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BJOG : An International Journal of... Jan 2014Various therapies are currently used to treat symptoms related to the niche (an anechoic area) in the caesarean scar, in particular to treat abnormal uterine bleeding... (Review)
Review
BACKGROUND
Various therapies are currently used to treat symptoms related to the niche (an anechoic area) in the caesarean scar, in particular to treat abnormal uterine bleeding (AUB).
OBJECTIVE
To systematically review the available literature reporting on the effect of various therapies on niche-related symptoms.
SEARCH STRATEGY
A systematic search of MEDLINE, Embase, Cochrane, trial registers and congress abstracts from AAGL and ESGE was performed.
SELECTION CRITERIA
Articles reporting on the effectiveness of therapies other than hysterectomy in women with niche-related symptoms were included. Studies were included if they reported one of the following outcomes: effect on AUB, pain relief, sexual function, quality of life (QOL), and surgical, anatomic, fertility, or pregnancy outcome.
DATA COLLECTION AND ANALYSIS
Two authors independently selected the articles to be included. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. A standardised checklist was used to score the methodological quality of the included studies.
MAIN RESULTS
Twelve studies were included, reporting on hysteroscopic niche resection (eight studies, 384 patients), laparoscopic repair (one study, 13 patients), (laparoscopic assisted) vaginal repair (two studies, 47 patients), and oral contraceptives (OCs) (one study, 11 patients). Reported AUB improved in the vast majority of the patients after these interventions, ranging from 87 to 100%. The rate of complications was low. Pregnancies were reported after therapy; however, sample sizes and follow-up were insufficient to study fertility or pregnancy outcome. The methodological quality of the selected papers was considered to be moderate to poor, and was therefore insufficient to make solid conclusions.
AUTHOR'S CONCLUSIONS
More evidence is needed before (surgical) niche interventions are implemented in daily practice.
Topics: Cesarean Section; Cicatrix; Contraceptives, Oral, Hormonal; Diagnostic Imaging; Female; Fertility; Humans; Hysteroscopy; Laparoscopy; Metrorrhagia; Pain; Patient Satisfaction; Pregnancy; Pregnancy Outcome; Quality of Life; Sexuality
PubMed: 24373589
DOI: 10.1111/1471-0528.12537 -
Contraception May 2013Unscheduled uterine bleeding is common among women who choose extended or continuous combined hormonal contraception and may subsequently lead to method discontinuation.... (Review)
Review
BACKGROUND
Unscheduled uterine bleeding is common among women who choose extended or continuous combined hormonal contraception and may subsequently lead to method discontinuation. This systematic review evaluates the evidence on treatments for unscheduled bleeding for women using continuous or extended combined hormonal contraception.
STUDY DESIGN
We searched the PubMed database for peer-reviewed articles that were published in any language from inception of the database through January 2012 and were relevant to therapeutic or prophylactic treatments for unscheduled uterine bleeding during extended or continuous combined hormonal contraception use. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence.
RESULTS
Four articles met the inclusion criteria. Evidence from two randomized controlled trials, both of fair quality, suggested that a short hormone-free interval of 3 or 4 days improved a current unscheduled bleeding episode. Evidence from one randomized controlled trial of fair quality suggested that oral doxycycline (100 mg twice daily) did not improve a current unscheduled bleeding episode. One good quality randomized controlled trial suggested that prophylactic treatment with a daily low dose of oral doxycycline (40 mg) caused earlier onset of amenorrhea in new extended combined oral contraceptive users.
CONCLUSIONS
Limited evidence suggests that introducing a short hormone-free interval when unscheduled bleeding occurs during continuous or extended hormonal contraceptive use may reduce unscheduled bleeding days; one study suggests that twice-daily oral doxycycline initiated at the time of unscheduled bleeding is an ineffective treatment. Limited data suggest that prophylactic low-dose daily oral doxycycline may induce earlier amenorrhea among new extended combined hormonal contraceptive users.
Topics: Contraceptive Devices, Female; Contraceptives, Oral, Combined; Female; Humans; Menstruation Disturbances; Metrorrhagia; Randomized Controlled Trials as Topic
PubMed: 23044386
DOI: 10.1016/j.contraception.2012.08.005 -
Journal de Gynecologie, Obstetrique Et... Dec 2012Diagnosis of pelvic inflammatory disease is difficult. We focus on a systematic literature review to study diagnostic values of history-taking, clinical examination,... (Review)
Review
Diagnosis of pelvic inflammatory disease is difficult. We focus on a systematic literature review to study diagnostic values of history-taking, clinical examination, laboratory tests and imagery. After this literature review, we build a diagnostic model for pelvic inflammatory disease. This diagnostic model is built on two major criteria: presence of adnexal tenderness or cervical motion tenderness. Additional minor criteria, increasing the likelihood of the diagnosis of pelvic inflammatory disease were added based on their specificity and their positive likelihood ratio. These minor criteria are supported by history-taking, clinical examination, laboratory tests and also on relevant ultrasonographic criteria.
Topics: Adolescent; Adult; Cervix Uteri; Chlamydia Infections; Chlamydia trachomatis; Diagnostic Imaging; Female; France; Humans; Laparoscopy; Leukorrhea; MEDLINE; Metrorrhagia; Palpation; Pelvic Inflammatory Disease; Pelvic Pain; Young Adult
PubMed: 23140620
DOI: 10.1016/j.jgyn.2012.09.016 -
Quality of Life Research : An... Apr 2020A niche in the uterus, present in 60% of women after caesarean section (CS), is associated with several gynaecological symptoms and possibly with subfertility. Studies...
BACKGROUND
A niche in the uterus, present in 60% of women after caesarean section (CS), is associated with several gynaecological symptoms and possibly with subfertility. Studies that focus on quality of life (QoL) in relation to a niche are lacking.
PURPOSE
To identify niche-related outcomes that influence QoL and to compare patient-reported outcomes with outcomes studied in the literature.
METHODS
Two focus group discussions (FGDs, Nā=ā8 and 5) were conducted in Amsterdam UMC-location VUmc. Participants were Dutch patients with a large niche, with (planned) surgical treatment for their symptoms. Niche-related symptoms and impact on functioning or participation were fixed topics. The transcripts of the FGDs were coded into outcomes, themes and domains of QoL according to the WHOQOL model. Additionally, participants created a top five important outcomes. Next, we performed a systematic review (SR) on niche-related outcomes and compared the FGDs with niche-related outcomes from the SR.
RESULTS
In four domains (physical health, psychological domain, social relationships and environment), fifteen themes were reported in the FGDs. Abnormal uterine bleeding (AUB), subfertility, sexual activity, abdominal pain and self-esteem were themes prioritised by participants. In the literature, gynaecological symptoms and reproductive outcomes were predominantly studied. Sexuality and self-esteem were prioritised in the FGDs but hardly or never studied in the literature.
CONCLUSION
We found a broad range of niche-related outcomes influencing QoL. Apart from symptoms evaluated in the literature such as AUB, abdominal pain and subfertility, clinicians and researchers should be more aware of sexual activity and self-esteem in this population.
Topics: Abdominal Pain; Adult; Cesarean Section; Cicatrix; Female; Focus Groups; Health Surveys; Humans; Infertility, Female; Metrorrhagia; Netherlands; Pregnancy; Quality of Life; Self Concept; Sexual Behavior; Uterus
PubMed: 31845165
DOI: 10.1007/s11136-019-02376-6