The niche in the uterine cesarean scar: a new problem of women’s reproductive health
- Authors: Nozhnitseva O.N.1, Bezhenar V.F.1
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Affiliations:
- Academician I.P. Pavlov First St. Petersburg State Medical University
- Issue: Vol 69, No 1 (2020)
- Pages: 53-62
- Section: Original study articles
- URL: https://journals.rcsi.science/jowd/article/view/33436
- DOI: https://doi.org/10.17816/JOWD69153-62
- ID: 33436
Cite item
Abstract
Hypothesis/aims of study. In the recent decades, the quality of uterine suture repair after a cesarean section is widely discussed, as local thinning of the myometrium forming uterine scar defects, or the so-called scar niche, are relatively common after the operation. The aim of this study was to identify the causes of local thinning of the uterine scar after cesarean section, to determine the effectiveness of existing methods for assessing the uterine scar in non-pregnant women, and to develop a method for surgical correction of this pathology.
Study design, materials and methods. Over 4 years, 175 non-pregnant women with a uterine scar were examined. The 50 of them were diagnosed with the uterine scar niche, with a laparoscopic metroplasty performed in these patients. The effectiveness of the operation was evaluated in the long-term postoperative period.
Results. Performing cesarean section because of weakness of labor activity and a complicated course of the postpartum period are significant factors in the formation of a uterine scar niche (p < 0.05). Ultrasound examination and magnetic resonance imaging of the pelvic organs can be used to detect local thinning of the myometrium with a sensitivity of 82% and 96%, and a specificity of 85% and 90%, respectively.
Conclusion. Metroplasty for patients with a diagnosed scar niche can significantly increase the thickness of the myometrium (p < 0.05) and reduce the frequency of complaints of such menstrual irregularities as postmenstrual vaginal bleeding, dysmenorrhea, and hypermenorrhea (p < 0.05).
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##article.viewOnOriginalSite##About the authors
Olga N. Nozhnitseva
Academician I.P. Pavlov First St. Petersburg State Medical University
Author for correspondence.
Email: 9111631880@mail.ru
MD, Assistant. The Department of Obstetrics, Gynecology, and Reproductive Sciences; the Department of Daycare, Obstetrics and Gynecology Clinic
Russian Federation, Saint PetersburgVitaliy F. Bezhenar
Academician I.P. Pavlov First St. Petersburg State Medical University
Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-7807-4929
MD, PhD, DSci (Medicine), Professor, Head of the Department of Obstetrics, Gynecology, and Reproductive Sciences, Head of the Department of Obstetrics, Gynecology, and Neonatology, Chief of the Obstetrics and Gynecology University Hospital
Russian Federation, Saint PetersburgReferences
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