Effectiveness of A Levonorgestrel-Releasing Intrauterine System Versus Hysteroscopic Treatment for Abnormal Uterine Bleeding in Women with Cesarean Scar Defects: A Systematic Review and Meta-Analysis.

IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Athanasios Douligeris, Nikolaos Kathopoulis, Konstantinos Kypriotis, Dimitrios Zacharakis, Anastasia Prodromidou, Anastasia Mortaki, Ioannis Chatzipapas, Themos Grigoriadis, Athanasios Protopapas
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Abstract

Background/Objectives: To assess the effectiveness of the levonorgestrel-releasing intrauterine device (LNG-IUD) compared to hysteroscopic resection for managing women with symptomatic cesarean scar defects (CSDs). Methods: This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive search of four electronic databases was conducted to identify studies comparing LNG-IUD with hysteroscopic management for symptomatic CSDs. Studies reporting outcomes of bleeding and spotting days and effectiveness rates were included. Quality assessment was performed using the ROBINS-I and RoB-2 tools. Results: Three studies involving 344 patients met the inclusion criteria. At 6 months, LNG-IUD use significantly reduced total bleeding days (MD -4.13; 95% CI: -5.17 to -3.09; p < 0.00001) and spotting days (MD 1.90; 95% CI: 0.43 to 3.37; p = 0.01) compared to hysteroscopic treatment. By 12 months, LNG-IUD demonstrated superior effectiveness (OR 3.46; 95% CI: 1.53 to 7.80; p = 0.003), with fewer total bleeding days (MD -5.69; 95% CI: -6.55 to -4.83; p < 0.00001) and spotting days (MD 3.09; 95% CI: 1.49 to 4.69; p = 0.0002). Approximately 50% of LNG-IUD users experienced amenorrhea within 1 year. Conclusions: LNG-IUD offers a minimally invasive and effective alternative to hysteroscopic resection for women with symptomatic CSD and no desire for future pregnancies. Its role should be considered in clinical practice, but further research is needed to validate these findings and define its long-term benefits and limitations.

左炔诺孕酮释放宫内系统与宫腔镜治疗剖宫产瘢痕缺损妇女异常子宫出血的疗效:系统回顾和荟萃分析
背景/目的:评价左炔诺孕酮释放宫内节育器(LNG-IUD)与宫腔镜切除治疗有症状的剖宫产瘢痕缺损(CSDs)的有效性。方法:本系统综述和荟萃分析遵循PRISMA指南。我们对四个电子数据库进行了全面的检索,以确定比较LNG-IUD和宫腔镜治疗症状性CSDs的研究。研究报告了出血和点滴日的结果和有效率。使用robins - 1和robins -2工具进行质量评估。结果:3项研究344例患者符合纳入标准。在6个月时,使用LNG-IUD可显著减少总出血天数(MD -4.13;95% CI: -5.17 ~ -3.09;p < 0.00001)和斑点日(MD 1.90;95% CI: 0.43 ~ 3.37;P = 0.01)。12个月后,LNG-IUD表现出卓越的有效性(OR 3.46;95% CI: 1.53 ~ 7.80;p = 0.003),总出血天数较少(MD -5.69;95% CI: -6.55 ~ -4.83;p < 0.00001)和斑点天数(MD 3.09;95% CI: 1.49 ~ 4.69;P = 0.0002)。大约50%的LNG-IUD使用者在1年内出现闭经。结论:对于有症状的CSD且不希望再怀孕的女性,LNG-IUD是一种微创、有效的替代宫腔镜切除的方法。在临床实践中应考虑其作用,但需要进一步的研究来验证这些发现并确定其长期益处和局限性。
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来源期刊
Journal of Personalized Medicine
Journal of Personalized Medicine Medicine-Medicine (miscellaneous)
CiteScore
4.10
自引率
0.00%
发文量
1878
审稿时长
11 weeks
期刊介绍: Journal of Personalized Medicine (JPM; ISSN 2075-4426) is an international, open access journal aimed at bringing all aspects of personalized medicine to one platform. JPM publishes cutting edge, innovative preclinical and translational scientific research and technologies related to personalized medicine (e.g., pharmacogenomics/proteomics, systems biology). JPM recognizes that personalized medicine—the assessment of genetic, environmental and host factors that cause variability of individuals—is a challenging, transdisciplinary topic that requires discussions from a range of experts. For a comprehensive perspective of personalized medicine, JPM aims to integrate expertise from the molecular and translational sciences, therapeutics and diagnostics, as well as discussions of regulatory, social, ethical and policy aspects. We provide a forum to bring together academic and clinical researchers, biotechnology, diagnostic and pharmaceutical companies, health professionals, regulatory and ethical experts, and government and regulatory authorities.
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