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The effect of a hysteroscopic niche resection compared with LNG-IUD on postmenstrual spotting in women with a symptomatic niche in the uterine cesarean scar:a prospective cohort study
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  • Xiaoqing He,
  • liang yan,
  • xiaoya zhao,
  • li yan,
  • chuqing he,
  • xiaofeng wang,
  • Guiling Liang,
  • hang Qi,
  • Chenfeng Zhu,
  • Ben Mol,
  • Jian Zhang,
  • Judith Huirne
Xiaoqing He
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xiaoya zhao
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chuqing he
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xiaofeng wang
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Guiling Liang
Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Chenfeng Zhu
Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Ben Mol
Monash University Medical Centre
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Jian Zhang
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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Judith Huirne
Amsterdam UMC - Locatie VUMC
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Abstract

Objective: To compare the effect of a hysteroscopic niche resection with a Levenorgestrel-releasing intrauterine device (LNG-IUD) on postmenstrual spotting in women with a symptomatic niche in the uterine cesarean scar. Design: Single center, prospective cohort study. Setting: A hospital affiliated to a medical college in China. Population: Women diagnosed with a niche by MRI scan and postmenstrual spotting of at least two days. Method: Women were allocated to two groups based on the shared medical decision-making approach, and were followed up for 1 year after treatment. Main outcome measures: The primary outcome was effectiveness in reducing postmenstrual spotting. Secondary outcomes were menstrual characteristics, direct medical costs, complications and side effects. Results: Effectiveness of LNG-IUD was significantly higher than a hysteroscopic niche resection during the first year, based on linear mixed models (P=0.009), and the effectiveness increased overtime within 1 year. Postmenstrual spotting reduced statistically in both groups. More slight side effects, although not statistically significant, were reported in LNG-LUD group at obviously lower direct medical costs. Conclusion:LNG-IUD is more effective in the treatment of postmenstrual spotting from the 6th month onwards than a hysteroscopic niche resection in women with a symptomatic niche at lower direct costs. Key Words:Niche, uterine cesarean scar, hysteroscopy niche resection, LNG-IUD, postmenstrual spotting, amenorrhea Tweetable abstract: LNG-IUD is more effective in the treatment of postmenstrual spotting related to a niche than hysteroscopic niche resection.

Peer review status:UNDER REVIEW

30 Aug 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
04 Sep 2020Assigned to Editor
04 Sep 2020Submission Checks Completed
13 Sep 2020Reviewer(s) Assigned