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Gundogdu F, Orhan N, Ozgul N, Usubutun A. Recurrent mucinous neoplasm arising in cesarean scar: A case report and review of literature. Int J Gynaecol Obstet 2021; 157:564-567. [PMID: 34498288 DOI: 10.1002/ijgo.13924] [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: 04/13/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022]
Abstract
Ovarian mucinous tumors are one of the common epithelial tumors in the ovary, but their recurrence is extremely rare. In a 37-year-old female patient who had had five operations in 7 years due to recurrent mucinous neoplasms, a mass extending to the umbilicus was recently detected during a routine examination. With this finding the patient underwent cystectomy, total abdominal hysterectomy, and left salpingo-oophorectomy. Two of the five operations were performed during cesarean delivery. In the recent surgical procedure, two cysts were removed. A 20 cm cyst in the pelvic region was diagnosed as a mucinous cystadenoma. The other cyst located in the myometrium was a mucinous cystadenoma with focal borderline change and arose in the previous cesarean scar. The authors present what is believed to be the first case of recurrent mucinous neoplasm arising within a cesarean scar. A review of the literature concerning the topic is also presented.
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Affiliation(s)
- Fatma Gundogdu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nazlı Orhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Ozgul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alp Usubutun
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Feng J, Zhao Q, Wang H, Lv W. Using laparoscopy and hysteroscopy to treat cesarean scar defects: A systematic review and meta-analysis. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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3
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Zhou D, Wu F, Zhang Q, Cui Y, Huang S, Lv Q. Clinical outcomes of hysteroscopy-assisted transvaginal repair of cesarean scar defect. J Obstet Gynaecol Res 2020; 46:279-285. [PMID: 31960535 DOI: 10.1111/jog.14161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 11/10/2019] [Indexed: 12/01/2022]
Abstract
AIM This study was conducted to evaluate comparative clinical outcomes of hysteroscopy-assisted transvaginal repair in the treatment of cesarean scar defect (CSD) in patients desirous of conceiving again. METHODS We retrospectively enrolled 63 patients with CSD who were treated at Beijing Hospital between January 2014 and January 2016. Patients were divided into the hysteroscopic electrocauterization group (electrocauterization group, n = 28) and hysteroscopy-assisted transvaginal repair group (transvaginal group, n = 35). Perioperative parameters including operation time, intraoperative blood loss, time to passage of flatus, hospitalization duration, duration of postoperative vaginal bleeding, pre- and postoperative myometrial thickness, rate of full-term births and surgical complications were compared between the two groups. RESULTS At the 6-month follow-up, myometrial thickness was significantly greater in the transvaginal group (9.8 ± 1.0 mm) compared to the electrocauterization group (3.3 ± 0.7 mm, P < 0.05). One patient in the transvaginal group required intraoperative conversion to laparotomy because of surgical complications. The transvaginal group had a significantly higher rate of full-term live birth compared to the electrocauterization group (92% vs 46%, P < 0.05). There were no significant between-group differences in the other pre-, intra-, and postoperative parameters. The maximum postoperative diameter of the CSD in the transvaginal and electrocauterization groups was 1.6 ± 0.8 and 17 ± 2.0 mm, respectively. CONCLUSION Compared to hysteroscopic electrocauterization, hysteroscopy-assisted transvaginal repair of CSD was associated with better clinical outcomes and higher rate of full-term live births.
