TY - JOUR
T1 - Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting
T2 - a randomised controlled trial
AU - Vervoort, A. J.M.W.
AU - van der Voet, L. F.
AU - Hehenkamp, W. J.K.
AU - Thurkow, A. L.
AU - van Kesteren, P. J.M.
AU - Quartero, H.
AU - Kuchenbecker, W.
AU - Bongers, M.
AU - Geomini, P.
AU - de Vleeschouwer, L. H.M.
AU - van Hooff, M. H.A.
AU - van Vliet, H.
AU - Veersema, S.
AU - Renes, W. B.
AU - Oude Rengerink, K.
AU - Zwolsman, S. E.
AU - Brölmann, H. A.M.
AU - Mol, B. W.J.
AU - Huirne, J. A.F.
N1 - This study is funded by ZonMw, a Dutch organization for Health Research and Development (project number 80-82305-97-12030) and was co-funded by the VU University Medical Centre Amsterdam. These sponsors had no role in the study design, data collection, data analysis, data interpretation or writing of this article.
PY - 2018/2
Y1 - 2018/2
N2 - Objective: To compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect. Design: Multicentre randomised controlled trial. Setting: Eleven hospitals collaborating in a consortium for women's health research in the Netherlands. Population: Women reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3 mm, measured during sonohysterography. Methods: Women were randomly allocated to hysteroscopic niche resection or expectant management for 6 months. Main outcome measures: The primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of lifel.macrae@abdn.ac.uk, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation. Results: We randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2–7 days) in the intervention group and 7 days (IQR 3–10 days) in the control group (P = 0.04); on a scale of 0–10, discomfort as a result of spotting had a median score of 2 (IQR 0–7) in the intervention group, compared with 7 (IQR 0–8) in the control group (P = 0.02). Conclusions: In women with a niche with a residual myometrium of ≥3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting-related discomfort. Tweetable abstract: A hysteroscopic niche resection is an effective treatment to reduce niche-related spotting.
AB - Objective: To compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect. Design: Multicentre randomised controlled trial. Setting: Eleven hospitals collaborating in a consortium for women's health research in the Netherlands. Population: Women reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3 mm, measured during sonohysterography. Methods: Women were randomly allocated to hysteroscopic niche resection or expectant management for 6 months. Main outcome measures: The primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of lifel.macrae@abdn.ac.uk, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation. Results: We randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2–7 days) in the intervention group and 7 days (IQR 3–10 days) in the control group (P = 0.04); on a scale of 0–10, discomfort as a result of spotting had a median score of 2 (IQR 0–7) in the intervention group, compared with 7 (IQR 0–8) in the control group (P = 0.02). Conclusions: In women with a niche with a residual myometrium of ≥3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting-related discomfort. Tweetable abstract: A hysteroscopic niche resection is an effective treatment to reduce niche-related spotting.
KW - Abnormal uterine bleeding
KW - caesarean section
KW - hysteroscopic resection
KW - niche
KW - postmenstrual spotting
UR - http://www.scopus.com/inward/record.url?scp=85021735850&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.14733
DO - 10.1111/1471-0528.14733
M3 - Article
C2 - 28504857
AN - SCOPUS:85021735850
VL - 125
SP - 326
EP - 334
JO - BJOG-An International Journal of Obstetrics and Gynaecology
JF - BJOG-An International Journal of Obstetrics and Gynaecology
SN - 1470-0328
IS - 3
ER -