Niche definition and guidance for detailed niche evaluation

Jordans, Inge P. M.; Leeuw, Robert de; Stegwee, Sanne I.; Amso, Nazar Najib; Barri-Soldevila, Pere; Bosch, T. Van den; Bourne, Tom; Brölmann, Hans A.M.; Donnez, Oliver; Dueholm, Margit; Hehenkamp, Wouter J.K.; Jastrow, Nicole; Mashiach, Roy; Naji, O.; Streuli, Isabelle; Timmerman, Dirk; Voet, Lucet F. van der; Huirne, Judith A.F.

doi:10.1111/aogs.13623

Cited by 11 publications

(7 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is no universal definition of an isthmocele or a standard characterization that indicates its location and size. Most authors and experts agree that the depth of the defect should be at least 2 mm [1].…”

Section: The Definition Of Isthmocelementioning

confidence: 99%

Optimal Isthmocele Management: Hysteroscopic, Laparoscopic, or Combination

Mashiach

Burke

2021

Journal of Minimally Invasive Gynecology

Self Cite

View full text Add to dashboard Cite

To conduct a systematic review of the literature on the hysteroscopic and laparoscopic repair of isthmocele. Data Sources: A thorough search of the PubMed/Medline, Embase, and Cochrane databases was performed. (PROSPERO registration number CRD42020190668). Methods of Study Selection: Studies from the last 20 years that addressed isthmocele repair were collected. Both authors screened for study eligibility and extracted data. All prospective and retrospective studies of more than 10 women were included. Tabulation, Integration, and Results: The initial search identified 666 articles (Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart) (see Supplemental Fig.). We excluded duplicates, case reports, reviews, video articles, and technique articles. We also excluded studies describing only laparotomy or vaginal repair as these were not in the scope of this review. A total of 31 articles met the inclusion criteria, 21 for hysteroscopic resection and 13 for laparoscopic or combined repair (4 articles tested both modalities and appear in both Tables 1 and 2).For abnormal uterine bleeding, hysteroscopic remodeling relived symptoms in 60% to 100% of cases and laparoscopy in 78% to 94%. Secondary infertility was not evaluated in all studies. After hysteroscopic and laparoscopic treatment, 46% to 100% and 37.5% to 90% of those who wished to conceive became pregnant, after the procedure, respectively. Pain and dysmenorrhea seem to be uncommon. All studies that tested improvement of pain had fewer than 10 women. However, between 66% and 100% of women who complain of pain or dysmenorrhea will note a marked improvement to full resolution. Conclusion:Patients with an isthmocele or cesarean scar defect are usually asymptomatic. For symptomatic women, a repair is a valid option. For those with residual myometrial thickness >2 to 3 mm, hysteroscopic remodeling is the modality of choice with an improvement in abnormal uterine bleeding, secondary infertility, and pain. Women with a residual myometrial thickness <2to 3-mm laparoscopic repair with simultaneous hysteroscopic guidance show similar results. Because available data are limited, no cutoff for the correct choice between hysteroscopy and laparoscopy can be concluded. We recommend 2.5 mm as the cutoff value based on common practice and expert opinion, although no significance between hysteroscopic and laparoscopic treatment was shown.

show abstract

Section: The Definition Of Isthmocelementioning

confidence: 99%

Optimal Isthmocele Management: Hysteroscopic, Laparoscopic, or Combination

Mashiach

Burke

2021

Journal of Minimally Invasive Gynecology

Self Cite

View full text Add to dashboard Cite

show abstract

“…It should be emphasized that TVS examination was done during the mid-follicular phase of the examinees, owing to a clear visualization of the niches in case of the fluid in the uteri cavity 28,29 . The size of the niche was affected by the thickness of endometrium 30 , however, we didn't find significant difference among the participants.…”

Section: Discussionmentioning

confidence: 99%

Selection of high-risk individuals for a large niche development based on a scoring classification model: a retrospective cohort study.

