Structured hysteroscopic examination of uterine niches: a modified Delphi procedure
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background: Uterine niches in the Caesarean section scar are seen in approximately half of women with a history of caesarean delivery. Whilst a structured ultrasound assessment of caesarean defects has been described, there is no consensus on a structured hysteroscopic evaluation.
Objectives: To propose a methodology for a structured hysteroscopic evaluation of uterine niches.
Materials and Methods: We conducted a modified Delphi procedure, including two online rounds and two face-to-face meetings of the members of the ESGE Uterine Niches Working Group. The taskforce members have extensive experience in hysteroscopic niche evaluation. The consensus was predefined as a Rate of Agreement of at least 75%.
Results: Thirteen experts participated in this modified Delphi procedure. There was consensus on the need for a standardised methodology and the hysteroscopic definition of a niche as any indentation in the myometrium at the site of a previous CS. There was consensus that a hysteroscopic evaluation of a niche must be combined with ultrasound to measure the residual myometrial thickness. In addition, it was agreed that niches should be subclassified as ‘simple’, ‘simple with one branch’, or ‘complex’. There was consensus that the following items should be described during a hysteroscopic niche evaluation: the number of niches, the size in relation to the size of cervical canal, the presence of polyps, crypts, cysts, fibrotic tissue, blood, mucus, placental remnants, a dynamic valve, the appearance of the endometrium, the number of blood vessels and bleeding from blood vessels within the defect.
Conclusion: Using a modified Delphi procedure with international experts, consensus was achieved on the hysteroscopic evaluation and classification of niches in the uterine caesarean section scar.
What is new? A structured registration form was developed to aid consistency in hysteroscopic niche reporting.
Objectives: To propose a methodology for a structured hysteroscopic evaluation of uterine niches.
Materials and Methods: We conducted a modified Delphi procedure, including two online rounds and two face-to-face meetings of the members of the ESGE Uterine Niches Working Group. The taskforce members have extensive experience in hysteroscopic niche evaluation. The consensus was predefined as a Rate of Agreement of at least 75%.
Results: Thirteen experts participated in this modified Delphi procedure. There was consensus on the need for a standardised methodology and the hysteroscopic definition of a niche as any indentation in the myometrium at the site of a previous CS. There was consensus that a hysteroscopic evaluation of a niche must be combined with ultrasound to measure the residual myometrial thickness. In addition, it was agreed that niches should be subclassified as ‘simple’, ‘simple with one branch’, or ‘complex’. There was consensus that the following items should be described during a hysteroscopic niche evaluation: the number of niches, the size in relation to the size of cervical canal, the presence of polyps, crypts, cysts, fibrotic tissue, blood, mucus, placental remnants, a dynamic valve, the appearance of the endometrium, the number of blood vessels and bleeding from blood vessels within the defect.
Conclusion: Using a modified Delphi procedure with international experts, consensus was achieved on the hysteroscopic evaluation and classification of niches in the uterine caesarean section scar.
What is new? A structured registration form was developed to aid consistency in hysteroscopic niche reporting.
Date Issued
2024-09
Date Acceptance
2024-09-01
Citation
Facts, Views and Vision in ObGyn, 2024, 16 (3), pp.253-262
ISSN
2032-0418
Publisher
Universa BV
Start Page
253
End Page
262
Journal / Book Title
Facts, Views and Vision in ObGyn
Volume
16
Issue
3
Copyright Statement
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
Identifier
http://dx.doi.org/10.52054/fvvo.16.3.036
Publication Status
Published
Date Publish Online
2024-09-30