Niche, a growing problem for gynecologist and obstetrician.
DOI:
https://doi.org/10.31686/ijier.vol8.iss2.2170Keywords:
cesarean scar defect, isthmocele, niche, sonohysterography, abnormal uterine bleedingAbstract
Niche formation is a growing problem in Brazil and worldwide. Today, cesarean delivery rates far exceed levels recommended by the World Health Organization. The procedure constitutes the most common surgery in the world, and its most frequent complication is niche formation (84% prevalence), as detected by sonohysterography. Several gynecological problems related to this cesarean scar defect can ensue, with the most frequent symptom being abnormal uterine bleeding. Obstetric problems in subsequent pregnancies include uterine rupture, abnormal placentation, and cesarean scar pregnancy. Recommended treatments yield good results, but there is no consensus on niche prevention, owing to an incomplete understanding of its pathophysiology. Comparisons of surgical techniques have revealed no significant differences. Further studies are needed to elucidate the multifactorial pathophysiology of niche and help to develop approaches for preventing its occurrence.
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References
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[4] Scapinelli, A.; Lugó, C.; Depes, D.B.; Yatabe, S.; Gomes, A. M. P.; Baracat, F. F.; Lopes, R. G. C. Cicatriz da cesariana: implicações ginecológicas e aspectos atuais. Femina, v. 37, n. 7, p. 395-398, jul. 2009. lil-537582
[5] Bij De Vaate, A.J.; Van Der Voet, L. F.; Naji, O.; Witmer, M.; Veersema, S.; Brölmann, H. A.; Bourne, T.; Huirne, J. A. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section: systematic review. Ultrasound in Obstetrics & amp; Gynecology, v. 43, n. 4, p. 372-382, Apr. 2014. DOI: 10.1002/uog.13199
[6] Fabres, C.; Arriagada, P.; Fernández, C.; Mackenna, A.; Zegers, F.; Fernández, E. Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect. Journal of Minimally Invasive Gynecology, v. 12, n. 1, p. 25-28, Jan. 2005. DOI:10.1016/j.jmig.2004.12.023
[7] Vervoort, A. J. M. W.; Van Der Voet, L.F.; Witmer, M.; Thurkow, A. L.; Radder, C. M.; Van Kesteren, P. J. M.; Quartero, H. W. P.; Kuchembecker, W. K. H.; Bongers, M. Y.; Geomini, P. M. A. J.; Vleeschouver, L. H. M.; Van Hooff, M. H. A.; Van Vliet, H. A. A. M.; Veersema, S.; Renes, W. B.; Van Meurs, H. S.; Bosmans, J.; Ouge Rengerink, K.; Brölmann, H. A. M.; Mol, B. W. J.; Huirne, J. A. F. The HysNiche trial: hysteroscopic resection of uterine caesarean scar defect (niche) in patients with abnormal bleeding, a randomised controlled trial. Bio Med Central Women's Health, v. 15 n. 103, p. 1-9, Feb. 2012. DOI 10.1186/s12905-015-0260-8
[8] Tulandi, T.; Cohen, A. Emerging manifestations of cesarean scar defect in reproductive-aged women. Journal of Minimally Invasive Gynecology, v. 23, n. 6, p. 893-902, Sep. 2016. http://dx.doi.org/10.1016/j.jmig.2016.06.020
[9] Kremer, T. G.; Ghiorzi, I. B.; Dibi, R. P. Isthmocele: an overview of diagnosis and treatment. Revista da Associação Médica Brasileira, v. 65, n. 5, p. 714-721, jun. 2019. http://dx.doi.org/10.1590/1806-9282.65.5.714
