Hysteroscopic and laparoscopic management of caesarean scar (niche) defects in symptomatic patients.

CONCLUSIONS: Anterior uterine wall should be explored in the case of symptomatic patients with previous caesarean section scar. Hysteroscopic resection should not be proposed when RMT is <3 mm. Laparoscopic/vaginal repair allows restoration of the anatomy of the lower uterine segment when residual myometrium is <3 mm. Laparoscopic repair allows antefixation in cases of retroverted uterus. Consideration of a surgical approach should be determined by the patient's plans for fertility and by niche thickness. For women who do not desire pregnancy and whose niche thickness is >3 mm, a hysteroscopic approach should be considered. Women with symptomatic caesarean scar defects who do not desire fertility may also be candidates for hysterectomy. Patients who desire future fertility, especially those with <3 mm of myometrium at the niche site, should undergo laparoscopic resection. PMID: 29944046 [PubMed - in process]
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research