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single‐ or double‐layer uterotomy closure: a randomized controlled trial

Abstract: The incidence of cesarean scar niche formation and the niche depth was independent of the hysterotomy closure technique.

Cited by 46 publications

References 22 publications

The prevalence and risk predictors of cesarean scar defect at 6 weeks postpartum in Shanghai, China: A prospective cohort study

The prevalence and risk predictors of cesarean scar defect at 6 weeks postpartum in Shanghai, China: A prospective cohort study

Efficacy of adjunctive azithromycin versus single-dose cephalosporin prophylaxis for caesarean scar defect: study protocol for a randomised controlled trial

Isthmocele: From Risk Factors to Management

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