TY - JOUR
T1 - Normalization of subendometrial peristalsis in women with a large uterine niche following laparoscopic niche repair
T2 - A prospective cohort study
AU - Klein Meuleman, Saskia J. M.
AU - Huang, Yizhou
AU - Mischi, Massimo
AU - Schoot, Dick
AU - de Leeuw, Robert A.
AU - Post Uiterweer, Emiel D.
AU - Huirne, Judith A. F.
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/4/17
Y1 - 2025/4/17
N2 - Objective: To study the impact of laparoscopic niche repair on subendometrial peristalsis in women with a large niche. Methods: A explorative prospective cohort study that included women with a large niche (residual myometrium ≤ 3 mm), actual wish to conceive who were scheduled for laparoscopic niche repair. To analyse the effect of a laparoscopic niche repair on the uterine anatomy and subendometrial peristalsis, all participants underwent a 4–5 min transvaginal ultrasound before surgery and three months post-surgery during the mid-luteal phase of the menstrual cycle. Subendometrial peristalsis was evaluated by strain analysis using a dedicated two-dimensional optical flow speckle tracking method. The following features were extracted from the strain signals: frequency, amplitude, velocity, coordination and direction of coordination. Results: Post-surgery, the mean niche volume significantly decreased, with a mean reduction of 963.9 mm3 (95 % CI 382.0–1545.7). Additionally, the residual myometrium thickness increased significantly, with a mean difference of 5.8 mm (95 % CI 6.8 to 4.7). Of the subendometrial peristalsis, a significant improvement of the frequency was observed. Although amplitude, velocity, and direction of the contractions shifted towards normal values, these changes did not reach statistical significance in this pilot study. The improvements in individual peristaltic characteristics were closely associated with reductions in niche volume and enlargement of residual myometrium. Conclusion: Subendometrial peristalsis is disturbed in women with a large niche. Individual contraction parameters such as velocity, amplitude and frequency decreased following laparoscopic niche repair which might be favourable for fertility purposes. These changes were associated with a reduction in niche volume and enlargement of the residual myometrium and warrant further validation in a larger cohort study.
AB - Objective: To study the impact of laparoscopic niche repair on subendometrial peristalsis in women with a large niche. Methods: A explorative prospective cohort study that included women with a large niche (residual myometrium ≤ 3 mm), actual wish to conceive who were scheduled for laparoscopic niche repair. To analyse the effect of a laparoscopic niche repair on the uterine anatomy and subendometrial peristalsis, all participants underwent a 4–5 min transvaginal ultrasound before surgery and three months post-surgery during the mid-luteal phase of the menstrual cycle. Subendometrial peristalsis was evaluated by strain analysis using a dedicated two-dimensional optical flow speckle tracking method. The following features were extracted from the strain signals: frequency, amplitude, velocity, coordination and direction of coordination. Results: Post-surgery, the mean niche volume significantly decreased, with a mean reduction of 963.9 mm3 (95 % CI 382.0–1545.7). Additionally, the residual myometrium thickness increased significantly, with a mean difference of 5.8 mm (95 % CI 6.8 to 4.7). Of the subendometrial peristalsis, a significant improvement of the frequency was observed. Although amplitude, velocity, and direction of the contractions shifted towards normal values, these changes did not reach statistical significance in this pilot study. The improvements in individual peristaltic characteristics were closely associated with reductions in niche volume and enlargement of residual myometrium. Conclusion: Subendometrial peristalsis is disturbed in women with a large niche. Individual contraction parameters such as velocity, amplitude and frequency decreased following laparoscopic niche repair which might be favourable for fertility purposes. These changes were associated with a reduction in niche volume and enlargement of the residual myometrium and warrant further validation in a larger cohort study.
KW - Caesarean section
KW - Infertility
KW - Laparoscopic niche repair
KW - Niche
KW - Residual Myometrium Thickness
KW - Subendometrial peristalsis
KW - Uterine scar defect
UR - https://www.scopus.com/pages/publications/85218268886
U2 - 10.1016/j.ejogrb.2025.02.033
DO - 10.1016/j.ejogrb.2025.02.033
M3 - Article
C2 - 39987679
SN - 0301-2115
VL - 308
SP - 15
EP - 22
JO - European Journal of Obstetrics and Gynecology and Reproductive Biology
JF - European Journal of Obstetrics and Gynecology and Reproductive Biology
ER -