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Torre A, Verspyck E, Hamamah S, Thomassin I, Thornton J, Fauconnier A, Crochet P. [Cesarean scare niche: Definition, diagnosis, risk factors, prevention, symptoms, adverse effects, and treatments]. ACTA ACUST UNITED AC 2021; 49:858-868. [PMID: 34144220 DOI: 10.1016/j.gofs.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To review the definitions, diagnostic methods, risk factors, symptoms, and treatments for caesarean scar niche. METHODS Review of the literature, critical reflection, and pragmatic advice. RESULTS There is no consensus on the definition of caesarean scar niche. Some suggest an indentation≥2mm of the myometrium of the caesarean scar, but this is present in more than half of women with caesarean history and takes no account of woman's symptoms. The most popular diagnostic method is ultrasound±hysterosonography. Risks factors for niche are multiple Caesareans, Cesarean during labor with too low incision, and retroverted uterus. Symptoms include abnormal gynaecologic bleeding and pelvic pain, and their presence establish the "Caesarean scar syndrome". The risks of pregnancy with niche is poorly studied, but pregnancy is not contraindicated, even if the niche is untreated. The treatment of caesarean scar niche is mainly surgery and conservative. The former should be reserved for symptomatic patients, and those with secondary infertility and fertility treatment failure. Patients with residual myometrium thickness≥2.5mm may benefit from first-line hysteroscopic treatment, whereas a laparoscopic or vaginal approach could be offered in other cases. CONCLUSIONS A pragmatic definition of caesarean scar niche as a disease including symptoms is the necessary prerequisite for the management of women. The treatment is mainly surgical, or conservative depending on the desire for subsequent pregnancy.
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Affiliation(s)
- A Torre
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Maternity building of the City Hospital, Hucknall Road, NG5 1PB Nottingham, Royaume-Uni; Service de gynécologie-obstétrique, CHU de Rouen, Université de Rouen, Rouen, France.
| | - E Verspyck
- Service de gynécologie-obstétrique, CHU de Rouen, Université de Rouen, Rouen, France
| | - S Hamamah
- Univ Montpellier, Inserm U1203, EmbryoPluripotency, Montpellier, France; IRMB, Univ Montpellier, Inserm, Montpellier, France; CHU Montpellier, ART/PGD Department, Arnaud de Villeneuve Hospital, Montpellier, France
| | - I Thomassin
- Department of Imaging, Hopital Tenon, AP-HP, 75020 Paris, France
| | - J Thornton
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Maternity building of the City Hospital, Hucknall Road, NG5 1PB Nottingham, Royaume-Uni
| | - A Fauconnier
- Department of Biology, Medicine and Health, Research unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France; Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-St Germain en Laye, Poissy, France
| | - P Crochet
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Marseille, La Conception Hospital, Aix Marseille Université, Marseille, France
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Preis H, Tovim S, Mor P, Grisaru-Granovsky S, Samueloff A, Benyamini Y. Fertility intentions and the way they change following birth- a prospective longitudinal study. BMC Pregnancy Childbirth 2020; 20:228. [PMID: 32303192 PMCID: PMC7164284 DOI: 10.1186/s12884-020-02922-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women's fertility intentions, their desired number of children and desired inter-pregnancy interval (IPI) are related to micro (personal) and macro (socio-cultural) level factors. We investigated factors that contribute to changes in women's fertility intentions in Israel, a developed country with high birth rates. METHODS Pregnant women (N = 1163), recruited from prenatal clinics and hospitals in two major metropolitan areas, completed self-report questionnaires prenatally (≥24 weeks gestation) and postpartum (2 months after childbirth). Women reported their socio-demographic background and obstetric history prenatally, their desired number of children and IPI at both time-points, and their objective and subjective birth experiences postpartum. RESULTS The findings indicated that background characteristics were related to prenatal fertility intentions. The strongest contributor to prenatal fertility intentions was women's degree of religiosity- the more religious they were, the more children they desired and the shorter their intended IPI. Women's postpartum fertility intentions were mostly consistent with their prenatal reports. In regression models, women who were very-religious, more educated and had previously given birth were less likely to report a lower number of desired of children at postpartum, compared to their prenatal report. Women who reported greater birth satisfaction and gave birth for the first time were less likely to change desired IPI. CONCLUSION Having a negative birth experience could adversely affect women's fertility intentions. Yet, in a pronatalist and medicalized birth culture, social pressures may decrease the effects of birth experiences on fertility intentions.
