Prospective Evaluation of the Ultrasound Signs Proposed for the Description of Uterine Niche in Nonpregnant Women.
cesarean delivery
preterm labor
residual myometrial thickness
uterine niche
uterine scar
Journal
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
ISSN: 1550-9613
Titre abrégé: J Ultrasound Med
Pays: England
ID NLM: 8211547
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
revised:
29
05
2021
received:
28
03
2021
accepted:
04
06
2021
pubmed:
2
7
2021
medline:
16
3
2022
entrez:
1
7
2021
Statut:
ppublish
Résumé
To evaluate the new ultrasound-based signs for the diagnosis of post-cesarean section uterine niche in nonpregnant women. We investigated prospectively a cohort of 160 consecutive women with one previous term cesarean delivery (CD) between December 2019 and 2020. All women were separated into two subgroups according to different stages of labor at the time of their CD: subgroup A (n = 109; 68.1%) for elective CD and CD performed in latent labor at a cervical dilatation (≤4 cm) and subgroup B (n = 51; 31.9%); for CD performed during the active stage of labor (>4 cm). Overall, the incidence of a uterine niche was significantly (P < .001) higher in women who had an elective (20/45; 44.4%) compared with those who had an emergent (21/115; 18.3%) CD. Compared with subgroup B, subgroup A presented with a significantly (P = .012) higher incidence of uterine niche located above the vesicovaginal fold and with a significantly (P = .0002) lower proportion of cesarean scar positioned below the vesicovaginal fold. There was a significantly (P < .001) higher proportion of women with a residual myometrial thickness (RMT) > 3 mm in subgroup A than in subgroup B and a significant negative relationship was found between the RMT and the cervical dilatation at CD (r = -0.22; P = .008). Sonographic cesarean section scar assessment indicates that the type of CD and the stage of labor at which the hysterotomy is performed have an impact on the location of the scar and the scarification process including the niche formation and RMT.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
917-923Informations de copyright
© 2021 American Institute of Ultrasound in Medicine.
Références
Boerma T, Ronsmans C, Melesse DY, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet 2018; 392:1341-1348.
Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update 2004; 10:515-523.
Jauniaux E, Jurkovic D. Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta 2012; 33:244-251.
Watson HA, Carter J, David AL, Seed PT, Shennan AH. Full dilation caesarean section: a risk factor for recurrent second-trimester loss and preterm birth. Acta Obstet Gynecol Scand 2017; 96:1100-1105.
Wang M, Kirby A, Gibbs E, Gidaszewski B, Khajehei M, Chua SC. Risk of preterm birth in the subsequent pregnancy following caesarean section at full cervical dilatation compared with mid-cavity instrumental delivery. Aust N Z J Obstet Gynaecol 2020; 60:382-388.
Levine LD, Sammel MD, Hirshberg A, Elovitz MA, Srinivas SK. Does stage of labor at time of cesarean delivery affect risk of subsequent preterm birth? Am J Obstet Gynecol 2015; 212:360.e1-360.e7.
Naji O, Wynants L, Smith A, et al. Does the presence of a caesarean section scar affect implantation site and early pregnancy outcome in women attending an early pregnancy assessment unit? Hum Reprod 2013; 28:1489-1496.
Vikhareva Osser O, Valentin L. Clinical importance of appearance of cesarean hysterotomy scar at transvaginal ultrasonography in nonpregnant women. Obstet Gynecol 2011; 117:525-532.
Bij de Vaate AJ, Brolmann HA, van der Voet LF, van der Slikke JW, Veersema S, Huirne JA. Ultrasound evaluation of the cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol 2011; 37:93-99.
van der Voet LF, Bij de Vaate AM, Veersema S, Brolmann HA, Huirne JA. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG 2014; 121:236-244.
Tower AM, Frishman GN. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol 2013; 20:562-572.
Schepker N, Garcia-Rocha GJ, von Versen-Hoynck F, Hillemanns P, Schippert C. Clinical diagnosis and therapy of uterine scar defects after caesarean section in non-pregnant women. Arch Gynecol Obstet 2015; 291:1417-1423.
Roeder HA, Cramer SF, Leppert PC. A look at uterine wound healing through a histopathological study of uterine scars. Reprod Sci 2012; 19:463-473.
Ben-Nagi J, Walker A, Jurkovic D, Yazbek J, Aplin JD. Effect of cesarean delivery on the endometrium. Int J Gynaecol Obstet 2009; 106:30-34.
Wu C, Chen X, Mei Z, et al. A preliminary study of uterine scar tissue following cesarean section. J Perinat Med 2018; 46:379-386.
Flo K, Widnes C, Vårtun Å, Acharya G. Blood flow to the scarred gravid uterus at 22-24 weeks of gestation. BJOG 2014; 121:210-215.
Buhimschi CS, Zhao G, Sora N, Madri JA, Buhimschi IA. Myometrial wound healing post-cesarean delivery in the MRL/MpJ mouse model of uterine scarring. Am J Pathol 2010; 177:197-207.
Jauniaux E, Moffett A, Burton GJ. Placental implantation disorders. Obstet Gynecol Clin North Am 2020; 47:117-132.
