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

Abstract

Background A niche in the uterus, present in 60% of women after caesarean section (CS), is associated with several gynaecological symptoms and possibly with subfertility. Studies that focus on quality of life (QoL) in relation to a niche are lacking. Purpose To identify niche-related outcomes that influence QoL and to compare patient-reported outcomes with outcomes studied in the literature. Methods Two focus group discussions (FGDs, N = 8 and 5) were conducted in Amsterdam UMC-location VUmc. Participants were Dutch patients with a large niche, with (planned) surgical treatment for their symptoms. Niche-related symptoms and impact on functioning or participation were fixed topics. The transcripts of the FGDs were coded into outcomes, themes and domains of QoL according to the WHOQOL model. Additionally, participants created a top five important outcomes. Next, we performed a systematic review (SR) on niche-related outcomes and compared the FGDs with niche-related outcomes from the SR. Results In four domains (physical health, psychological domain, social relationships and environment), fifteen themes were reported in the FGDs. Abnormal uterine bleeding (AUB), subfertility, sexual activity, abdominal pain and self-esteem were themes prioritised by participants. In the literature, gynaecological symptoms and reproductive outcomes were predominantly studied. Sexuality and self-esteem were prioritised in the FGDs but hardly or never studied in the literature. Conclusion We found a broad range of niche-related outcomes influencing QoL. Apart from symptoms evaluated in the literature such as AUB, abdominal pain and subfertility, clinicians and researchers should be more aware of sexual activity and self-esteem in this population.

Symptoms and Quality of Life Changes after Hysteroscopic Treatment in Patients with Symptomatic Isthmocele—Preliminary Results

“…All patients provided information about the result of the procedure, assessed the impact of the procedure on improving their quality of life in the physical, social, environmental, and psychological domains. The survey was prepared by the authors based on the research of the Stegwee et al [1] and included simple questions about subjective feelings related to the niche symptoms influencing QoL. From the final analysis, we excluded all patients in whom other pathologies such as: polyp, myoma, or congenital abnormalities were detected during hysteroscopy.…”

“…Isthmocoele, also known as "niche", is a common problem in gynecological and obstetrical care and it develops in 50-60% of women who have had a cesarean section [1]. As the number of cesarean section deliveries grows, cesarean scar defects and its implications must be well diagnosed and properly treated.…”

“…It is widely understood that isthmocele has a negative impact on patients' quality of life. According to Stegwee et al, the most relevant symptoms for QoL in isthmocele patients were abnormal uterine bleeding (AUB), subfertility, sexual activity, and selfesteem [1]. When it comes to AUB, quality of life is decreased because of AUB-associated odor, recurrent fungal infections, irregularity of AUB, discomfort during leisure activities (e.g., sport), and a lower work capacity.…”

Effect of single‐ versus double‐layer uterine closure during caesarean section on postmenstrual spotting (2Close): multicentre, double‐blind, randomised controlled superiority trial

“…A frequently reported gynaecological symptom is postmenstrual spotting (25%), which is associated with both thin residual myometrium and the presence and size of a niche 4–6 . This chronic symptom is considered to be a major contributor to impaired maternal quality of life, sexuality and social interaction in the long term 11 …”

Die Sectionarbe im gynäkologischen Ultraschall

“…In einer rezenten Fokusgruppenstudie untersuchte eine niederländische Arbeitsgruppe die Lebensqualität von Frauen mit markanter Nischenbildung nachSectio, beideneneine operative Korrektur angestrebt war: Im Vordergrund der von den Patientinnen präsentierten Probleme standen Blutungsunregelmäßigkeiten, Schmerzen, ein schlechtes Körpergefühl und, darauf basierend, Einschränkungen der sexuellen Aktivität und Reduktion der Fertilität [3]. Beim Einlegen von IUD, aber auch bei der intrauterinen Insemination, können Nischen in alten Sectionarben in eine "fausse route" leiten und zu Perforationen des Uterus führen (.…”