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Affiliation(s)
- Heidi Preis
- Bob Shapell School of Social Work, Tel Aviv University, 69978, Tel Aviv, Israel. .,Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | - Selen Tovim
- Bob Shapell School of Social Work, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Pnina Mor
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, 69978, Tel Aviv, Israel
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Kjerulff KH, Paul IM, Weisman CS, Hillemeier MM, Wang M, Legro RS, Repke JT. Association Between Mode of First Delivery and Subsequent Fecundity and Fertility. JAMA Netw Open 2020; 3:e203076. [PMID: 32310282 PMCID: PMC7171551 DOI: 10.1001/jamanetworkopen.2020.3076] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE More than 20% of births globally are by cesarean delivery, including more than 30% in the US. Prior studies have reported lower rates of childbearing after cesarean delivery, but it is not clear if this is due to maternal choice or lower conception rates. OBJECTIVE To investigate the association between mode of first delivery and subsequent conceptions and live births. DESIGN, SETTING, AND PARTICIPANTS The First Baby Study was a multicenter prospective cohort study of women aged 18 to 35 years with singleton pregnancies, enrolled and interviewed before first childbirth, who delivered in Pennsylvania from 2009 to 2011 and were followed up for 36 months after delivery (until April 2014). Data analysis for this study took place between May and July 2019 and in January 2020. EXPOSURES Mode of first delivery (cesarean or vaginal). MAIN OUTCOMES AND MEASURES Rates of subsequent conceptions and live births. Discrete-time Cox proportional hazard regression models were used to compare the rate of subsequent conception (vaginal vs cesarean) among those who completed the 36-month survey, accounting for reported months of unprotected intercourse during the follow-up period and adjusting for relevant covariates. A log binomial regression was used to compare the age-adjusted rate of subsequent live birth (vaginal vs cesarean) among those who completed the 36-month survey. RESULTS The study population consisted of 2423 women who were retained to the 36-month survey (mean [SD] age at baseline was 27.2 [4.4] years and 712 [29.4%] delivered by cesarean). There were 2046 women who had unprotected intercourse during the follow-up period, 2021 of whom provided data on months of unprotected intercourse. Cesarean delivery was associated with lower rates of conception after unprotected intercourse during the follow-up period (413 of 599 [68.9%]) compared with vaginal delivery (1090 of 1422 [76.7%]) (adjusted hazard ratio, 0.85; 95% CI, 0.74-0.96). Cesarean delivery was also associated with reduced likelihood of a subsequent live birth (305 women [42.8%]) compared with vaginal delivery (857 women [50.1%]), with an age-adjusted risk ratio of 0.83 (95% CI, 0.75-0.92). CONCLUSIONS AND RELEVANCE In the 3 years following first childbirth, women who delivered their first child by cesarean had lower rates of conception after unprotected intercourse, and fewer of these women had a second child than those who delivered vaginally.
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Affiliation(s)
- Kristen H. Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ian M. Paul
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Carol S. Weisman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Marianne M. Hillemeier
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Health Policy and Administration, Penn State College of Health & Human Development, University Park, Pennsylvania
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Richard S. Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - John T. Repke
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
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Guo C, Ma W, Fan D, Ma Y, Liu L. Non spontaneous vaginal delivery was associated with lower probability of subsequent fertility. Eur J Obstet Gynecol Reprod Biol 2020; 248:30-36. [PMID: 32172023 DOI: 10.1016/j.ejogrb.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Previous systematic reviews have reported that cesarean birth is associated with reduced rate of subsequent fertility. However, other common mode of delivery was poorly understood. The aim of this study was to systematically investigate the subsequent fertility in patients having different modes of non-spontaneous vaginal delivery, if compared to normal vaginal delivery. STUDY DESIGNS Medline (via PubMed), Web of Science, Embase (via Dialog), CENTRAL (via Cochrane Library), ScienceDirect (via Elsevier) and ClinicalTrial.gov were searched up to October 2019, without language restrictions in this systematic review and meta-analysis. Articles assessing the mode of delivery and subsequent fertility were included. Quality assessment was evaluated using the nine-point Newcastle Ottawa Scale by two independent reviewers. RESULTS Twenty-one articles, including 4,423,544 women of reproductive age, were included. Results showed that women had a 9% (RR: 0.91 [95 %CI 0.88, 0.94]) lower probability of subsequent fertility in primary cesarean birth group, compared with spontaneous vaginal delivery. Further analysis discovered that a 13 % (0.87, [0.85, 0.90]) lower probability of subsequent fertility was observed in women delivered by emergency cesarean birth, a 14 % (0.86, [0.82, 0.91) lower probability by elective cesarean birth, a 39 % (0.61, [0.57, 0.66]) by maternal-requested cesarean birth, and a 2% (0.98, [0.97, 1.00]) by instrumental vaginal delivery. CONCLUSIONS Non-spontaneous vaginal delivery may be associated with lower probability of subsequent fertility. Decision makers and obstetricians should be cautious when choosing the mode of delivery.
