Search

Objectives: To evaluate the reproductive outcomes after different approaches of surgical isthmocele excision in women with secondary infertility., Methods: The present study was conducted between November 2017 and February 2023 in the Department of Gynecological Endocrinology and Gynecology at Jagiellonian University Medical College, Krakow, Poland. Women with large isthmocele with residual myometrial thickness (RMT) <3 mm and secondary infertility were included in this retrospective study. Surgical removal of the uterine defect was performed either by the laparoscopic or laparotomic approach. Pregnancy outcomes were measured., Results: Fifty-eight women aged 32.3 ± 3.5 years with a body mass index 22.9 ± 3.4 kg/m 2 were included. Pregnancy was confirmed in 62.1% of women after surgical repair of isthmocele either via laparoscopy (n = 19) or laparotomy (n = 17) and 36 women (44.8%) women delivered healthy babies. There were no differences in the type of surgical approach used for isthmocele removal regarding pregnancy outcomes. Women in the laparotomic group had a higher number of abdominal surgeries (2.8 times) and longer postsurgical hospitalization (+85.7%). There were no differences between the laparoscopy and laparotomy groups regarding the duration of infertility, number of pregnancies, performed cesarean sections, and the type of cesarean sections (urgent vs planned)., Conclusion: Surgical treatment should be offered to symptomatic women with isthmocele and secondary infertility. Given the absence of comparative studies, laparoscopic niche resection is the method of choice for a large uterine niche with an RMT <3 mm. Nonetheless, it offers comparable pregnancy outcomes to the laparotomic approach., (© 2024 International Federation of Gynecology and Obstetrics.)

Abstract Depending on the developing laparoscopic technique and experience, the treatment of cesarean scar choriocarcinoma can be safely performed laparoscopically by experts.

Introduction: After incomplete healing of the uterine cesarean section scar, a niche can be observed; 24% of the women develop large niches with a residual myometrial thickness <3 mm. In these cases a laparoscopic resection is possible. The effect of this new treatment on fertility outcome is not known yet. This paper describes reproductive outcomes 2 years after a laparoscopic niche resection and compares women with or without secondary infertility at baseline., Material and Methods: A prospective cohort study was performed, with consecutive inclusion of women between 2011 and 2019. Women with a niche in the uterine cesarean scar, with a residual myometrial thickness of <3 mm and with a desire to become pregnant, were scheduled to undergo a laparoscopic niche resection because of one or more of the following problems (1) postmenstrual spotting; (2) midcycle intrauterine fluid accumulation diagnosed during the fertility workup or (3) difficulties with a previous embryo transfer and preferring a surgical therapy. The study is registered in the ISRCTN register (ref. no. ISRCTN02271575) on April 23, 2013., Results: There were 133 (62%) women included with a desire to become pregnant, 88 with secondary infertility. In all, 83 had an ongoing pregnancy at the 2-year follow-up. The ongoing pregnancy rate in patients with previous fertility problems was 60.2% compared with 66.7% in patients without infertility (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.32-1.7). The OR for live births was 0.57 (95% CI 0.02-1.2). Overall, 8.3% of the pregnancies resulted in miscarriages by the 2-year follow-up., Conclusions: The reproductive outcomes in women with and without previous fertility problems undergoing resection of a large niche are very promising and quite comparable in both groups. These results suggest, but do not prove, a beneficial effect of this therapy for these indications. The results support the design of future randomized controlled trials to evaluate the effect of niche resection vs expectant management to assess its additional value in women with or without fertility problems who desire pregnancy., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Objective: To analyze outcomes and postoperative complications in patients undergoing robot-assisted isthmocele repair., Method: This retrospective cohort study included 33 patients who had robot-assisted laparoscopic surgical management of an isthmocele between September 2013 and August 2020 in two French university hospitals. All charts were reviewed to identify patient characteristics, preoperative and postoperative anatomical findings, complications, and postoperative fertility and symptoms. Patients who had undergone this procedure were asked to complete a telephone questionnaire about their treatment satisfaction and symptoms., Results: The isthmocele was discovered most often as a result of subfertility (57.6%), but also ectopic pregnancy (18.2%), pelvic pain (15.2%), and postmenstrual bleeding (9.1%). Robot-assisted repair of the isthmocele significantly improved myometrial thickness (from 1.55 mm before surgery to 4.26 mm after surgery [mean difference 2.71; 95% confidence interval, 1.91-3.51], P = 0.0005). Among 20 patients who still desired a child after surgery, 15 became pregnant and 14 had full-term live births. Among the nine patients who had surgery for disabling symptoms, five had no persistent symptoms, three reported global improvement, and one had the same gynecologic discomfort. Seventeen patients agreed to complete the questionnaires (51.5%), and all stated that they would choose to have this surgery again., Conclusion: Robot-assisted repair of an isthmocele is a viable minimally invasive procedure., (© 2022 International Federation of Gynecology and Obstetrics.)

