Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: A randomised controlled trial

A. J.M.W. Vervoort, Lucy (Lucet) F. van der Voet, W. J.K. Hehenkamp, A. L. Thurkow, P. J.M. van Kesteren, H. Quartero, W. Kuchenbecker, M. Bongers, P. Geomini, L. H.M. de Vleeschouwer, M. H.A. van Hooff, H. van Vliet, S. Veersema, W. B. Renes, K. Oude Rengerink, S. E. Zwolsman, H. A.M. Brölmann, B. W.J. Mol, J. A.F. Huirne

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)326-334
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume125
Issue number3
DOIs
Publication statusPublished - 1 Feb 2018

Cite this

Vervoort, A. J.M.W. ; van der Voet, Lucy (Lucet) F. ; Hehenkamp, W. J.K. ; Thurkow, A. L. ; van Kesteren, P. J.M. ; Quartero, H. ; Kuchenbecker, W. ; Bongers, M. ; Geomini, P. ; de Vleeschouwer, L. H.M. ; van Hooff, M. H.A. ; van Vliet, H. ; Veersema, S. ; Renes, W. B. ; Oude Rengerink, K. ; Zwolsman, S. E. ; Brölmann, H. A.M. ; Mol, B. W.J. ; Huirne, J. A.F. / Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting : A randomised controlled trial. In: BJOG: An International Journal of Obstetrics and Gynaecology. 2018 ; Vol. 125, No. 3. pp. 326-334.
@article{f08dec50460b4c37ac8e987e2b189a08,
title = "Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: A randomised controlled trial",
abstract = "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.",
keywords = "Abnormal uterine bleeding, Caesarean section, Hysteroscopic resection, Niche, Postmenstrual spotting",
author = "Vervoort, {A. J.M.W.} and {van der Voet}, {Lucy (Lucet) F.} and Hehenkamp, {W. J.K.} and Thurkow, {A. L.} and {van Kesteren}, {P. J.M.} and H. Quartero and W. Kuchenbecker and M. Bongers and P. Geomini and {de Vleeschouwer}, {L. H.M.} and {van Hooff}, {M. H.A.} and {van Vliet}, H. and S. Veersema and Renes, {W. B.} and {Oude Rengerink}, K. and Zwolsman, {S. E.} and Br{\"o}lmann, {H. A.M.} and Mol, {B. W.J.} and Huirne, {J. A.F.}",
year = "2018",
month = "2",
day = "1",
doi = "10.1111/1471-0528.14733",
language = "English",
volume = "125",
pages = "326--334",
journal = "BJOG: An International Journal of Obstetrics & Gynaecology",
issn = "1470-0328",
publisher = "Wiley Online Library",
number = "3",

}

Vervoort, AJMW, van der Voet, LLF, Hehenkamp, WJK, Thurkow, AL, van Kesteren, PJM, Quartero, H, Kuchenbecker, W, Bongers, M, Geomini, P, de Vleeschouwer, LHM, van Hooff, MHA, van Vliet, H, Veersema, S, Renes, WB, Oude Rengerink, K, Zwolsman, SE, Brölmann, HAM, Mol, BWJ & Huirne, JAF 2018, 'Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: A randomised controlled trial' BJOG: An International Journal of Obstetrics and Gynaecology, vol. 125, no. 3, pp. 326-334. https://doi.org/10.1111/1471-0528.14733

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting : A randomised controlled trial. / Vervoort, A. J.M.W.; van der Voet, Lucy (Lucet) F.; Hehenkamp, W. J.K.; Thurkow, A. L.; van Kesteren, P. J.M.; Quartero, H.; Kuchenbecker, W.; Bongers, M.; Geomini, P.; de Vleeschouwer, L. H.M.; van Hooff, M. H.A.; van Vliet, H.; Veersema, S.; Renes, W. B.; Oude Rengerink, K.; Zwolsman, S. E.; Brölmann, H. A.M.; Mol, B. W.J.; Huirne, J. A.F.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 125, No. 3, 01.02.2018, p. 326-334.

Research output: Contribution to journalArticleAcademicpeer-review

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, Lucy (Lucet) 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.

PY - 2018/2/1

Y1 - 2018/2/1

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 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.

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 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.

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

VL - 125

SP - 326

EP - 334

JO - BJOG: An International Journal of Obstetrics & Gynaecology

JF - BJOG: An International Journal of Obstetrics & Gynaecology

SN - 1470-0328

IS - 3

ER -