Uterine niche after cesarean section: a review of diagnostic methods

Budny-Wińska, Joanna; Pomorski, Michał

doi:10.5603/gp.a2021.0195

Cited by 20 publications

(28 citation statements)

References 29 publications

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“…The key to the success is the evaluation of own surgical results both in the settings of big clinical trials and in the micro scale -by the surgeons themselves. The tool for CS scar assessment -TVUS is widely available and uterine CS scar assessment techniques are easy to implement and use [22]. Dear Readers, we encourage all of you to assess the CS scars after the cesareans you have performed -maybe your technique will turn out to be a milestone on the way to a perfect CS.…”

Section: Perfect Cesarean Section -The Holy Grail Of Obstetriciansmentioning

confidence: 99%

Perfect cesarean section — the Holy Grail of obstetricians

Pomorski

Zimmer

2022

Ginekol Pol

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Section: Perfect Cesarean Section -The Holy Grail Of Obstetriciansmentioning

confidence: 99%

Perfect cesarean section — the Holy Grail of obstetricians

Pomorski

Zimmer

2022

Ginekol Pol

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“…The most common method to diagnose isthmocele is two-dimensional (2D) transvaginal ultrasonography (TVS), with or without injection of contrast agents, mainly saline, although some studies have used three-dimensional State-of-the-Art Review 337 (3D) TVS, hysterosalpingography, hysteroscopy or magnetic resonance imaging. Although there is no diagnostic method universally considered as the gold standard 9 , the modified Delphi consensus by Jordans et al 10 in 2019 found that gel or saline sonography is a useful adjunct to conventional ultrasound for diagnosis of this lesion. They defined isthmocele as an anechoic defect within the myometrium of the lower uterine segment at least 2.0 mm in depth 10 , although previous studies have used a cut-off of 1 mm in depth 11 .…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis

Dominguez¹,

Pacheco²,

Moratalla

et al. 2023

Ultrasound in Obstet & Gyne

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The purpose of this State‐of‐the‐Art Review was to provide a strategic analysis, in terms of strengths, weaknesses, opportunities and threats (SWOT analysis), of the current evidence regarding the management of uterine isthmocele. Strengths include the fact that isthmocele can be adequately diagnosed on two‐dimensional transvaginal ultrasound, and that surgical repair may restore natural fertility potential and prevent secondary infertility, as well as reduce the risk of abortion and other obstetrical complications. However, there is a lack of high‐quality evidence sustaining the best diagnostic method and criteria, as well as the potential benefits of surgical repair on fertility. There is an outstanding need for highly experienced surgeons with adequate skills in all applicable techniques, and isthmocele repair does not prevent the need for a Cesarean delivery in subsequent pregnancy. Nevertheless, increasing awareness of the accuracy of transvaginal ultrasound in diagnosing isthmocele presents an opportunity for increased diagnosis of this pathology. This may lead to surgical correction and prevention of obstetric and perinatal complications in subsequent pregnancy, including cesarean scar pregnancy. Regarding threats, the existence of different surgical techniques creates a risk of selecting an inadequate approach if the type of isthmocele and patient's features are not considered. There is a risk of overtreatment when asymptomatic defects are surgically repaired. Finally, there is an absence of cost‐effectiveness analyses to justify the routine application of the repair. Thus, while there are many data suggesting that isthmocele decreases both natural fertility and the outcomes of assisted reproduction techniques, high‐quality evidence to support surgical isthmocele repair in all asymptomatic patients desiring future fertility are lacking. There is progressive agreement in recommending hysteroscopic repair of isthmocele as a first‐choice approach as long as the residual myometrium thickness is at least 2.5‐3 mm.This article is protected by copyright. All rights reserved.

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“…Transvaginal sonography (TVS), with or without saline or gel contrast, magnetic resonance imaging, or hysteroscopy can examine uterine niches. Transvaginal ultrasound should be considered the first‐line tool as it is widely available and not expensive 6 . The use of gel or saline contrast sonography (sonohysterography) or three‐dimensional dimensional (3D) reconstructions can improve the characterization of uterine niches.…”

Section: Introductionmentioning

confidence: 99%

“…Transvaginal ultrasound should be considered the first-line tool as it is widely available and not expensive. 6 The use of gel or saline contrast sonography (sonohysterography) or threedimensional dimensional (3D) reconstructions can improve the characterization of uterine niches. In 2019, an international group of experts reached a consensus through a modified Delphi procedure to guide a detailed TVS evaluation of uterine niches.…”

mentioning

confidence: 99%

Incidence and ultrasonographic characteristics of cesarean scar niches after uterine closure by double‐layer barbed suture: A prospective comparative study

Alessandri

Centurioni

Perrone

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo compare the ultrasonographic features of uterine scars and clinical symptoms after cesarean delivery (CD) using barbed and conventional smooth sutures.MethodsThis case–control study enrolled women who underwent primary CD at 37 weeks of pregnancy or later. The uterus was closed using either double‐layer unidirectional barbed suture or conventional double‐layer smooth suture. Ultrasound scans of the uterine scar and evaluations of menstrual patterns were performed at 6, 12, and 24 months after surgery.ResultsIn all, 102 patients underwent uterine closure with barbed suture, while 135 patients underwent smooth suture. At 6 months, patients in the barbed group had a lower incidence of uterine niches (20.2% vs 32.6%) that were also shallower in depth (P < 0.001). Lower incidence of niches was also observed in the barbed group at 12 and 24 months (P = 0.043 and 0.048, respectively). At these two follow‐up times, the smooth group had a higher number of patients reporting postmenstrual spotting (P < 0.05) and more postmenstrual spotting days per month (P < 0.050).ConclusionThe use of double‐layer barbed suture during CD was associated with a lower incidence of scar niches and a more favorable menstrual pattern compared with the use of smooth suture.

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Uterine niche after cesarean section: a review of diagnostic methods

Cited by 20 publications

References 29 publications

Perfect cesarean section — the Holy Grail of obstetricians

Perfect cesarean section — the Holy Grail of obstetricians

Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis

Incidence and ultrasonographic characteristics of cesarean scar niches after uterine closure by double‐layer barbed suture: A prospective comparative study

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