PDF(Pubmed)
Abstract：
After incomplete healing of the uterine cesarean section scar, a niche can be observed; 24% of the women develop large niches with a residual myometrial thickness <3 mm. In these cases a laparoscopic resection is possible. The effect of this new treatment on fertility outcome is not known yet. This paper describes reproductive outcomes 2 years after a laparoscopic niche resection and compares women with or without secondary infertility at baseline.
A prospective cohort study was performed, with consecutive inclusion of women between 2011 and 2019. Women with a niche in the uterine cesarean scar, with a residual myometrial thickness of <3 mm and with a desire to become pregnant, were scheduled to undergo a laparoscopic niche resection because of one or more of the following problems (1) postmenstrual spotting; (2) midcycle intrauterine fluid accumulation diagnosed during the fertility workup or (3) difficulties with a previous embryo transfer and preferring a surgical therapy. The study is registered in the ISRCTN register (ref. no. ISRCTN02271575) on April 23, 2013.
There were 133 (62%) women included with a desire to become pregnant, 88 with secondary infertility. In all, 83 had an ongoing pregnancy at the 2-year follow-up. The ongoing pregnancy rate in patients with previous fertility problems was 60.2% compared with 66.7% in patients without infertility (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.32-1.7). The OR for live births was 0.57 (95% CI 0.02-1.2). Overall, 8.3% of the pregnancies resulted in miscarriages by the 2-year follow-up.
The reproductive outcomes in women with and without previous fertility problems undergoing resection of a large niche are very promising and quite comparable in both groups. These results suggest, but do not prove, a beneficial effect of this therapy for these indications. The results support the design of future randomized controlled trials to evaluate the effect of niche resection vs expectant management to assess its additional value in women with or without fertility problems who desire pregnancy.
A prospective cohort study was performed, with consecutive inclusion of women between 2011 and 2019. Women with a niche in the uterine cesarean scar, with a residual myometrial thickness of <3 mm and with a desire to become pregnant, were scheduled to undergo a laparoscopic niche resection because of one or more of the following problems (1) postmenstrual spotting; (2) midcycle intrauterine fluid accumulation diagnosed during the fertility workup or (3) difficulties with a previous embryo transfer and preferring a surgical therapy. The study is registered in the ISRCTN register (ref. no. ISRCTN02271575) on April 23, 2013.
There were 133 (62%) women included with a desire to become pregnant, 88 with secondary infertility. In all, 83 had an ongoing pregnancy at the 2-year follow-up. The ongoing pregnancy rate in patients with previous fertility problems was 60.2% compared with 66.7% in patients without infertility (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.32-1.7). The OR for live births was 0.57 (95% CI 0.02-1.2). Overall, 8.3% of the pregnancies resulted in miscarriages by the 2-year follow-up.
The reproductive outcomes in women with and without previous fertility problems undergoing resection of a large niche are very promising and quite comparable in both groups. These results suggest, but do not prove, a beneficial effect of this therapy for these indications. The results support the design of future randomized controlled trials to evaluate the effect of niche resection vs expectant management to assess its additional value in women with or without fertility problems who desire pregnancy.
摘要：
背景：剖宫产子宫瘢痕不完全愈合后，可以观察到生态位；24％的女性会出现大的壁ni，残留的子宫肌层厚度<3毫米。在这些情况下,腹腔镜切除是可能的。这种新疗法对生育结果的影响尚不清楚。本文描述了腹腔镜利基切除术后2年的生殖结果，并比较了基线时有无继发性不孕症的女性。
方法：进行了前瞻性队列研究，2011年至2019年期间连续纳入女性。子宫剖宫产疤痕有利基的女性，残余子宫肌层厚度<3毫米，并有怀孕的愿望，由于以下一个或多个问题，计划进行腹腔镜小生境切除术：（1）月经后斑点；（2）在生育检查期间诊断出的中期宫腔内积液或（3）先前胚胎移植困难，并且倾向于手术治疗。该研究已在ISRCTN登记册中注册（参考文献。不。ISRCTN02271575），2013年4月23日。
结果：有133名（62%）妇女有怀孕的愿望，88伴有继发性不孕症。总之,83在2年的随访中持续怀孕。既往有生育问题的患者的持续妊娠率为60.2%，而没有不孕的患者为66.7%（比值比[OR]0.68，95%置信区间[CI]0.32-1.7）。活产的OR为0.57（95％CI0.02-1.2）。总的来说,在2年的随访中，有8.3％的怀孕导致流产。
结论：在有或没有生育问题的女性中，接受大生态位切除的生殖结果非常有希望，并且在两组中具有可比性。这些结果表明,但不证明,这种疗法对这些适应症的有益效果。结果支持设计未来的随机对照试验，以评估利基切除与期待管理的效果，以评估其在有或没有生育问题的女性中的附加价值。
方法：进行了前瞻性队列研究，2011年至2019年期间连续纳入女性。子宫剖宫产疤痕有利基的女性，残余子宫肌层厚度<3毫米，并有怀孕的愿望，由于以下一个或多个问题，计划进行腹腔镜小生境切除术：（1）月经后斑点；（2）在生育检查期间诊断出的中期宫腔内积液或（3）先前胚胎移植困难，并且倾向于手术治疗。该研究已在ISRCTN登记册中注册（参考文献。不。ISRCTN02271575），2013年4月23日。
结果：有133名（62%）妇女有怀孕的愿望，88伴有继发性不孕症。总之,83在2年的随访中持续怀孕。既往有生育问题的患者的持续妊娠率为60.2%，而没有不孕的患者为66.7%（比值比[OR]0.68，95%置信区间[CI]0.32-1.7）。活产的OR为0.57（95％CI0.02-1.2）。总的来说,在2年的随访中，有8.3％的怀孕导致流产。
结论：在有或没有生育问题的女性中，接受大生态位切除的生殖结果非常有希望，并且在两组中具有可比性。这些结果表明,但不证明,这种疗法对这些适应症的有益效果。结果支持设计未来的随机对照试验，以评估利基切除与期待管理的效果，以评估其在有或没有生育问题的女性中的附加价值。
