Objectives

To determine how does a uterine niche diagnosed prior to conception, affects future fertility and obstetrical outcomes, in a group of patients with secondary infertility undergoing fertility treatments.

Study design

A retrospective case-control study was performed, recruiting patients after cesarean delivery, before fertility treatment. Using stored ultrasound photos and video loops, we determined niche's sonographic parameters during the preconception period and retrieved the fertility and obstetrical outcomes thereafter.

Results

104 patients met the inclusion criteria, and 86 were available for analysis. 56 (65%) had uterine niches larger than 2 mm in depth, and 30 (34%) had a uterine scar of 2 mm or less. Demographic characteristics were not different between groups. No statistically significant differences were observed regarding rates of implantation and clinical pregnancy between the groups. There were four cases of cesarean scar rupture during failed trial of labor (TOLAC), all of which were in the group with larger than 2 mm niche (33% of all TOLAC cases in the respected group).

Conclusions

While it appears that pre-conception presence of uterine niches larger than 2 mm in depth does not adversely affect future fertility, these niches might serve as a risk factor for future uterine rupture during TOLAC.

中文翻译：

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剖宫产瘢痕位、生育力和分娩时子宫破裂——一项回顾性研究

目标

在一组接受生育治疗的继发性不孕症患者中，确定受孕前诊断出的子宫壁龛如何影响未来的生育能力和产科结果。

学习规划

进行了一项回顾性病例对照研究，招募剖宫产后、生育治疗前的患者。使用存储的超声照片和视频循环，我们确定了受孕前利基的超声参数，然后检索了生育率和产科结果。

结果

104 名患者符合纳入标准，86 名患者可用于分析。56 名 (65%) 的子宫壁龛深度大于 2 毫米，30 名 (34%) 的子宫疤痕不超过 2 毫米。人口统计学特征在各组之间没有差异。两组间的着床率和临床妊娠率未观察到统计学上的显着差异。试产失败 (TOLAC) 期间有 4 例剖宫产瘢痕破裂，均发生在壁龛大于 2 mm 的组中（占所有 TOLAC 病例的 33%）。

结论

虽然受孕前存在的深度大于 2 毫米的子宫壁龛似乎不会对未来的生育能力产生不利影响，但这些壁龛可能成为未来 TOLAC 期间子宫破裂的危险因素。