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Affiliation(s)
- Dan Zhou
- Department of Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Fengli Wu
- Department of Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Qiao Zhang
- Department of Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Ying Cui
- Department of Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Shuai Huang
- Department of Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Qiubo Lv
- Department of Gynecology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
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Tang X, Wang J, Du Y, Xie M, Zhang H, Xu H, Hua K. Caesarean scar defect: Risk factors and comparison of evaluation efficacy between transvaginal sonography and magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2019; 242:1-6. [DOI: 10.1016/j.ejogrb.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/17/2019] [Accepted: 09/04/2019] [Indexed: 11/25/2022]
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Davari Tanha F, Dehbashi Z, Amini Harandi M. A Large Cervical Diverticulum Represented as Asherman's Syndrome. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fatemeh Davari Tanha
- Department of Reproductive Endocrinology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Dehbashi
- Department of Obstetrics and Gynecology and Reproductive Endocrinology of Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Amini Harandi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Chen H, Wang H, Zhou J, Xiong Y, Wang X. Vaginal Repair of Cesarean Section Scar Diverticula Diagnosed in Non-pregnant Women. J Minim Invasive Gynecol 2019; 26:526-534. [DOI: 10.1016/j.jmig.2018.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/01/2022]
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Babcock Gilbert S, Reading JI, Post MD, Alvero R, Al-Safi ZA. Cornual uterine diverticulum following a failed pregnancy. Gynecol Endocrinol 2018; 34:928-929. [PMID: 29733747 DOI: 10.1080/09513590.2018.1469609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The discovery of a uterine diverticulum is a rare event. Diverticula can lead to outcomes including pelvic pain, ectopic pregnancy, and diverticula rupture and should be considered in cases of uterine cystic masses. We report a case of a 32-year-old G3P0030 with a complicated pregnancy and surgical history who presented to us following an abnormal laparoscopy for severe pelvic pain four years after salpingectomy for a tubal pregnancy. This laparoscopy reported a cornual uterine cystic structure. Saline infusion sonohysterography was performed with fluid filling a uterine cornual cystic mass. On hysteroscopy, no outpouching was identified. With chromopertubation on laparoscopy, methylene blue filled the diverticulum. The diverticulum was laparoscopically removed. Pathology examination was consistent with a diverticulum containing a placental implantation site and necrotic chorionic villi.
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Affiliation(s)
- Sara Babcock Gilbert
- a Department of Obstetrics and Gynecology , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Julia I Reading
- b David Geffen School of Medicine, University of California Los Angeles , Los Angeles , CA , USA
| | - Miriam D Post
- c Department of Pathology , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Ruben Alvero
- a Department of Obstetrics and Gynecology , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Zain A Al-Safi
- a Department of Obstetrics and Gynecology , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
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Wong WSF, Fung WT. Magnetic Resonance Imaging in the Evaluation of Cesarean Scar Defect. Gynecol Minim Invasive Ther 2018; 7:104-107. [PMID: 30254950 PMCID: PMC6135163 DOI: 10.4103/gmit.gmit_23_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The incidence of Cesarean scar defect (CSD) would increase with the increasing trends of cesarean section delivery. The actual incidence of this condition is unknown, but it had been estimated by hysteroscopy, sonohysterography, or transvaginal ultrasound to be around 50% of patients with cesarean section. CSD is often asymptomatic, but it may produce common symptoms such as abnormal uterine bleeding, infertility, and pelvic pain. Adverse pregnancy outcomes with scar ectopic pregnancy, uterine rupture had been reported. The use of magnetic resonance imaging (MRI) imaging of this condition is seldom performed and reported. This paper is to analyze retrospectively the MRI finding of 158 women, so as to review the MRI findings of CSD, their appearances and measurements.
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Affiliation(s)
- Wu Shun Felix Wong
- Department of Obstetrics and Gynecology, The University of New South Wales, Sydney, New South Wales, Australia
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Pan Y, Liu MB. The value of hysteroscopic management of cesarean scar pregnancy: a report of 44 cases. Taiwan J Obstet Gynecol 2017; 56:139-142. [PMID: 28420496 DOI: 10.1016/j.tjog.2016.06.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE With the incidence of cesarean scar pregnancy (CSP) rising, the reports of serious adverse outcomes of it have increased gradually. The management of CSP remains an inadequately explored clinical field, and there is no consensus on it presently. The present study was performed to investigate the efficacy and safety of operative hysteroscopy in the diagnosis and treatment of CSP. MATERIALS AND METHODS Forty-four patients with CSP underwent operative hysteroscopy for removal of scar ectopic pregnancy in our institution. Among them, hysteroscopy was combined with laparoscopy in two patients, three cases with massive hemorrhage were pretreated with bilateral uterine artery embolization before hysteroscopic surgery, and four patients were pretreated with mifepristone (200 mg for 3 days) and methotrexate (25 mg for 2 days). Clinical data, serum β-human chorionic gonadotropin, myometrial thickness, residual conceptus, cesarean scar defect, operation time, blood loss, and hospital stay were recorded. RESULTS All of the ectopic gestations were removed entirely by operative hysteroscopy. Mean operation time was 34.8±16.5 minutes (range 20-120 minutes), and mean blood loss was 35.3±24.4 mL (range 5-100 mL). The mean hospital stay was 5.0±3.01 days (range 1-19 days). Cesarean scar defect could be diagnosed in 70% (31/44) of patients, while in 20/32 cases (63%), a conceptus remained after uterine curettage only was performed. CONCLUSION Operative hysteroscopy might be recommended as a first-line treatment modality for patients with a cesarean scar ectopic pregnancy, especially when myometrium thickness between bladder and gestational sac is more than 3 mm.
