Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial.
OBJECTIVE
To compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect.


DESIGN
Multicentre randomised controlled trial.


SETTING
Eleven hospitals collaborating in a consortium for women's health research in the Netherlands.


POPULATION
Women reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3 mm, measured during sonohysterography.


METHODS
Women were randomly allocated to hysteroscopic niche resection or expectant management for 6 months.


MAIN OUTCOME MEASURES
The primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of life, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation.


RESULTS
We randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2-7 days) in the intervention group and 7 days (IQR 3-10 days) in the control group (P = 0.04); on a scale of 0-10, discomfort as a result of spotting had a median score of 2 (IQR 0-7) in the intervention group, compared with 7 (IQR 0-8) in the control group (P = 0.02).


CONCLUSIONS
In women with a niche with a residual myometrium of ≥3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting-related discomfort.


TWEETABLE ABSTRACT
A hysteroscopic niche resection is an effective treatment to reduce niche-related spotting.
['Vervoort|Ajmw|A|', 'van der Voet|L F|LF|', 'Hehenkamp|Wjk|W|', 'Thurkow|A L|AL|', 'van Kesteren|Pjm|P|', 'Quartero|H|H|', 'Kuchenbecker|W|W|', 'Bongers|M|M|', 'Geomini|P|P|', 'de Vleeschouwer|Lhm|L|', 'van Hooff|Mha|M|', 'van Vliet|H|H|', 'Veersema|S|S|', 'Renes|W B|WB|', 'Oude Rengerink|K|K|', 'Zwolsman|S E|SE|', 'Brölmann|Ham|H|', 'Mol|Bwj|B|', 'Huirne|Jaf|J|']
D000328:Adult D002585:Cesarean Section D002921:Cicatrix D005260:Female D006801:Humans D015907:Hysteroscopy D008796:Metrorrhagia D009215:Myometrium D009426:Netherlands D011183:Postoperative Complications D011788:Quality of Life D016896:Treatment Outcome D016387:Women's Health
hysteroscopic resection niche postmenstrual spotting caesarean section Abnormal uterine bleeding