Definition of large niche after Cesarean section based on prediction of postmenstrual spotting: Chinese cohort study in non-pregnant women.
Cesarean section
definition
large niche
transvaginal sonography
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
revised:
14
11
2021
received:
20
06
2021
accepted:
15
11
2021
pubmed:
23
11
2021
medline:
6
4
2022
entrez:
22
11
2021
Statut:
ppublish
Résumé
A large niche after Cesarean section (CS) is associated with long-term complications, of which postmenstrual spotting is associated positively with the size of the niche. However, the diagnosis of a large niche in the literature is inconsistent and the definition is largely subjective. The aim of this study was to generate a definition for a large niche in non-pregnant women based on the presence of postmenstrual spotting. Women who had undergone CS in our hospital between January 2012 and June 2017 were selected randomly from our database, contacted by telephone and subsequently examined between January 2016 and June 2020. Eligible for inclusion were non-pregnant women who had their last CS more than 1 year earlier and agreed to undergo transvaginal sonography (TVS). All participants underwent examination of their CS scar by TVS (two-dimensional color Doppler) during the midfollicular phase. Niche depth, length, width, residual myometrial thickness (RMT), adjacent myometrial thickness (AMT) and ratio of niche depth/AMT were recorded. Women diagnosed with a niche, defined as an indentation at the site of the CS with a depth of at least 2 mm, were classified into two groups (symptomatic or asymptomatic) according to whether they experienced postmenstrual spotting. Logistic regression analysis was used to establish the best cut-off values for the niche parameters to predict postmenstrual spotting. A new definition was generated based on the niche parameters with the highest area under the receiver-operating-characteristics (ROC) curve (AUC) for the prediction of postmenstrual spotting. A total of 727 women who had a CS > 1 year earlier underwent TVS examination, of whom 263 were diagnosed with a niche (prevalence of 36.2%). Of these, 160 women experienced postmenstrual spotting and 103 were asymptomatic. The three variables with the highest AUC for prediction of postmenstrual spotting were niche depth/AMT ratio (AUC, 0.798; 95% CI, 0.745-0.852), niche depth (AUC, 0.731; 95% CI, 0.668-0.795) and RMT (AUC, 0.683; 95% CI, 0.618-0.748). Based on the best cut-offs according to ROC-curve analysis, a large niche was defined as: niche depth ≥ 0.50 cm, RMT ≤ 0.21 cm or niche depth/AMT ratio ≥ 0.56. The prevalence of a large niche according to this definition was 22.4% (163/727). The new definition had a specificity of 61.17% (95% CI, 52.34-70.41%) and sensitivity of 76.87% (95% CI, 70.28-84.16%) for a large niche. This study has provided a new definition for a large niche after CS. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
450-456Informations de copyright
© 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Références
Bij de Vaate, AJ, van der Voet LF, Naji O, Witmer M, Veersema S, Brölmann HA, Bourne T, Huirne JA. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. Ultrasound Obstet Gynecol 2014; 43: 372-382.
Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM; WHO Working Group on Caesarean Section. WHO Statement on Caesarean Section Rates. BJOG 2016; 123: 667-670.
Kang L, Ye S, Jing K, Fan Y, Chen Q, Zhang N, Zhang B. A Segmented Logistic Regression Approach to Evaluating Change in Caesarean Section Rate with Reform of Birth Planning Policy in Two Regions in China from 2012 to 2016. Risk Manag Healthc Policy 2020; 13: 245-253.
Jordans IPM, de Leeuw RA, Stegwee SI, Amso NN, Barri-Soldevila PN, van den Bosch T, Bourne T, Brölmann HAM, Donnez O, Dueholm M, Hehenkamp WJK, Jastrow N, Jurkovic D, Mashiach R, Naji O, Streuli I, Timmerman D, van der Voet LF, Huirne JAF. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure. Ultrasound Obstet Gynecol 2019; 53: 107-115.
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.
Sholapurkar SL. Etiology of Cesarean Uterine Scar Defect (Niche): Detailed Critical Analysis of Hypotheses and Prevention Strategies and Peritoneal Closure Debate. J Clin Med Res 2018; 10: 166-173.
Vikhareva Osser O, Valentin L. Risk factors for incomplete healing of the uterine incision after caesarean section. BJOG 2010; 117: 1119-1126.
Valentin L. Prediction of scar integrity and vaginal birth after caesarean delivery. Best Pract Res Clin Obstet Gynaecol 2013; 27: 285-295.