Ovarian mucinous tumors are one of the common epithelial tumors in the ovary, but their recurrence is extremely rare. In a 37-year-old female patient who had had five operations in 7 years due to recurrent mucinous neoplasms, a mass extending to the umbilicus was recently detected during a routine examination. With this finding the patient underwent cystectomy, total abdominal hysterectomy, and left salpingo-oophorectomy. Two of the five operations were performed during cesarean delivery. In the recent surgical procedure, two cysts were removed. A 20 cm cyst in the pelvic region was diagnosed as a mucinous cystadenoma. The other cyst located in the myometrium was a mucinous cystadenoma with focal borderline change and arose in the previous cesarean scar. The authors present what is believed to be the first case of recurrent mucinous neoplasm arising within a cesarean scar. A review of the literature concerning the topic is also presented., (© 2021 International Federation of Gynecology and Obstetrics.)

Objective: To identify the clinical characteristics of, and the diagnostic and therapeutic strategies for, gestational trophoblastic neoplasia (GTN) located in the cesarean scar., Methods: The present retrospective analysis was conducted among patients diagnosed with GTN located in the cesarean scar at Peking Union Medical College Hospital, Beijing, China, between June 1, 2006, and May 31, 2016. Clinical features, diagnostic and therapeutic procedures, and outcomes were reviewed., Results: Of 938 women diagnosed with GTN, 31 (3.3%) patients had GTN located in the cesarean scar. Irregular vaginal bleeding was the main clinical manifestation. Twenty (65%) patients received an accurate diagnosis based on a history of molar pregnancy/a high β-human chorionic gonadotropin level/typical imaging presentations. The remaining 11 patients were initially misdiagnosed; the definitive diagnosis was made by pathology. All patients received chemotherapy; 22 (71%) women also underwent hysterectomy or localized uterine lesion resection because of chemoresistant lesions. All patients had a complete remission; at a median follow-up of 35 months, only 1 (3%) woman had a relapse., Conclusion: Owing to its rarity and nonspecific symptoms, GTN located in the cesarean scar is prone to misdiagnosis. In patients without typical manifestations, the definitive diagnosis often relies on pathology. For treatment, uterine lesion resection is a useful adjunct to chemotherapy., (© 2017 International Federation of Gynecology and Obstetrics.)

Objective: To investigate maternal outcomes after leaving the placenta in situ for placenta accreta spectrum (PAS) disorders in patients with placenta previa on a cesarean delivery scar., Methods: The present retrospective study reviewed medical records from women with placenta previa on a cesarean scar underwent perinatal care at secondary- or tertiary-level perinatal centers in Japan between January 1, 2010, and December 31, 2014. Perinatal management was conducted based on each leading obstetrician's discretion. The primary outcome was success of the leaving the placenta in situ approach for PAS disorders (defined as preserving the uterus without hysterectomy)., Results: Of 178 eligible centers, 126 (71%) participated in this study; data from 613 patients were included. Of these, 41 had the placenta left in situ owing to PAS disorders and follow-up data were available for 36 women. Leaving the placenta in situ was successful in 25 (69%) patients, with placental resorption occurring postpartum (median 89 days; range 6-510). Hysterectomy was performed for 11 patients, primarily owing to hemorrhage and/or infection (median 30 days; range 0-95 days, postpartum)., Conclusion: Leaving the placenta in situ, with close postpartum follow-up for at least several months, could be a uterus-preserving option for patient with PAS disorders., (© 2017 International Federation of Gynecology and Obstetrics.)