Differentiated approaches to surgical correction of post-caesarean uterine scar niche

DOI

https://dx.doi.org/10.18565/aig.2024.231

Bezhenar V.F., Grigorian A.E., Romanova M.L.
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint-Petersburg, Russia

Objective: To evaluate the effectiveness of laparoscopic metroplasty with hysteroscopic assistance and laparoscopic metroplasty combined with transabdominal cerclage in correcting the post-caesarean uterine scar niche.
Materials and methods: This randomized controlled trial included 38 patients with a post-caesarean uterine scar niche. Group 1 comprised of 18 patients who underwent laparoscopic metroplasty with simultaneous hysteroscopy and transabdominal cerclage. Group 2 included 20 patients who underwent laparoscopic metroplasty with simultaneous hysteroscopy. Scar thickness was assessed before and six months after surgery using pelvic MRI data.
Results: Six months after surgery, the study group exhibited greater scar thickness (6.0 [4.0; 7.3] mm) than the control group (5.0 [4.0; 6.65] mm), as determined by pelvic MRI. MRI data revealed a significant change in scar thickness in both groups before and after laparoscopic metroplasty (p=0.0002 and p=0.0001, respectively). Following the surgical procedure, a notable reduction in the severity of clinical symptoms was observed. In group 1, the duration of postmenstrual bleeding decreased from 5 to 2 days, while in group 2, the duration decreased from 4 to 2 days. Prior to surgery, the mean dyspareunia score according to the visual analog scale (VAS) was 6 in group 1, decreasing to 4 postoperatively. In group 2, the mean score was 5, which decreased to 3 after the metroplasty. No complications were observed after surgery in any of the patient groups.
Conclusion: Laparoscopic correction of the post-caesarean uterine scar niche using both methods increased the thickness of the uterine scar and reduced the severity of the clinical symptoms associated with a thinned uterine scar.

Authors’ contributions: Bezhenar V.F. – conception and design of the study, drafting and editing of the manuscript; Grigorian A.E. – material collection and processing, statistical analysis, editing of the manuscript; Romanova M.L. – drafting and editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Pavlov First Saint Petersburg SMU, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Bezhenar V.F., Grigorian A.E., Romanova M.L. Differentiated approaches to
surgical correction of post-caesarean uterine scar niche.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (11): 118-127 (in Russian)
Authors’ contributions: Bezhenar V.F. – conception and design of the study, drafting and editing of the manuscript; Grigorian A.E. – material collection and processing, statistical analysis, editing of the manuscript; Romanova M.L. – drafting and editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Pavlov First Saint Petersburg SMU, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Bezhenar V.F., Grigorian A.E., Romanova M.L. Differentiated approaches to
surgical correction of post-caesarean uterine scar niche.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (11): 118-127 (in Russian)
https://dx.doi.org/10.18565/aig.2024.231

cesarean section

uterine scar

scar niche

metroplasty

cerclage

Full text (in Russian)

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Received 13.09.2024

Accepted 29.10.2024

Vitaly F. Bezhenar, Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Neonatology/Reproductology, Head of the Clinic of Obstetrics and Gynecology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, +7(812)338-78-66,
bez-vitaly@yandex.ru, https://orcid.org/0000-0002-7807-4929
Anna E. Grigorian, PhD Student at the Department of Obstetrics, Gynecology and Neonatology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, +7(981)104-91-84, Annagrigoryan2112@mail.ru, https://orcid.org/0000-0002-1674-7753
Maria L. Romanova, PhD, Associate Professor at the Department of Obstetrics, Gynecology and Reproductology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, +7(905)205-25-13, Mariaro@mail.ru, https://orcid.org/0000-0002-4378-6424

Differentiated approaches to surgical correction of post-caesarean uterine scar niche

Bezhenar V.F., Grigorian A.E., Romanova M.L.

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