Fertility outcomes after hysteroscopic niche resection compared with expectant management in women with a niche in the uterine cesarean scar

Chuqing He; Wei Xia; Li Yan; Yang Wang; Yuan Tian; Ben W. Mol; Jian Zhang; J. A.F. Huirne

doi:10.1016/j.ejogrb.2023.03.009

Fertility outcomes after hysteroscopic niche resection compared with expectant management in women with a niche in the uterine cesarean scar

Chuqing He, Wei Xia, Li Yan, Yang Wang, Yuan Tian, Ben W. Mol, Jian Zhang^*, J. A.F. Huirne

^*Corresponding author for this work

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Abstract

Objective: To determine whether hysteroscopic niche resection (HNR) and expectant management are suitable in women with fertility desire and a niche with a residual myometrium thickness (RMT) ≥ 2.5 mm. Study design: This retrospective cohort study was conducted at International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China between September 2016 and December 2021. We reported the fertility outcomes between women (with fertility desire and a niche with RMT ≥ 2.5 mm) who received HNR or expectant management. Results: We studied 166 women, of whom 72 accepted HNR and 94 accepted expectant management. The HNR group included more symptomatic women, in terms of postmenstrual spotting or infertility. No differences were found regarding niche measures before treatment. The live birth rate was comparable in both groups (HNR versus expectant management as 55.5% versus 45.7%, risk ratio = 1.48, 95% Cl 0.80–2.75, p = 0.21). The pregnancy rate was higher in HNR group than that in expectant management group (n = 72.2% versus n = 56.4%, risk ratio = 2.01, 95% CI 1.04–3.88, p = 0.04). In a subgroup of women with infertility before entry in the study, HNR resulted in a significant higher live birth rate (p = 0.04) and pregnancy rate (p = 0.01). Conclusion: In women with infertility with a symptomatic niche with RMT ≥ 2.5 mm, HNR may be superior to expectant management. This retrospective cohort biased selection against a randomized study, our results still need to be validated in the future with larger clinical multicenter randomized controlled trials.

Original language	English
Pages (from-to)	136-142
Number of pages	7
Journal	European Journal of Obstetrics and Gynecology and Reproductive Biology
Volume	284
Early online date	27 Mar 2023
DOIs	https://doi.org/10.1016/j.ejogrb.2023.03.009
Publication status	Published - May 2023

Bibliographical note

Funding Information:
This work was supported by Medical innovation research project of the 2020 'Science and Technology Innovation Action Plan' of Shanghai Science and Technology Commission (20Y11907700) and Shanghai Municipal Key Clinical Specialty (shslczdzk01802).

Funding Information:
We appreciated all the participants in this study and all the staff at International Peace Maternal and Child Health Hospital for their precise data recording. Jian Zhang and Ben W. Mol conceived and designed this study; Jian Zhang, JAF Hurine and Ben W. Mol contributed to the manuscript editing and language editing; Chuqing He was responsible for the data analysis and manuscript writing; Wei Xia, Li Yan, Yang Wang and Yuan Tian contributed to the data collection. The final version of manuscript has been approved by all authors.

Publisher Copyright:
© 2023 The Authors

Keywords

Expectant management
Fertility outcomes
Hysteroscopic niche resection
Live birth Rate
Niche
Pregnancy rate

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10.1016/j.ejogrb.2023.03.009

He_etal_EJOGRB_Fertility_Outcomes_After_VOR
© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/).
Final published version, 1.23 MBLicence: CC BY-NC-ND

Cite this

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title = "Fertility outcomes after hysteroscopic niche resection compared with expectant management in women with a niche in the uterine cesarean scar",

abstract = "Objective: To determine whether hysteroscopic niche resection (HNR) and expectant management are suitable in women with fertility desire and a niche with a residual myometrium thickness (RMT) ≥ 2.5 mm. Study design: This retrospective cohort study was conducted at International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China between September 2016 and December 2021. We reported the fertility outcomes between women (with fertility desire and a niche with RMT ≥ 2.5 mm) who received HNR or expectant management. Results: We studied 166 women, of whom 72 accepted HNR and 94 accepted expectant management. The HNR group included more symptomatic women, in terms of postmenstrual spotting or infertility. No differences were found regarding niche measures before treatment. The live birth rate was comparable in both groups (HNR versus expectant management as 55.5% versus 45.7%, risk ratio = 1.48, 95% Cl 0.80–2.75, p = 0.21). The pregnancy rate was higher in HNR group than that in expectant management group (n = 72.2% versus n = 56.4%, risk ratio = 2.01, 95% CI 1.04–3.88, p = 0.04). In a subgroup of women with infertility before entry in the study, HNR resulted in a significant higher live birth rate (p = 0.04) and pregnancy rate (p = 0.01). Conclusion: In women with infertility with a symptomatic niche with RMT ≥ 2.5 mm, HNR may be superior to expectant management. This retrospective cohort biased selection against a randomized study, our results still need to be validated in the future with larger clinical multicenter randomized controlled trials.",

keywords = "Expectant management, Fertility outcomes, Hysteroscopic niche resection, Live birth Rate, Niche, Pregnancy rate",

author = "Chuqing He and Wei Xia and Li Yan and Yang Wang and Yuan Tian and Mol, {Ben W.} and Jian Zhang and Huirne, {J. A.F.}",