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Affiliation(s)
- Congcong Guo
- Reproductive Medicine Center, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Wenmin Ma
- Reproductive Medicine Center, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, 528000, China.
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Li Liu
- Department of Library, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
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van den Tweel MM, Klijn NF, Diaz de Pool JDN, van der Westerlaken LAJ, Louwe LA. Previous caesarean section is associated with lower subsequent in vitro fertilization live birth rates. HUM FERTIL 2019; 25:93-98. [DOI: 10.1080/14647273.2019.1696990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marjolein M. van den Tweel
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Obstetrics and Gynecology, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | - Nicole F. Klijn
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Juan D. N. Diaz de Pool
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Leoni A. Louwe
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
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Shorey S, Yang YY, Ang E. The impact of negative childbirth experience on future reproductive decisions: A quantitative systematic review. J Adv Nurs 2018; 74:1236-1244. [DOI: 10.1111/jan.13534] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; National University Health System; Singapore
| | - Yen Yen Yang
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; National University Health System; Singapore
| | - Emily Ang
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med 2018; 15:e1002494. [PMID: 29360829 PMCID: PMC5779640 DOI: 10.1371/journal.pmed.1002494] [Citation(s) in RCA: 415] [Impact Index Per Article: 69.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/18/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of this systematic review is to describe the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies. The primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death. METHODS AND FINDINGS Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were systematically searched for published studies in human subjects (last search 25 May 2017), supplemented by manual searches. Included studies were randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies with greater than or equal to one-year follow-up comparing outcomes of women delivering by cesarean delivery and by vaginal delivery. Two assessors screened 30,327 abstracts. Studies were graded for risk of bias by two assessors using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies. Results were pooled in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I2 ≥ 40%). One RCT and 79 cohort studies (all from high income countries) were included, involving 29,928,274 participants. Compared to vaginal delivery, cesarean delivery was associated with decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies). Children delivered by cesarean delivery had increased risk of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies) and obesity up to the age of 5 years (OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies). Pregnancy after cesarean delivery was associated with increased risk of miscarriage (OR 1.17, 1.03 to 1.32; n = 151,412; 4 studies) and stillbirth (OR 1.27, 1.15 to 1.40; n = 703,562; 8 studies), but not perinatal mortality (OR 1.11, 0.89 to 1.39; n = 91,429; 2 studies). Pregnancy following cesarean delivery was associated with increased risk of placenta previa (OR 1.74, 1.62 to 1.87; n = 7,101,692; 10 studies), placenta accreta (OR 2.95, 1.32 to 6.60; n = 705,108; 3 studies), and placental abruption (OR 1.38, 1.27 to 1.49; n = 5,667,160; 6 studies). This is a comprehensive review adhering to a registered protocol, and guidelines for the Meta-analysis of Observational Studies in Epidemiology were followed, but it is based on predominantly observational data, and in some meta-analyses, between-study heterogeneity is high; therefore, causation cannot be inferred and the results should be interpreted with caution. CONCLUSIONS When compared with vaginal delivery, cesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse, but this should be weighed against the association with increased risks for fertility, future pregnancy, and long-term childhood outcomes. This information could be valuable in counselling women on mode of delivery.
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Affiliation(s)
- Oonagh E. Keag
- NHS Lothian Department of Obstetrics and Gynaecology, Simpson’s Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jane E. Norman
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Sarah J. Stock
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen’s Medical Research Institute, Edinburgh, United Kingdom
- School of Women’s and Infants’ Health, University of Western Australia, Crawley, Australia
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