scholarly journals Post-Caesarean section niche-related impaired fertility: hypothetical mechanisms

2020 ◽  
Vol 35 (7) ◽  
pp. 1484-1494
Author(s):  
Jolijn Vissers ◽  
Wouter Hehenkamp ◽  
Cornelis Bavo Lambalk ◽  
Judith Anna Huirne
Keyword(s):  
Caesarean Section ◽  
Direct Evidence ◽  
Expectant Management ◽  
Daily Practice ◽  
Abdominal Adhesions ◽  
Randomized Controlled ◽  
Sperm Penetration ◽  
Uterine Scar ◽  
Additional Value ◽  
Surgical Treatments

Abstract Caesarean section can result in an indentation of the myometrium at the site of the Caesarean scar, called a niche. Niches can cause symptoms of abnormal uterine blood loss, dysmenorrhoea, chronic pelvic pain and dyspareunia and are possibly related to subfertility. Various other explanations for the cause of subfertility after Caesarean section have been proposed in the literature, such as uterine pathology, intra-abdominal adhesions and women’s reproductive choices. Not all niches cause symptoms and the relation with subfertility and a niche in the uterine scar still needs further study since direct evidence is lacking so far. Based on the limited available evidence, and in combination with observations made during sonographic hysteroscopic evaluations and laparoscopic niche repair, we propose and discuss three hypothetical mechanisms: (i) the environment for sperm penetration and implantation may be detrimental; (ii) there could be a physical barrier to embryo transfer and implantation; and (iii) psychogenic factors may reduce the likelihood of pregnancy. Several innovative surgical treatments have been developed and are being implemented for niche-related problems. Promising results are reported, but more evidence is needed before further implementation in daily practice. The additional value of niche resections should be compared to expectant management or fertility therapies, such as ART, in randomized controlled trials. Therefore, our suggested hypotheses should, for the time being, not be used for justification of any specific procedures outside clinical trials.

Cesarean scar defect: terminological aspects

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 70-75
Author(s):  
Sergey A. Martynov ◽  
Leyla V. Adamyan
Keyword(s):  
Caesarean Section ◽  
Postpartum Period ◽  
Russian Literature ◽  
Cesarean Scar ◽  
The Status ◽  
Uterine Scar

The review aim was to summarize information and to provide terminological analysis of the foreign and Russian literature on assessing the status of the uterine scar after a caesarean section, as well as to identify terms that are most appropriate to use out and during pregnancy, in childbirth and in the postpartum period.

Diagnosis and surgical correction of isthmocele after caesarean section

2021 ◽  
Vol 20 (3) ◽  
pp. 56-62
Author(s):  
N.S. Mikhaelyan ◽  
◽  
D.V. Bryunin ◽  
I.D. Khokhlova ◽  
T.A. Dzhibladze ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Surgical Correction ◽  
Postoperative Rehabilitation ◽  
Double Row ◽  
Anatomical Structures ◽  
Group 3 ◽  
Group 2 ◽  
Uterine Scar ◽  
Group 1

Objective. To compare the efficacy of different methods of surgical correction of isthmocele after caesarean section. Patients and methods. The study included 56 patients aged 29–41 years, who were divided into three groups: group 1 (n = 16) – patients who underwent surgical laparoscopy with suturing the uterine wound with single-row separate muscularmuscular sutures; group 2 (n = 23) – patients after repair of the uterus with a double-row continuous seromuscular and muscular-muscular suture performed by laparoscopy; group 3 (n = 17) consisted of patients who underwent laparotomy and suturing the uterine wound with a double-row continuous suture. Results. We developed a three-stage plastic and reconstructive surgical laparotomic and laparoscopic program in case of the uterine scar incompetence, which improved the quality of life in all patients. Pregnancy occurred 9–14 months after plastic and reconstructive surgery on the uterus and resulted in timely surgical delivery in 4 (25%) patients in group 1, in 7 (30.4%) patients in group 2 and in 3 (17.6%) patients in group 3. Two (12.5%) patients in group 1 and three (13.04%) patients in group 2 were observed during pregnancy with a period of 10–28 weeks. Conclusion. The use of laparoscopy ensured better visualization of anatomical structures (vessels, nerves, ureters, bladder), which led to a decrease in intraoperative blood loss, in the risk of damage to adjacent organs and in the development of adhesions, and to accelerated postoperative rehabilitation of patients. Key words: double-row suture, istmocele, laparoscopy, metroplasty

Hysteroscopic management of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hatem Hussein El-Gamal ◽  
Walid El-Basuony Mohammad ◽  
Ahmed Samir Mohamed Zeerban
Keyword(s):  
Quality Of Life ◽  
Caesarean Section ◽  
Controlled Trial ◽  
Intervention Group ◽  
Expectant Management ◽  
Control Group ◽  
Randomised Controlled ◽  
Caesarean Scar Defect ◽  
Interventional Group

