Highlights
- •LNG-IUD is more effective in the treatment of niche related postmenstrual spotting than hysteroscopic niche resection.
- •The effectiveness rate of LNG-IUD increased over time within 1 year.
- •The mean direct medical costs were lower in the LNG-IUD group.
Abstract
Objective
To compare the effect of a hysteroscopic niche resection with a Levonorgestrel-releasing
intrauterine device (LNG-IUD, 52 mg) on postmenstrual spotting duration in patients
with a symptomatic niche in the uterine cesarean scar.
Study design
This prospective cohort study was conducted at the International Peace Maternity and
Child Health Hospital, School of Medicine, Shanghai Jiaotong University, China. Patients
with postmenstrual spotting symptomatic niches were allocated to hysteroscopy group
or LNG-IUD group based on the shared medical decision-making approach, and were followed
up for 1 year after treatment.
Main outcome measures
The primary outcome was reduced postmenstrual spotting days at 6th month after treatment.
Secondary outcomes were effectiveness rate (proportion of patients with spotting days
reduced by at least 50% from baseline), menstrual characteristics, menstruation satisfaction,
direct medical costs, complications and side effects.
Results
78 out of the 82 eligible patients were included, 36 patients in both group finished
1-year follow-up. Reduced spotting days at the 6th month was 7 days in LNG-IUD group,
significantly higher than 5 days in hysteroscopy group, P = 0.004; The effectiveness
rate increased over time within 1 year after the insertion of LNG-IUD (63.89%, 83.33%,
88.89%, 88.89%, P for trend = 0.006), while no trend change was observed in hysteroscopy
group (71.05%, 71.05%, 66.67%, 61.11%, P for trend = 0.77).
The mean direct medical costs were 817[785,856] $ in the hysteroscopy group and 243[239,255]
$ in the LNG-IUD group (p＜0.001). 2 patients removed IUD and 2 patients reported weight
gain of more than 5 kg and breast distended pain in LNG-IUD group; 2 patients got
pregnant in hysteroscopy group. No serious complications were observed in both groups.
Conclusions
LNG-IUD is more effective in the treatment of postmenstrual spotting from the 6th
month onwards than a hysteroscopic niche resection in patients with a symptomatic
niche at lower direct costs.
Abbreviations:
LNG-IUD (Levonorgestrel-releasing intrauterine device), IUD (Intrauterine device), MRI (Magnetic resonance image), ITT (Intention to treat)Keywords
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Article info
Publication history
Published online: August 17, 2021
Accepted:
August 13,
2021
Received in revised form:
August 9,
2021
Received:
March 31,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
