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Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial
Author(s) -
Vervoort AJMW,
Voet LF,
Hehenkamp WJK,
Thurkow AL,
Kesteren PJM,
Quartero H,
Kuchenbecker W,
Bongers M,
Geomini P,
Vleeschouwer LHM,
Hooff MHA,
Vliet H,
Veersema S,
Renes WB,
Oude Rengerink K,
Zwolsman SE,
Brölmann HAM,
Mol BWJ,
Huirne JAF
Publication year - 2018
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14733
Subject(s) - medicine , obstetrics , caesarean section , interquartile range , population , randomized controlled trial , spotting , gynecology , pregnancy , surgery , genetics , physics , environmental health , optics , biology
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 life, 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.