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Affiliation(s)
- Ying Pan
- Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mu-Biao Liu
- Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangzhou, China.
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Yao M, Wang W, Zhou J, Sun M, Zhu J, Chen P, Wang X. Cesarean section scar diverticulum evaluation by saline contrast-enhanced magnetic resonance imaging: The relationship between variable parameters and longer menstrual bleeding. J Obstet Gynaecol Res 2017; 43:696-704. [PMID: 28168867 DOI: 10.1111/jog.13255] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Min Yao
- Department of Gynecology, Shanghai First Maternity and Infant Hospital; affiliated to Tongji University; Shanghai China
| | - Wenjing Wang
- Department of Radiology, Shanghai First Maternity and Infant Hospital; affiliated to Tongji University; Shanghai China
| | - Jieru Zhou
- Department of Gynecology, Shanghai First Maternity and Infant Hospital; affiliated to Tongji University; Shanghai China
| | - Minghua Sun
- Department of Radiology, Shanghai First Maternity and Infant Hospital; affiliated to Tongji University; Shanghai China
| | - Jialiang Zhu
- Department of Radiology, Shanghai First Maternity and Infant Hospital; affiliated to Tongji University; Shanghai China
| | - Pin Chen
- Department of Ultrasonography, Shanghai First Maternity and Infant Hospital; affiliated to Tongji University; Shanghai China
| | - Xipeng Wang
- Department of Gynecology, Shanghai First Maternity and Infant Hospital; affiliated to Tongji University; Shanghai China
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Wahba AH, Hassan AM, Kotb M, ElShenoufy H, Haggag HM. Impact of Uterine Scar on Pain Experienced During Outpatient Hysteroscopy: A Prospective Blinded Comparative Study. J Minim Invasive Gynecol 2017; 24:626-631. [PMID: 28161494 DOI: 10.1016/j.jmig.2017.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/19/2017] [Accepted: 01/26/2017] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To study the impact of uterine scar on pain experienced during outpatient hysteroscopy. DESIGN A prospective blinded comparative study (Canadian Task Force classification II-1). SETTING Outpatient hysteroscopy clinic at a university hospital. PATIENTS We included 140 women in the childbearing period attending an outpatient hysteroscopy clinic. Patients were divided into 2 groups. Group A included patients with previous uterine scar (n = 70) and Group B included those with unscarred uterus (n = 70). None of the patients had a previous attempt of a vaginal delivery. INTERVENTION Diagnostic outpatient hysteroscopy without the use of anesthesia or analgesia. MEASUREMENTS We assessed pain experienced during and immediately after the procedure using a 100-mm visual analog scale. We also evaluated the successful completion of the procedure. RESULTS There were no statistically significant differences in the pain scores between patients with scarred uterus and those with unscarred uterus during or immediately after the procedure. The procedure was aborted in only 1 case in the scarred uterus group. This patient had a history of surgical site infection, which may denote a weak scar. There were no statistically significant differences in pain scores between patients with cesarean scar and those with myomectomy scar. No statistically significant differences in pain scores were found between patients with 1, 2, 3, or 4 cesarean deliveries. CONCLUSION Uncomplicated uterine scars do not have an impact on pain experienced during or immediately after diagnostic outpatient hysteroscopy using a 3.8-mm hysteroscope.
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Affiliation(s)
- Amr H Wahba
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt.
| | | | - Mohamed Kotb
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hossam ElShenoufy
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hisham M Haggag
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt; Department of Obstetrics and Gynecology, University of Wuerzburg, Wuerzburg, Germany
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Ledbetter KA, Shetty M, Myers DT. Hysterosalpingography: an imaging Atlas with cross-sectional correlation. ACTA ACUST UNITED AC 2014; 40:1721-32. [PMID: 25389063 DOI: 10.1007/s00261-014-0284-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hysterosalpingography (HSG) provides a unique combination of both fallopian tube and uterine cavity evaluation. A comprehensive understanding of both HSG and correlative cross-sectional imaging findings are essential radiologic skills. This article will review the spectrum of technical artifacts, anatomic variants, congenital uterine anomalies, uterine and tubal pathology, and postsurgical findings as they appear on HSG. Additionally, correlation with MR and ultrasound images is provided. This review article serves as a reference for residents new to HSG as well as staff who perform and interpret HSG infrequently.