Abstract Background Long-term complaints after caesarean section, such as postmenstrual spotting, dysmenorrhea, dyspareunia, or chronic pelvic pain, are frequently described in relation to the presence of a niche. A post-caesarean niche is defined as an indentation in the myometrium at the site of the uterine scar. Two independent prospective cohort studies reported that the presence of a niche after caesarean section increases the risk of postmenstrual spotting for more than 2 days from 15 to 30%. Postmenstrual spotting may be caused by a mechanical outflow problem, with the retention of menstrual blood in a niche, or by the accumulation of blood because of impaired uterine contractions at the site of the niche. Additionally, newly formed fragile vessels in the niche may play a role in the formation of blood or fluid in the niche and uterine cavity. Objective The aim of this study was to compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect. Methods This trial is a randomised controlled trial that provides evidence for the (cost) effectiveness of hysteroscopic resection of a niche versus expectant management in women with niche related postmenstrual spotting. It was carried out on 28 cases divided into two equal group. The study was conducted at Ain Shams University on the women reporting postmenstrual spotting after a caesarean section. The primary outcome was the number of days of postmenstrual spotting 6 months after randomization. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, quality of life, women’s satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, also at 6 months after randomization. Results The results of this study show a significant improvement in interventional group after 3 months more than the control group in bleeding micturition characteristics which includes total days of spotting, spotting end of menstruation, intermenstral spotting, discomfort from spotting, dysmenorrhea and daily pain during micturition, after 6 months the two group improved but the interventional group was significantly higher than control group. Regarding the radiological assessment it was found that there was a significant improvement in intervention group more than the control group after 3 months, also the control group improved after 6 months also, but the intervention groups was significantly higher than the control group. The quality of life show a significant increasing in intervention group more than the control group after 3 months of intervention, at the end of follow up the intervention group was significantly higher in quality of life more than the control group. Conclusion A hysteroscopic niche resection reduces postmenstrual spotting, and the discomfort from spotting, compared with expectant management after 3 months of follow-up in women with a niche with a residual myometrium of at least 3 mm.

Clinical diagnosis and therapy of uterine scar defects after caesarean section in non-pregnant women

2014 ◽  
Vol 291 (6) ◽  
pp. 1417-1423 ◽  
Author(s):  
Neele Schepker ◽  
Guillermo-José Garcia-Rocha ◽  
Frauke von Versen-Höynck ◽  
Peter Hillemanns ◽  
Cordula Schippert
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Clinical Diagnosis ◽  
Diagnosis And Therapy ◽  
Uterine Scar

scholarly journals Application of Artificial Intelligence in Early Gastric Cancer Diagnosis

Digestion ◽  
2021 ◽  
pp. 1-7
Author(s):  
Zili Xiao ◽  
Danian Ji ◽  
Feng Li ◽  
Zhengliang Li ◽  
Zhijun Bao
Keyword(s):  
Artificial Intelligence ◽  
Gastric Cancer ◽  
New Technologies ◽  
Narrow Band Imaging ◽  
Daily Practice ◽  
Colorectal Polyps ◽  
Current Status ◽  
Randomized Controlled ◽  
Depth Prediction ◽  
Substantial Effort

<b><i>Background:</i></b> With the development of new technologies such as magnifying endoscopy with narrow band imaging, endoscopists achieved better accuracy for diagnosis of gastric cancer (GC) in various aspects. However, to master such skill takes substantial effort and could be difficult for inexperienced doctors. Therefore, a novel diagnostic method based on artificial intelligence (AI) was developed and its effectiveness was confirmed in many studies. AI system using convolutional neural network has showed marvelous results in the ongoing trials of computer-aided detection of colorectal polyps. <b><i>Summary:</i></b> With AI’s efficient computational power and learning capacities, endoscopists could improve their diagnostic accuracy and avoid the overlooking or over-diagnosis of gastric neoplasm. Several systems have been reported to achieved decent accuracy. Thus, AI-assisted endoscopy showed great potential on more accurate and sensitive ways for early detection, differentiation, and invasion depth prediction of gastric lesions. However, the feasibility, effectiveness, and safety in daily practice remain to be tested. <b><i>Key messages:</i></b> This review summarizes the current status of different AI applications in early GC diagnosis. More randomized controlled trails will be needed before AI could be widely put into clinical practice.

scholarly journals Caesarean section at Koudougou regional hospital centre: indications and prognosis

2020 ◽  
Vol 9 (12) ◽  
pp. 4792
Author(s):  
Djiguemde Nebnomyidboumbou Norbert Wenceslas ◽  
Lankaonde Martin ◽  
Savadogo-Komboigo B. Eveline ◽  
S. I. B. Sansan Rodrigue ◽  
Ouedraogo Wendlassida Estelle ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Caesarean Section Rate ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Important Place ◽  
History Of ◽  
Group 3 ◽  
Group 5 ◽  
Uterine Scar

Background: Objective was to study the indications and the prognosis of cesarean section in the obstetrics and gynecology department of CHR Koudougou from August 1st to October 16th 2018.Methods: This was a cross-sectional study for descriptive purposes with prospective collection of data over the month and monitoring of parturients up to the 42nd day post caesarean section. The study covered the period from August 1 to October 16, 2018. Gestures received in the work room and those hospitalized for a scheduled cesarean were involved in this study.Results: This study involved 316 deliveries. The caesarean section rate was 34.8% (n=110). The average age was 26.75 years with extremes of 12 and 42 years. Term pregnancies represented 90.9%. History of cesarean section was observed in 47, 3%. The main groups contributing to the caesarean section rate represent: Groups 5 (9.5%), Group 1 (9.2%), Group 3 (5.1%), the scar uterus (17.3%) and suffering fetal (14.6%). The reported complications were 15.5% including 3.6% parietal suppuration and 0.8% stillbirth.Conclusions: The caesarean section occupies an important place in the maternity service of the RHC of Koudougou. Robson's group 5 was the largest contributor to the overall cesarean rate in our study. Measures should be taken in this group so that the uterine scar does not become an absolute indication for cesarean.

Fractional CO2laser treatment of caesarean section scars-A randomized controlled split-scar trial with long term follow-up assessment

2016 ◽  
Vol 49 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Katrine E. Karmisholt ◽  
Elisabeth H. Taudorf ◽  
Camilla B. Wulff ◽  
Emily Wenande ◽  
Peter A. Philipsen ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Randomized Controlled ◽  
Long Term Follow Up
Sign in / Sign up

Export Citation Format

Share Document