[10] Kok, N.; Wiersma, I. C.; Opmeer, B. C.; De Graaf, I. M.; Mol, B. W., Pajkrt, E. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous cesarean section: a meta-analysis. Ultrasound in Obstetrics & amp; Gynecology, v. 42, n. 2, p. 132-139, Aug. 2013. DOI: 10.1002/uog.12479
[11] Mannini, L.; Sorbi, F.; Ghizzoni, V.; Masini, G.; Fambrini, M.; Noci, I. Spontaneous unscarred uterine rupture at 15 weeks of pregnancy: a case report. Ochsner Journal, v. 16, n. 4, p. 545-547, 2016. PMID: 27999515
[12] Lydon-Rochelle, M.; Holt, V. L.; Easterling, T.R.; Martin, D. P. Risk of uterine rupture during labor among women with a prior cesarean delivery. The New England Journal of Medicine, v. 345, n. 1, p. 3-8, July 2001. DOI: 10.1056/NEJM200107053450101
[13] Yasmin, S.; Sadaf, J.; Fatima, N. Impact of methods for uterine incision closure on repeat caesarean section scar of lower uterine segment. Journal of the College of Physicians and Surgeons Pakistan, v. 21, n. 9, p. 522-526, Sep. 2011. DOI: 09.2011/JCPSP.522526
[14] Osser, O. V.; Jokubkiene, L.; Valentin, L. High prevalence of defects in cesarean section scars at transvaginal ultrasound examination. Ultrasound in Obstetrics & amp; Gynecology, v. 34, n. 1, p. 90-97, July 2009. DOI: 10.1002/uog.6395
[15] Jastrow, N.; Demers, S.; Chaillet, N.; Girard, M.; Gauthier, R. J.; Pasquier, J. C.; Abdous, B.; Vachon-Marceau, C.; Marcoux, S.; Irion, O.; Brassard, N.; Boulvain, M.; Bujold, E. Lower uterine segment thickness to prevent uterine rupture and adverse perinatal outcomes: a multicenter prospective study. American Journal of Obstetrics & Gynecology, v. 215, n. 5, p. 604e1-604e6, Nov. 2016. http://dx.doi.org/10.1016/j.ajog.2016.06.018
[16] Seliger, G.; Chaoui, K.; Lautenschläger, C.; Riemer, M.; Tchirikov, M. Technique of sonographic assessment of lower uterine segment in women with previous cesarean delivery: a prospective, pre/intraoperative comparative ultrasound study. Archives of Gynecology and Obstetrics, v. 298, N. 2, p. 297-306, Aug. 2018. https://doi.org/10.1007/s00404-018-4805-6
[17] Fabres, C.; Aviles, G.; De La Jara, C.; Escalona, J.; Muñoz, J.F.; Mackenna, A.; Fernández, C.; Zegers-Hochschild, F.; Fernández E. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. Journal of Ultrasound in Medicine, v. 22, n. 7, p.695-700, July 2003. https://doi.org/10.7863/jum.2003.22.7.695
[18] Antila-Långsjö, R. M.; Mäenpää, J. U.; Huhtala, H. S.; Tomás, E. I.; Staff, S. M. Cesarean scar defect: a prospective study on risk factors. American Journal of Obstetrics & Gynecology, v. 458, n. 5, p. 458.e1-458.e8, Nov. 2018. https://doi.org/10.1016/j.ajog.2018.09.004
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Copyright (c) 2020 Newton de Paula Ishikawa, Nathalia Bersi Ishikawa, Mayra Prado Rodrigues, Maria Clara de Oliveira Junqueira, César Augusto Sobrinho, Iandara Schettert Silva, Rondon Tosta Ramalho, Ricardo Dutra Aydos
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de Paula Ishikawa, N., Bersi Ishikawa, N., Prado Rodrigues, M., de Oliveira Junqueira, M. C., Augusto Sobrinho, C., Schettert Silva, I., Tosta Ramalho, R., & Dutra Aydos, R. (2020). Niche, a growing problem for gynecologist and obstetrician. International Journal for Innovation Education and Research, 8(2), 66-78. https://doi.org/10.31686/ijier.vol8.iss2.2170
