This study aims to determine the association between the size of caesarean scar niche and uterine position in childbearing women. Research hypothesis: There is a relation between uterine position and degree of cesarean scar niche. Research question: Is there a relation between uterine position and degree of cesarean scar niche?
It has been noted that the cesarean scar defect in patients with retroflexed uteri appear to be larger than are those in patients with anteverted uteri. This study will describe the association between position of the uterus whether share in degree of cesarean scar niche or not and associated symptoms. Primary outcome: The association between the position of the uterus (Anteverted/Retroverted) and large CSD (the ratio between the depth and adjacent myometrial thickness) Secondary outcomes: The association between position of the uterus (Anteverted/Retroverted) and: * Residual myometrial thickness (RMT). * Depth, Width, Length of SCD. The association to the clinical symptoms as: * Postmenstrual spotting: more than 2 days of intermenstrual spotting, or more than 2 days of brownish discharge after the end of menstruation if bleeding duration exceeds 7 days (discharge is considered normal if bleeding duration is \< 7 days). * Abnormal uterine bleeding (AUB) as per FIGO guideline. * Pain as dysmenorrhea, chronic pelvic pain or dyspareunia. If present will be assed using Visual Analogue Scale (VAS). * Secondary infertility: inability of a couple to conceive after one year of regular, unprotected intercourse.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
86
Women will be examined in the lithotomy position with an empty bladder. The uterus will be examined in a standardized way excluding causes of abnormal uterine bleeding or pelvic pain (myoma, polyp, pelvic inflammatory disease, adenomyosis). Upon detection of the SCD, the following will be measured: In the midsagittal plane: the depth (the vertical distance between the base and apex of the defect), width (the length of the widest gap along the cervicoisthmic canal), residual myometrial thickness (RMT) overlying the defect, and the adjacent myometrial thickness fundal to the defect. In the transverse plane: the length of the defect. The uterine position will be classified as anteverted or retroverted. Clinical symptoms of the patients will be reviewed such as :Postmenstrual spotting, Abnormal uterine bleeding, Pain, Secondary infertility.
Ain Shams University
Cairo, Egypt
correlation between position of the uterus and large Cesarean Scar defect (CSD)
By using transvaginal ultrasound, the uterus will be examined in a mid sagittal plane to evaluate the position of the uterus that will be described as (Anteverted: the uterus tilts forward at the cervix/ Retroverted: the uterus tilts backward at the cervix), which will be correlated to the presence of Large CSD (ratio between the depth (mm) and adjacent myometrial thickness (mm) more than or equal to 0.50)
Time frame: through study completion, up to 6 months
correlation between position of uterus and Residual myometrial thickness
By using transvaginal ultrasound, the uterus will be examined in a mid sagittal plane to evaluate the position of the uterus that will be described as (Anteverted: the uterus tilts forward at the cervix/ Retroverted: the uterus tilts backward at the cervix), and measuring the thickness of the myometrium over the SCD (mm)
Time frame: through study completion, up to 6 months
correlation between position of uterus and Depth, Length, Width of SCD
By using transvaginal ultrasound, the uterus will be examined in a mid sagittal plane to evaluate the position of the uterus that will be described as (Anteverted: the uterus tilts forward at the cervix/ Retroverted: the uterus tilts backward at the cervix), and measure depth (mm) and width (mm) of the Cesarean scar defect, while in transverse plane of the uterus measure length (mm) of the cesarean scar defect.
Time frame: through study completion, up to 6 months
correlation between position of uterus and postmenstrual spotting
By using transvaginal ultrasound, the uterus will be examined in a mid sagittal plane to evaluate the position of the uterus that will be described as (Anteverted: the uterus tilts forward at the cervix/ Retroverted: the uterus tilts backward at the cervix), and correlates to the presence of more than or equal to 2 days of intermenstrual spotting or more than or equal to 2 days of brownish discharge after the end of menstruation if bleeding duration exceeds 7 days (discharge is considered normal if bleeding duration is less than 7 days)
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Time frame: through study completion, up to 6 months
correlation between position of uterus and Abnormal Uterine Bleeding (AUB)
By using transvaginal ultrasound, the uterus will be examined in a mid sagittal plane to evaluate the position of the uterus that will be described as (Anteverted: the uterus tilts forward at the cervix/ Retroverted: the uterus tilts backward at the cervix), and correlates to the presence of AUB as per Figo guideline as regards frequency (in days), duration (in days), regularity (Regular/irregular) and intermenstrual bleeding
Time frame: through study completion, up to 6 months
correlation between position of uterus and Pelvic Pain
By using transvaginal ultrasound, the uterus will be examined in a mid sagittal plane to evaluate the position of the uterus that will be described as (Anteverted: the uterus tilts forward at the cervix/ Retroverted: the uterus tilts backward at the cervix), and correlates it to the presence of Dysmenorrhea, Chronic pelvic pain or dyspareunia.
Time frame: through study completion, up to 6 months
correlation between position of uterus and secondary infertility
secondary infertility is defined as inability of a couple to conceive after 1 year of regular, unprotected intercourse.
Time frame: through study completion, up to 6 months