note = "Funding Information: This work was supported by Medical innovation research project of the 2020 'Science and Technology Innovation Action Plan' of Shanghai Science and Technology Commission (20Y11907700) and Shanghai Municipal Key Clinical Specialty (shslczdzk01802). Funding Information: We appreciated all the participants in this study and all the staff at International Peace Maternal and Child Health Hospital for their precise data recording. Jian Zhang and Ben W. Mol conceived and designed this study; Jian Zhang, JAF Hurine and Ben W. Mol contributed to the manuscript editing and language editing; Chuqing He was responsible for the data analysis and manuscript writing; Wei Xia, Li Yan, Yang Wang and Yuan Tian contributed to the data collection. The final version of manuscript has been approved by all authors. Publisher Copyright: {\textcopyright} 2023 The Authors",

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language = "English",

volume = "284",

pages = "136--142",

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T1 - Fertility outcomes after hysteroscopic niche resection compared with expectant management in women with a niche in the uterine cesarean scar

AU - He, Chuqing

AU - Xia, Wei

AU - Yan, Li

AU - Wang, Yang

AU - Tian, Yuan

AU - Mol, Ben W.

AU - Zhang, Jian

AU - Huirne, J. A.F.

N1 - Funding Information: This work was supported by Medical innovation research project of the 2020 'Science and Technology Innovation Action Plan' of Shanghai Science and Technology Commission (20Y11907700) and Shanghai Municipal Key Clinical Specialty (shslczdzk01802). Funding Information: We appreciated all the participants in this study and all the staff at International Peace Maternal and Child Health Hospital for their precise data recording. Jian Zhang and Ben W. Mol conceived and designed this study; Jian Zhang, JAF Hurine and Ben W. Mol contributed to the manuscript editing and language editing; Chuqing He was responsible for the data analysis and manuscript writing; Wei Xia, Li Yan, Yang Wang and Yuan Tian contributed to the data collection. The final version of manuscript has been approved by all authors. Publisher Copyright: © 2023 The Authors

PY - 2023/5

Y1 - 2023/5

N2 - Objective: To determine whether hysteroscopic niche resection (HNR) and expectant management are suitable in women with fertility desire and a niche with a residual myometrium thickness (RMT) ≥ 2.5 mm. Study design: This retrospective cohort study was conducted at International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China between September 2016 and December 2021. We reported the fertility outcomes between women (with fertility desire and a niche with RMT ≥ 2.5 mm) who received HNR or expectant management. Results: We studied 166 women, of whom 72 accepted HNR and 94 accepted expectant management. The HNR group included more symptomatic women, in terms of postmenstrual spotting or infertility. No differences were found regarding niche measures before treatment. The live birth rate was comparable in both groups (HNR versus expectant management as 55.5% versus 45.7%, risk ratio = 1.48, 95% Cl 0.80–2.75, p = 0.21). The pregnancy rate was higher in HNR group than that in expectant management group (n = 72.2% versus n = 56.4%, risk ratio = 2.01, 95% CI 1.04–3.88, p = 0.04). In a subgroup of women with infertility before entry in the study, HNR resulted in a significant higher live birth rate (p = 0.04) and pregnancy rate (p = 0.01). Conclusion: In women with infertility with a symptomatic niche with RMT ≥ 2.5 mm, HNR may be superior to expectant management. This retrospective cohort biased selection against a randomized study, our results still need to be validated in the future with larger clinical multicenter randomized controlled trials.

AB - Objective: To determine whether hysteroscopic niche resection (HNR) and expectant management are suitable in women with fertility desire and a niche with a residual myometrium thickness (RMT) ≥ 2.5 mm. Study design: This retrospective cohort study was conducted at International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China between September 2016 and December 2021. We reported the fertility outcomes between women (with fertility desire and a niche with RMT ≥ 2.5 mm) who received HNR or expectant management. Results: We studied 166 women, of whom 72 accepted HNR and 94 accepted expectant management. The HNR group included more symptomatic women, in terms of postmenstrual spotting or infertility. No differences were found regarding niche measures before treatment. The live birth rate was comparable in both groups (HNR versus expectant management as 55.5% versus 45.7%, risk ratio = 1.48, 95% Cl 0.80–2.75, p = 0.21). The pregnancy rate was higher in HNR group than that in expectant management group (n = 72.2% versus n = 56.4%, risk ratio = 2.01, 95% CI 1.04–3.88, p = 0.04). In a subgroup of women with infertility before entry in the study, HNR resulted in a significant higher live birth rate (p = 0.04) and pregnancy rate (p = 0.01). Conclusion: In women with infertility with a symptomatic niche with RMT ≥ 2.5 mm, HNR may be superior to expectant management. This retrospective cohort biased selection against a randomized study, our results still need to be validated in the future with larger clinical multicenter randomized controlled trials.

KW - Expectant management

KW - Fertility outcomes

KW - Hysteroscopic niche resection

KW - Live birth Rate

KW - Niche

KW - Pregnancy rate

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JO - European Journal of Obstetrics and Gynecology and Reproductive Biology

JF - European Journal of Obstetrics and Gynecology and Reproductive Biology

ER -

Fertility outcomes after hysteroscopic niche resection compared with expectant management in women with a niche in the uterine cesarean scar

Abstract

Bibliographical note

Keywords

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