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Affiliation(s)
- Karyn A Ledbetter
- Department of Diagnostic Radiology, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA,
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Successful management of a cesarean scar defect with dehiscence of the uterine incision by using wound lavage. Case Rep Obstet Gynecol 2014; 2014:421014. [PMID: 25431714 PMCID: PMC4241336 DOI: 10.1155/2014/421014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/13/2014] [Indexed: 11/18/2022] Open
Abstract
Cesarean scar defects (CSDs) that can be visualized using transvaginal ultrasonography (TVUS) may cause prolonged menstruation, irregular genital bleeding, and secondary infertility; surgical repair is sometimes necessary. We present a case of CSD, with dehiscence of the uterine incision, which was managed using wound lavage. A 38-year-old woman (gravida 4, para 4) had delivered her third and fourth children by cesarean section. Upon the resumption of menstruation, 9 months after her second cesarean section, she demonstrated prolonged menstruation and the presence of a menstrual fistula due to dehiscence of the cesarean section incision from the myometrium to the serosa. We treated the defect by lavaging with a physiological saline solution. After lavaging the wound 3 times, spontaneous healing of the dehiscent muscle layer was successfully achieved. The treatment was complication-free and the healing of the muscle layer has been maintained for more than 8 months.
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Allornuvor GFN, Xue M, Zhu X, Xu D. The definition, aetiology, presentation, diagnosis and management of previous caesarean scar defects. J OBSTET GYNAECOL 2014; 33:759-63. [PMID: 24219709 DOI: 10.3109/01443615.2013.816663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Caesarean sections are the most commonly performed surgical procedures involving the uterus in fertile women. Typically, this surgery involves a transverse incision in the anterior lower uterine segment. The incidence of caesarean sections is on the increase worldwide, and consequently, the complications associated with them are becoming more common. One such complication that is gaining more attention is previous lower uterine segment caesarean scar defect (PCSD). In this review, we sought to explore the definition, aetiology, presentation, diagnosis and management of PCSD.
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Affiliation(s)
- G F N Allornuvor
- Department of Obstetrics and Gynaecology, Third Xiangya Hospital, Central South University , Changsha, Hunan , China
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Bij de Vaate AJM, van der Voet LF, Naji O, Witmer M, Veersema S, Brölmann HAM, Bourne T, Huirne JAF. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:372-382. [PMID: 23996650 DOI: 10.1002/uog.13199] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/07/2013] [Accepted: 08/27/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To review systematically the medical literature reporting on the prevalence of a niche at the site of a Cesarean section (CS) scar using various diagnostic methods, on potential risk factors for the development of a niche and on niche-related gynecological symptoms in non-pregnant women. METHODS The PubMed and EMBASE databases were searched. All types of clinical study reporting on the prevalence, risk factors and/or symptoms of a niche in non-pregnant women with a history of CS were included, apart from case reports and case series. RESULTS Twenty-one papers were selected for inclusion in the review. A wide range in the prevalence of a niche was found. Using contrast-enhanced sonohysterography in a random population of women with a history of CS, the prevalence was found to vary between 56% and 84%. Nine studies reported on risk factors and each study evaluated different factors, which made it difficult to compare studies. Risk factors could be classified into four categories: those related to closure technique, to development of the lower uterine segment or location of the incision or to wound healing, and miscellaneous factors. Probable risk factors are single-layer myometrium closure, multiple CSs and uterine retroflexion. Six out of eight studies that evaluated niche-related symptoms described an association between the presence of a niche and postmenstrual spotting. CONCLUSIONS The reported prevalence of a niche in non-pregnant women varies depending on the method of detection, the criteria used to define a niche and the study population. Potential risk factors can be categorized into four main categories, which may be useful for future research and meta-analyses. The predominant symptom associated with a niche is postmenstrual spotting.
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Affiliation(s)
- A J M Bij de Vaate
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
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Peng KW, Lei Z, Xiao TH, Jia FG, Zhong WX, Gao Y, Shen BX, Xie JW. First trimester caesarean scar ectopic pregnancy evaluation using MRI. Clin Radiol 2014; 69:123-9. [DOI: 10.1016/j.crad.2013.07.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/21/2013] [Accepted: 07/24/2013] [Indexed: 10/25/2022]
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Ahmadi F, Akhbari F, Niknejad F. Various Types of Niche Imaging by Sonohysterography: A Pictorial Review. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10009-1369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. Recently cesarean section delivery has been raised around the world markedly; therefore women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual Spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy.
Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs have been used as a powerful tool for detecting the uterine scar of a previous cesarean section.
Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently.
