Prevalence of cesarean scar disorder in patients 3 years after a first cesarean section

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2025-08-21 DOI:10.1111/aogs.70005

Saskia J. M. Klein Meuleman, Carry Verberkt, Pere N. Barri, Ally Murji, Oliver Donnez, Grigoris Grimbizis, Ertan Saridogan, Tom Bourne, Jian Zhang, Michal Pomorski, Shunichiro Tsuji, Thierry van den Bosch, Sanne I. Stegwee, Judith A. F. Huirne, Robert A. de Leeuw, 2Close study group, CSDi study group

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Abstract

Introduction

A symptomatic uterine niche is a long-term complication after a cesarean section (CS). A group of international niche experts reached consensus on a standardized definition of a disorder caused by a symptomatic niche, named cesarean scar disorder (CSDi). However, the prevalence of this disorder is unclear. The aim of this study was to assess the prevalence of CSDi in patients 3 years after a first CS.

Material and Methods

A secondary analysis was performed on the 3-year follow-up results of the 2Close study. The 2Close study was a multicenter randomized controlled trial that evaluated single- versus double-layer uterine closure at CS in 32 hospitals in the Netherlands and included 2292 patients (registered in Dutch trial register: [NTR5480]). Patients, aged ≥18 years, undergoing a first CS were included. Three months after their CS, transvaginal ultrasonography was performed to evaluate the uterine scar for the presence of a niche. Three years after their CS, a digital questionnaire was sent to evaluate the primary and secondary symptoms of CSDi. For this secondary analysis, patients were excluded if they were pregnant, breastfeeding, or using hormonal contraception. The primary outcome of the study was the prevalence of CSDi.

Results

Of the 1648 participants who completed the 3-year questionnaire, patients were excluded due to pregnancy or breastfeeding (n = 305), use of hormonal contraception (n = 509), missing ultrasound evaluations (n = 76), and incomplete responses (n = 88). Of the 670 patients included in this analysis, 543 (81.0%) had a uterine niche visible on ultrasound and 127 (19.0%) were without a niche. The prevalence of CSDi at 3 years following a first CS was 42.5% (285/670). Most reported symptoms were chronic pelvic pain (35.0%), postmenstrual spotting (32.8%), and abnormal vaginal discharge (23.2%).

Conclusions

Our study found a high prevalence of CSDi 3 years following their first CS. Symptoms were self-reported and the exclusion criteria of pregnancy, breastfeeding, or hormonal contraception use could have introduced selection bias. Therefore, this percentage could be an overestimation of the actual prevalence. However, this high prevalence should be included in counseling patients with a scheduled CS.

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首次剖宫产术后3年剖宫产瘢痕障碍患病率

剖宫产术后出现症状性子宫壁龛是一种长期并发症。一组国际生态位专家就一种由症状性生态位引起的疾病的标准化定义达成共识，命名为剖宫产疤痕障碍（CSDi）。然而，这种疾病的患病率尚不清楚。本研究的目的是评估首次CS患者3年后CSDi的患病率。材料和方法：对2Close研究的3年随访结果进行二次分析。2Close研究是一项多中心随机对照试验，评估了荷兰32家医院CS的单层和双层子宫闭合，包括2292例患者（在荷兰试验注册：[NTR5480]）。患者年龄≥18岁，接受首次CS。术后3个月，经阴道超声检查子宫瘢痕是否存在生态位。在他们的CS三年后，发送一份数字问卷来评估CSDi的主要和次要症状。在这一次要分析中，排除了怀孕、哺乳或使用激素避孕的患者。该研究的主要结果是CSDi的患病率。结果：在完成3年问卷调查的1648名参与者中，由于怀孕或母乳喂养（n = 305），使用激素避孕（n = 509），缺少超声检查（n = 76）和不完整应答（n = 88），患者被排除在外。本组670例患者中，543例（81.0%）超声可见子宫壁龛，127例（19.0%）未见子宫壁龛。首次CS后3年的CSDi患病率为42.5%（285/670）。大多数报告的症状是慢性盆腔疼痛（35.0%）、经后点滴（32.8%）和阴道分泌物异常（23.2%）。结论：我们的研究发现，CSDi在首次CS后3年的患病率很高。症状是自我报告的，排除怀孕、母乳喂养或使用激素避孕的标准可能会引入选择偏差。因此，这个百分比可能是对实际患病率的高估。然而，这一高患病率应包括在咨询计划CS患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.