Wang¹,

Pang²,

Wei³

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective: To develop a risk prediction model to identify the high-risk individuals of large niche formation after cesarean section (CS). Design A retrospective study. Setting Women's health research in Anhui, China. Population: Women received CS between Jan 2012 to Jun 2017. Methods: Women were arranged to receive uterine scar examination by transvaginal ultrasonography, and those diagnosed with niche were divided into two groups according to whether they suffer from postmenstrual spotting. The cut-off values of depth, RMT (residual myometrium thickness), and depth/AMT (adjacent myometrium thickness) were chosen to define a large niche. Then, all participants were classified into three groups, including a control, a small niche, and a large niche group. The scores of each variable in the prediction model were calculated by dividing the minimum βcoefficient from the multivariate logistic analysis. Main outcome: Primary outcome was a prediction scoring model for large niche formation. Results: In total, 727 women were recruited in this study, and the large niche was defined as more than 0.50 cm in depth, less than 0.21 cm in RMT, more than 0.56 in depth/AMT. The large niche prediction model included eight variables of age at delivery, retroflexed uterine, meconium-stained amniotic fluid, history of CS, B-Lynch suture, operation duration, premature rupture of membranes and cervical dilatation more than 4 cm. The cut-off value of 5 in this score-based model presented sensitivity and specificity as 67.48% and 90.07% respectively. Conclusions: This score-based risk prediction model could present the risk of large niche formation of individuals after CS.

show abstract

“…From 2005 to 2014, the rate of caesarean section (CS) in Singapore increased by 5.2%, reaching 37.4% of all births in 2014, 1 comparable to other developed countries 2–4 . Poor healing of the CS incision results in a niche, 5 an indentation of the uterine myometrium of at least 2 mm at the site of the transverse lower segment CS scar, 6 increasing the probability of a caesarean scar pregnancy (CSP) in subsequent pregnancies 7 . This is because, a CSP occurs when the gestational sac (GS) is implanted within or in close contact with the niche 8–11 .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of first trimester sonographic features in diagnosing caesarean scar pregnancy

Chew,

Chua,

Lombardo

et al. 2023

Sonography

View full text Add to dashboard Cite

IntroductionCaesarean scar pregnancy (CSP), if not managed timely, can result in pre‐term labour, postpartum haemorrhage, hysterectomy or maternal and fetal death. This study aims to compare the diagnostic performances of different sonographic features recommended in various good practice recommendations and literature; then propose an algorithm that could aid in easier identification of CSP using transvaginal ultrasound.MethodsA retrospective review of ultrasound images of intrauterine pregnancy (IUP) and CSP between 4.9 and 11.9 weeks gestation was conducted. The diagnostic performance of the Royal College of Obstetricians & Gynaecologists (RCOG) guideline, Timor‐Tritsch et al. (TT) method and combined method were evaluated. An algorithm was then created to calculate a numerical value for diagnosis. The methods were tested for intra‐ and inter‐observer agreement.ResultsA total of 66 ultrasound cases (30 IUP and 36 CSP) were included in this study. The sensitivity of the RCOG guideline, TT method and combined method were 58.3%, 94.4% and 100% while the specificity were 96.7%, 90% and 90%, respectively. The TT method and combined method performed significantly better than the RCOG guideline (p = .0016 and .0002, respectively). Using the proposed algorithm, a value larger or equal to 52.2 gave 97.2% sensitivity and 93.3% specificity that CSP is present. Intra‐ and inter‐observer agreement for all methods were moderate to almost perfect.ConclusionScreening during early first trimester is important to improve the diagnostic accuracy of CSP. The TT method is a good supplement to the RCOG guideline. The proposed algorithm is a useful tool to improve diagnostic accuracy and confidence.

show abstract

Niche definition and guidance for detailed niche evaluation

Cited by 11 publications

References 5 publications

Optimal Isthmocele Management: Hysteroscopic, Laparoscopic, or Combination

Optimal Isthmocele Management: Hysteroscopic, Laparoscopic, or Combination

Selection of high-risk individuals for a large niche development based on a scoring classification model: a retrospective cohort study.

Accuracy of first trimester sonographic features in diagnosing caesarean scar pregnancy

Contact Info

Product

Resources

About