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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:
The association to the clinical symptoms as:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cesarean Scar Defect (CSD) | Other | cesarean scar niche/defect (CSD) by transvaginal ultrasound that is defined as "indentation at the site in the cesarean section scar with a depth of at least 2 mm" that was agreed upon in 2019 by a European task force |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Caesarean scar defect evlauation by ultraosund | Diagnostic Test | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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) | through study completion, up to 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| 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) | through study completion, up to 6 months |
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Inclusion Criteria:
Exclusion Criteria:
women in child bearing age with history of previous cesarean section and at least 6 months postpartum.
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| Name | Affiliation | Role |
|---|---|---|
| Maya M. Abdelrazek | Ain Shams University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ain Shams University | Cairo | Egypt |
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| ID | Term |
|---|---|
| D060725 | Uterine Retroversion |
| ID | Term |
|---|---|
| D014591 | Uterine Diseases |
| D005831 | Genital Diseases, Female |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
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|
| 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. | 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) | 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 | 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. | 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. | through study completion, up to 6 months |
| D000091642 | Urogenital Diseases |
| D000091662 | Genital Diseases |
| D014102 | Torsion Abnormality |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |