Impact of pre-conception uterine niche diagnosis on future fertility and obstetrical outcomes

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Created On: 02/08/2023

In a retrospective case-control study, researchers examined the impact of a pre-conception diagnosis of uterine niche on future fertility and obstetrical outcomes in people with secondary infertility who were undergoing fertility interventions.

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Key take away

Uterine niches larger than 2 mm before conception do not harm future fertility but can escalate the risk of uterine rupture during the trial of labor after cesarean delivery.

Background

Method

Patients who had undergone cesarean delivery were recruited prior to fertility treatment. Utilizing archived ultrasound images and video loops, the sonographic parameters of the uterine niche were assessed during the preconception period. An examination of subsequent obstetrical and fertility outcomes was done.

Result

Out of the 104 volunteers meeting the inclusion criteria, 86 were incorporated in the analysis. Among them, 56 (65%) had uterine niches >2 mm in depth, while 30 (34%) had a uterine scar measuring <2 mm. There were no profound differences in demographic characteristics between the two groups.

Regarding rates of implantation and clinical pregnancy, there were no vital differences. However, 4 cases of cesarean scar rupture occurred during the trial of labor after cesarean delivery (TOLAC), all of which were from the group with uterine niches >2 mm (representing 33% of all TOLAC cases in that group).

Conclusion

While the pre-conception presence of uterine niches >2 mm in depth does not appear to harm future fertility, there may be a potential increase in the risk of uterine rupture during TOLAC.