How to cite this article
Ahmadi F, Akhbari F, Niknejad F. Various Types of Niche Imaging by Sonohysterography: A Pictorial Review. Donald School J Ultrasound Obstet Gynecol 2014;8(3):311-315.
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Comstock CH, Bronsteen RA. The antenatal diagnosis of placenta accreta. BJOG 2013; 121:171-81; discussion 181-2. [DOI: 10.1111/1471-0528.12557] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2013] [Indexed: 11/29/2022]
Affiliation(s)
- CH Comstock
- Department of Obstetrics and Gynecology; William Beaumont Hospital; Royal Oak MI USA
- Department of Obstetrics and Gynecology; University of Michigan; Ann Arbor MI USA
- Department of Obstetrics and Gynecology; Wayne State University; Detroit MI USA
| | - RA Bronsteen
- Department of Obstetrics and Gynecology; William Beaumont Hospital; Royal Oak MI USA
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Ahmadi F, Torbati L, Akhbari F, Shahrzad G. Appearance of uterine scar due to previous cesarean section on hysterosalpingography: various shapes, locations and sizes. IRANIAN JOURNAL OF RADIOLOGY : A QUARTERLY JOURNAL PUBLISHED BY THE IRANIAN RADIOLOGICAL SOCIETY 2013; 10:103-10. [PMID: 24046789 PMCID: PMC3767017 DOI: 10.5812/iranjradiol.5143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 07/07/2012] [Accepted: 01/02/2013] [Indexed: 11/16/2022]
Abstract
Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes that is used predominantly in the assessment of infertility and evaluation of abnormalities of the uterus and fallopian tubes. Some of the abnormalities that can be detected by HSG include congenital anomalies, polyps, leiomyomas, synechiae and adenomyosis. HSG is also used to evaluate any scarring on the uterus and fallopian tubes. Cesarean section is the most commonly performed surgical procedure involving the uterus in fertile women. Cesarean section involves an incision made in the lower uterine segment or isthmus. Various changes in the site of the cesarean incision may be seen due to wall weakness and fibrosis. The scar may have various shapes; unilateral or bilateral, single or multiple, wedge-shaped or linear. Awareness of the appearance and locations of uterine defects due to previous cesarean section is necessary in order to differentiate them from normal variations and other pathologies mimicking it. In this study, we demonstrate the appearance of anatomic defects of the uterine cavity on HSG after cesarian section. We define different shapes such as thin linear defect, focal saccular outpouching, unilateral or bilateral diverticula (dog-ear like) and fistula and different locations such as the uterine body, lower uterine segment, uterine isthmus and the upper endocervical canal.
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Affiliation(s)
- Firoozeh Ahmadi
- Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Corresponding author: Firoozeh Ahmadi, Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Tel.: +98-2123562446, Fax: +98-2123562172, E-mail:
| | - Leila Torbati
- Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Farnaz Akhbari
- Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Gholam Shahrzad
- Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility. Curr Opin Obstet Gynecol 2012; 24:180-6. [PMID: 22395067 DOI: 10.1097/gco.0b013e3283521202] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the treatments of the cesarean-induced isthmocele in restoring infertility, associated techniques, and the risks of complications associated with their use. RECENT FINDINGS Isthmocele is a reservoir-like pouch defect on the anterior wall of the uterine isthmus located at the site of a previous cesarean delivery scar. The flow of menstrual blood through the cervix may be slowed by the presence of isthmocele, as the blood may accumulate in the niche because of the presence of fibrotic tissue, causing pelvic pain in the suprapubic area. Moreover, persistence of the menstrual blood after menstruation in the cervix may negatively influence the mucus quality and sperm quality, obstruct sperm transport through the cervical canal, interfere with embryo implantation, leading to secondary infertility. The removal of the local inflamed tissue may be performed by laparoscopic, combined laparoscopic-vaginal, or vaginal surgery, and operative hysteroscopy, a minimally invasive approach to improve symptoms and restore fertility. SUMMARY Isthmocele occurs after cesarean section, a common method of delivery and one of the most frequent surgical procedures, so that its upward incidence appears likely to continue in the near future. Because of its minimal invasiveness, resectoscopy may be the better choice for treatment, yielding good therapeutic results.
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Luo L, Niu G, Wang Q, Xie HZ, Yao SZ. Vaginal Repair of Cesarean Section Scar Diverticula. J Minim Invasive Gynecol 2012; 19:454-8. [DOI: 10.1016/j.jmig.2012.03.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/01/2012] [Accepted: 03/08/2012] [Indexed: 10/28/2022]
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