Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

摘要

To compare in women with postmenstrual spotting and a uterine caesarean scar defect the effectiveness of a hysteroscopic niche resection versus no treatment. Multicentre randomised controlled trial. 11 hospitals collaborating in a consortium for women's health research in the Netherlands. Women reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3mm measured during sonohysterography. Women were randomly allocated to hysteroscopic niche resection or expectant management for six months. Primary outcome was the number of days of postmenstrual spotting six months after randomisation. Secondary outcomes were spotting at the end of the menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of life, women's satisfaction, sexual function and additional therapy. Outcomes were measured at three and except for niche measurements also at six months after randomisation. We randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. Median postmenstrual spotting at baseline was 8 days in both groups. At six months after randomisation, the median number of days of postmenstrual spotting was 4 (IQR 2-7) in the intervention group and 7 (IQR 3-10) in the control group (p=0.04); discomfort due to spotting had, on a scale of 0-10, a median score of 2 (IQR 0-7) in the intervention group compared to 7 (IQR 0-8) in the control group (p=0.02). In women with a niche with a residual myometrium of ≥3mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting related discomfort. This article is protected by copyright. All rights reserved