Comparison of The Effect of a Hysteroscopic Niche Resection and LNG-IUD on Niche Related Postmenstrual Spotting: An Interventional Study | ||||
| Suez Canal University Medical Journal | ||||
| Article 3, Volume 28, Issue 8, August 2025, Page 17-26 PDF (440.19 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/scumj.2025.445361 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Esraa M. Abd Elfatah  ; Amira M. Elbahie; Hanan M. Ghoneim; Mohamed Amr M. Khodair; Mahmoud A. Greash
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| Obstetrics & Gynecology Department, Faculty of Medicine, Suez Canal University Ismailia, Egypt. | ||||
| Abstract | ||||
| Background: Caesarean deliveries are regarded as one of the most prevalent surgical procedures, constituting one-third of all births globally. In a few cases, the scar on the uterus from a caesarean section doesn't heal fully, which leads to the formation of the uterine niche. This can cause irregular uterine bleeding, dysmenorrhea, and secondary infertility. Aim: To improve women’s physical health by reducing cesarean section long term complication such as niche related postmenstrual spotting and bleeding by using different modalities of interventions. Objectives: To evaluate the efficacy of hysteroscopic niche excision versus LNG-IUD in mitigating niche-related postmenstrual spotting at six months post-treatment. Subjects and methods: his study was performed in the Department of Obstetrics & Gynecology at Suez Canal University Hospital from December 2021 to June 2023, involving 56 women presenting with postmenstrual spotting and diagnosed with a niche. Participants will be randomly assigned to either the hysteroscopy group or the LNG-IUD group following the fulfilment of inclusion criteria and will be monitored for 6 months post-treatment. Results: Fifty of the fifty-six eligible patients were included, with twenty-five patients in each group completing the six-month follow-up. The LNG-IUD group demonstrated markedly superior outcomes in all menstrual and bleeding characteristics, which were considerably lower than those in the hysteroscopy group, with a p-value of less than 0.0001.The efficacy rate improved over a period of 6 months following the implantation of the LNG-IUD (from 60% to 88%; P value < 0.006), whereas no trend change was noted in the hysteroscopy group. Conclusion: the LNG-IUD demonstrates superior efficacy in addressing postmenstrual spotting from the 6th month onwards compared to hysteroscopic niche excision in patients with a symptomatic niche, while incurring fewer direct expenses. | ||||
| Keywords | ||||
| Uterine cesarean scar niche; Hysteroscopy niche excision; Levonorgestrel-releasing intrauterine device; Postmenstrual bleeding | ||||
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