Pomorski M, Fuchs T, Zimmer M. Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the nonpregnant uterus: a prospective observational study. BMC Pregnancy Childbirth 2014; 14: 365.
Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, Brölmann HA, Mol BW, Huirne JA. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod 2015; 30: 2695-2702.
van der Voet LF, Bij de Vaate AM, Veersema S, Brölmann 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.
Wang CB, Chiu WW, Lee CY, Sun YL, Lin YH, Tseng CJ. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol 2009; 34: 85-89.
Uppal T, Lanzarone V, Mongelli M. Sonographically detected caesarean section scar defects and menstrual irregularity. J Obstet Gynaecol 2011; 31: 413-416.
Du Q, Liu G, Zhao W. A novel method for typing of cesarean scar pregnancy based on size of cesarean scar diverticulum and its significance in clinical decision-making. J Obstet Gynaecol Res 2020; 46: 707-714.
Monteagudo A, Carreno C, Timor-Tritsch IE. Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the “niche” in the scar. J Ultrasound Med 2001; 20: 1105-1115.
Regnard C, Nosbusch M, Fellemans C, Benali N, van Rysselberghe M, Barlow P, Rozenberg S. Cesarean section scar evaluation by saline contrast sonohysterography. Ultrasound Obstet Gynecol 2004; 23: 289-292.
Ofili-Yebovi D, Ben-Nagi J, Sawyer E, Yazbek J, Lee C, Gonzalez J, Jurkovic D. Deficient lower-segment Cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol 2008; 31: 72-77.
Vikhareva Osser O, Jokubkiene L, Valentin L. High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol 2009; 34: 90-97.
Vikhareva Osser O, Jokubkiene L, Valentin L. Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement. Ultrasound Obstet Gynecol 2010; 35: 75-83.
Vervoort A, Vissers J, Hehenkamp W, Brölmann H, Huirne J. The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study. BJOG 2018; 125: 317-325.
Naji O, Abdallah Y, Bij De Vaate AJ, Smith A, Pexsters A, Stalder C, McIndoe A, Ghaem-Maghami S, Lees C, Brölmann HA, Huirne JA, Timmerman D, Bourne T. Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol 2012; 39: 252-259.
Pomorski M, Fuchs T, Rosner-Tenerowicz A, Zimmer M. Standardized ultrasonographic approach for the assessment of risk factors of incomplete healing of the cesarean section scar in the uterus. Eur J Obstet Gynecol Reprod Biol 2016; 205: 141-145.
Rasheedy R, Sammour H, Elkholy A, Fadel E. Agreement between transvaginal ultrasound and saline contrast sonohysterography in evaluation of cesarean scar defect. J Gynecol Obstet Hum Reprod 2019; 48: 827-831.
Bij de Vaate AJ, Brölmann 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.
Marjolein Bij de Vaate AJ, Linskens IH, van der Voet LF, Twisk JW, Brölmann HA, Huirne JA. Reproducibility of three-dimensional ultrasound for the measurement of a niche in a caesarean scar and assessment of its shape. Eur J Obstet Gynecol Reprod Biol 2015; 188: 39-44.
Vikhareva O, Rickle GS, Lavesson T, Nedopekina E, Brandell K, Salvesen KÅ. Hysterotomy level at Cesarean section and occurrence of large scar defects: a randomized single-blind trial. Ultrasound Obstet Gynecol 2019; 53: 438-442.
Vervoort A, van der Voet LF, Hehenkamp W, Thurkow AL, van Kesteren P, Quartero H, Kuchenbecker W, Bongers M, Geomini P, de Vleeschouwer L, van Hooff M, van Vliet H, Veersema S, Renes WB, Oude Rengerink K, Zwolsman SE, Brölmann H, Mol B, Huirne J. Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial. BJOG 2018; 125: 326-334.
Pomorski M, Fuchs T, Rosner-Tenerowicz A, Zimmer M. Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section. Ginekol Pol 2017; 88: 174-179.
Bujold E, Jastrow N, Simoneau J, Brunet S, Gauthier RJ. Prediction of complete uterine rupture by sonographic evaluation of the lower uterine segment. Am J Obstet Gynecol 2009; 201: 320.e1-6.
Timor-Tritsch IE, Horwitz G, D'Antonio F, Monteagudo A, Bornstein E, Chervenak J, Messina L, Morlando M, Cali G. Recurrent Cesarean scar pregnancy: case series and literature review. Ultrasound Obstet Gynecol 2021; 58: 121-126.