Zosmer N, Fuller J, Shaikh H, Johns J, Ross JA. Natural history of early first-trimester pregnancies implanted in cesarean scars. Ultrasound Obstet Gynecol 2015; 46:367-375.
Timor-Tritsch IE, Monteagudo A, Cali G, et al. Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound Obstet Gynecol 2014; 43:383-395.
Antila-Langsjo RM, Maenpaa JU, Huhtala HS, Tomas EI, Staff SM. Cesarean scar defect: a prospective study on risk factors. Am J Obstet Gynecol 2018; 219:458.e1-458.e8.
Vikhareva O, Rickle GS, Lavesson T, Nedopekina E, Brandell K, Salvesen KA. Hysterotomy level at cesarean section and occurrence of obstetrics & gynecology. Ultrasound Obstet Gynecol 2019; 53:438-442.
Regnard C, Nosbusch M, Fellemans C, et al. Cesarean section scar evaluation by saline contrast sonohysterography. Ultrasound Obstet Gynecol 2004; 23:289-292.
Jordans IPM, de Leeuw RA, Stegwee SI, et al. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure. Ultrasound Obstet Gynecol 2019; 53:107-115.
Zimerman AL, Smolin A, Maymon R, Weinraub Z, Herman A, Tobvin Y. Intrapartum measurement of cervical dilatation using translabial 3-dimensional ultrasonography: correlation with digital examination and interobserver and intraobserver agreement assessment. J Ultrasound Med 2009; 28:1289-1296.
Antoine C, Pimentel RN, Reece EA, Oh C. Endometrium-free uterine closure technique and abnormal placental implantation in subsequent pregnancies. J Matern Fetal Neonatal Med 2019; 3:1-9.
Ofili-Yebovi D, Ben-Nagi J, Sawyer E, et al. Deficient lower-segment cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol 2008; 31:72-77.
Roberge S, Demers S, Berghella V, Chaillet N, Moore L, Bujold E. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis. Am J Obstet Gynecol 2014; 211:453-460.
Stegwee SI, Jordans I, van der Voet LF, et al. Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta-analysis. BJOG 2018; 125:1097-1108.
Di Spiezio SA, Saccone G, McCurdy R, Bujold E, Bifulco G, Berghella V. Risk of cesarean scar defect in single- versus double-layer uterine closure: a systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol 2017; 50:578-583.
Antoine C, Pimentel RN, Timor-Tritsch IE, Mittal K, Bennett TA, Bourroul FM. Origin of a post-cesarean delivery niche: diagnosis, pathophysiologic characteristics, and video documentation. J Ultrasound Med 2021; 40:205-208.
Stegwee SI, Jordans IPM, van der Voet LF, et al. Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development-the 2Close study: a multicentre randomised controlled trial. BMC Pregnancy Childbirth 2019; 19:85.
Kamel R, Eissa T, Sharaf M, Negm S, Thilaganathan B. Position and integrity of uterine scar are determined by degree of cervical dilatation at time of Cesarean section. Ultrasound Obstet Gynecol 2021; 57:466-470.
Zimmer EZ, Bardin R, Tamir A, Bronshtein M. Sonographic imaging of cervical scars after cesarean section. Ultrasound Obstet Gynecol 2004; 23:594-598.
Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC III, Hauth JC, Wenstrom KD (eds). Williams Obstetrics. 1st ed. New York, NY: McGraw-Hill Professional; 2001:256.
Glazewska-Hallin A, Story L, Suff N, Shennan A. Late-stage cesarean section causes recurrent early preterm birth: how to tackle this problem? Ultrasound Obstet Gynecol 2019; 54:293-296.
Berghella V, Gimovsky AC, Levine LD, Vink J. Cesarean in the second stage: a possible risk factor for subsequent spontaneous preterm birth. Am J Obstet Gynecol 2017; 217:1-3.
Vink JY, Qin S, Brock CO, et al. A new paradigm for the role of smooth muscle cells in the human cervix. Am J Obstet Gynecol 2016; 215:478.e1-478.e11.
Kamara M, Henderson JJ, Doherty DA, Dickinson JE, Pennell CE. The risk of placenta accreta following primary elective caesarean delivery: a case-control study. BJOG 2013; 120:879-886.
Colmorn LB, Krebs L, Jakobsson M, et al. Mode of first delivery and severe maternal complications in the subsequent pregnancy. Acta Obstet Gynecol Scand 2017; 96:1053-1062.
Mashiach R, Burke YZ. Optimal Isthmocele management: hysteroscopic, laparoscopic, or combination. J Minim Invasive Gynecol 2021; 28:565-574.
Vitale SG, Ludwin A, Vilos GA, et al. From hysteroscopy to laparo-endoscopic surgery: what is the best surgical approach for symptomatic isthmocele? A systematic review and meta-analysis. Arch Gynecol Obstet 2020; 301:33-52.
Maymon R, Halperin R, Mendlovic S, et al. Ectopic pregnancies in caesarean section scars: the 8-year experience of one medical Centre. Hum Reprod 2004; 19:278-284.