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

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.

Zusammenfassung

Einleitung

Nach einem Kaiserschnitt lässt sich bei 42–84 % aller Frauen eine Uterusnische nachweisen, und bei 11–45 % treten große Defekte mit einem Restmyometrium < 2,2 mm auf. Wenn die Nische > 50 % der Myometriumdicke einnimmt, steigt das Risiko einer Uterusruptur während der Geburt. Die Nahttechnik könnte wesentlich zur Pathogenese von Nischen beitragen. Ziel dieser Studie ist es, den Einfluss der Nahttechnik auf die Nischenprävalenz mithilfe einer standardisierten zweischichtigen Operationstechnik zu untersuchen.

Methoden

Frauen mit einem vorangegangenen Kaiserschnitt wurden innerhalb von 6–23 Monaten nach dem Kaiserschnitt mittels kontrastmittelgestützter transvaginaler Sonografie auf die Prävalenz, den sonomorphologischen Aspekt und die klinischen Symptome einer Uterusnische untersucht. Die angewandte Operationstechnik war: Dilatation der Zervix, Einzelknopfnaht der ersten Schicht (ohne Endometrium), kontinuierlicher Verschluss des viszeralen und parietalen Peritoneums.

Ergebnisse

Bei der nativen Vaginalsonografie waren in der gesamten Kohorte keine Nischen sichtbar. In 3 Fällen war eine kleine Nische mit einer Tiefe zwischen 2,3 und 3,9 mm in der Kontrast-Hysterosonografie nachweisbar. Bezogen auf die Gesamtdicke des Myometriums betrug die Nischentiefe weniger als 50 %. Alle Patientinnen waren symptomfrei.

Fazit

In unserer Studienpopulation gab es nur 3 Fälle (9,1 %) mit einer kleinen uterinen Nische. Sowohl das Restmyometrium als auch der prozentuale Anteil der Nische bezogen auf die Myometriumdicke war in allen 3 Fällen ausgezeichnet. Somit zeigen unsere Ergebnisse, dass die in der Studienkohorte angewandte Uterotomie-Verschlusstechnik im Hinblick auf die Entstehung von Uterusnischen im Vergleich zur erwarteten Prävalenz überlegen sein könnte.

Keywords

uterine niche - caesarean scar defect - isthmocele - uterotomy closure technique - wound healing - contrast hysterosonography

Schlüsselwörter

Uterusnische - Kaiserschnittnarbendefekt - Isthmozele - Uterotomieverschlusstechnik - Wundheilung - Kontrasthysterosonografie

Publikationsverlauf

Eingereicht: 05. März 2024

Angenommen nach Revision: 11. Mai 2024

Artikel online veröffentlicht:
06. August 2024

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