Contrast Hysterosonographic Evaluation of Niche Prevalence Following a Standardized Suturing Technique for Caesarean Sections.

IF 2.4 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Geburtshilfe Und Frauenheilkunde Pub Date : 2024-08-06 eCollection Date: 2024-08-01 DOI:10.1055/a-2341-4586
Anita Hafner, Marie Christine Pohle, Maximilian Rauh, Annegret Schnabel, Sylvia Meyer, Angela Köninger
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Abstract

Introduction: After caesarean section a uterine niche can be detected in 42-84% of all women and in 11-45% large defects with a residual myometrium < 2.2 mm occur. If the niche compromises > 50% of myometrial thickness, risk of uterine rupture during birth increases. The suturing technique might contribute substantially on pathogenesis of niches. The objective of this study is to investigate the effect of the suturing technique on niche prevalence by using a standardized two-layer surgical technique.

Methods: Women with one previous caesarean section were examined within 6-23 months after caesarean section using contrast medium-supported transvaginal sonography regarding the prevalence, sonomorphological aspect and clinical symptoms of a uterine niche. The surgical technique used was: dilatation of the cervix, interrupted suture of the first layer (excluding the endometrium), continuous closure of the visceral and parietal peritoneum.

Results: Using native vaginal sonography, no niches were visible in the whole cohort. In three cases, there was a small niche detectable with a depth between 2.3 and 3.9 mm by contrast hysterosonography. Regarding the total myometrial thickness, the niche depth compromised less than 50%. All patients were symptom-free.

Conclusion: In our study population, there were only three cases (9.1%) with a small uterine niche. Residual myometrium and niche percentage on myometrial thickness were excellent in all three cases. Thus, our results show that the uterotomy closure technique used in the study cohort might be superior with respect to the development of uterine niches compared with the expected prevalence.

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剖腹产标准化缝合技术后宫腔粘连率的对比子宫超声评估
导言:在剖腹产手术后,42%-84%的产妇会出现子宫龛,11%-45%的大缺损产妇会出现残留子宫肌厚度为子宫肌厚度 50%的子宫龛,分娩时子宫破裂的风险会增加。缝合技术可能会对龛影的发病机制产生重大影响。本研究的目的是通过使用标准化的两层手术技术,研究缝合技术对龛影发生率的影响:方法:使用造影剂支持的经阴道超声波检查剖腹产术后 6-23 个月内曾进行过一次剖腹产的妇女的子宫龛的发生率、声像图和临床症状。采用的手术方法是:扩张宫颈,间断缝合第一层(不包括子宫内膜),连续缝合内脏和腹膜旁:通过阴道超声检查,所有病例均未发现龛影。在三个病例中,通过造影剂子宫超声检查发现了一个深度在 2.3 至 3.9 毫米之间的小龛。就子宫肌层的总厚度而言,龛影深度不足 50%。所有患者均无症状:在我们的研究人群中,只有三例(9.1%)患者的子宫龛较小。结论:在我们的研究人群中,只有三例(9.1%)子宫龛较小,所有三例患者的残余子宫肌层和子宫龛占子宫肌层厚度的比例都非常好。因此,我们的研究结果表明,与预期的发生率相比,本研究中使用的子宫切口闭合技术在子宫龛的形成方面可能更胜一筹。
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来源期刊
Geburtshilfe Und Frauenheilkunde
Geburtshilfe Und Frauenheilkunde 医学-妇产科学
CiteScore
2.50
自引率
22.20%
发文量
828
审稿时长
6-12 weeks
期刊介绍: Geburtshilfe und Frauenheilkunde (GebFra) addresses the whole field of obstetrics and gynecology and is concerned with research as much as with clinical practice. In its scientific section, it publishes original articles, reviews and case reports in all fields of the discipline, namely gynecological oncology, including oncology of the breast obstetrics and perinatal medicine, reproductive medicine, and urogynecology. GebFra invites the submission of original articles and review articles. In addition, the journal publishes guidelines, statements and recommendations in cooperation with the DGGG, SGGG, OEGGG and the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF, Association of Scientific Medical Societies, www.awmf.org). Apart from the scientific section, Geburtshilfe und Frauenheilkunde has a news and views section that also includes discussions, book reviews and professional information. Letters to the editors are welcome. If a letter discusses an article that has been published in our journal, the corresponding author of the article will be informed and invited to comment on the letter. The comment will be published along with the letter.
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