Evidence map›Paper›PMID 40836782›Full record

Trial reportActa obstetricia et gynecologica Scandinavica2025

Prevalence of cesarean scar disorder in patients 3 years after a first cesarean section.

Saskia J M Klein Meuleman, Carry Verberkt, Pere N Barri, Ally Murji, Oliver Donnez, Grigoris Grimbizis, Ertan Saridogan, Tom Bourne, Jian Zhang, Michal Pomorski and 6 more

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Acta obstetricia et gynecologica Scandinavica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Saskia J M Klein MeulemanDepartment of Obstetrics & Gynecology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Carry VerberktDepartment of Obstetrics & Gynecology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Pere N BarriDepartment of Obstetrics, Gynecology and Reproductive Medicine, Hospital Universitario Dexeus, Barcelona, Spain.
Ally MurjiDepartment of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
Oliver DonnezComplex Endometriosis Center, Polyclinique Urbain V, (Elsan Group), Avignon, France.
Grigoris Grimbizis1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Ertan SaridoganReproductive Medicine Unit, Elizabeth Garrett Anderson Wing Institute for Women's Health, University College Hospital, London, UK.
Tom BourneInstitute for Reproductive and Developmental Biology, Imperial College London, London, UK.
Jian ZhangDepartment of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Michal Pomorski2nd Department of Gynaecology and Obstetrics, Wroclaw Medical University, Wroclaw, Poland.
Shunichiro TsujiDepartment of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan.
Thierry van den BoschDepartment of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.
Sanne I StegweeDepartment of Obstetrics & Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands.
Judith A F HuirneDepartment of Obstetrics & Gynecology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.ORCID 0000-0002-8248-2677
Robert A de LeeuwDepartment of Obstetrics & Gynecology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
2Close study group, CSDi study group

Funding

ZonMw 843002605
6 · The paper itself

Abstract

introductionA symptomatic uterine niche is a long-term complication after a cesarean section (CS). A group of international niche experts reached consensus on a standardized definition of a disorder caused by a symptomatic niche, named cesarean scar disorder (CSDi). However, the prevalence of this disorder is unclear. The aim of this study was to assess the prevalence of CSDi in patients 3 years after a first CS. MATERIAL AND

methodsA secondary analysis was performed on the 3-year follow-up results of the 2Close study. The 2Close study was a multicenter randomized controlled trial that evaluated single- versus double-layer uterine closure at CS in 32 hospitals in the Netherlands and included 2292 patients (registered in Dutch trial register: [NTR5480]). Patients, aged ≥18 years, undergoing a first CS were included. Three months after their CS, transvaginal ultrasonography was performed to evaluate the uterine scar for the presence of a niche. Three years after their CS, a digital questionnaire was sent to evaluate the primary and secondary symptoms of CSDi. For this secondary analysis, patients were excluded if they were pregnant, breastfeeding, or using hormonal contraception. The primary outcome of the study was the prevalence of CSDi.

resultsOf the 1648 participants who completed the 3-year questionnaire, patients were excluded due to pregnancy or breastfeeding (n = 305), use of hormonal contraception (n = 509), missing ultrasound evaluations (n = 76), and incomplete responses (n = 88). Of the 670 patients included in this analysis, 543 (81.0%) had a uterine niche visible on ultrasound and 127 (19.0%) were without a niche. The prevalence of CSDi at 3 years following a first CS was 42.5% (285/670). Most reported symptoms were chronic pelvic pain (35.0%), postmenstrual spotting (32.8%), and abnormal vaginal discharge (23.2%).

conclusionsOur study found a high prevalence of CSDi 3 years following their first CS. Symptoms were self-reported and the exclusion criteria of pregnancy, breastfeeding, or hormonal contraception use could have introduced selection bias. Therefore, this percentage could be an overestimation of the actual prevalence. However, this high prevalence should be included in counseling patients with a scheduled CS.

Indexed as

Cesarean SectionCicatrixPostoperative ComplicationsAdultFemaleFollow-Up StudiesHumansNetherlandsPregnancyPrevalenceabnormal uterine bleedingcesarean scar defectcesarean sectionchronic pelvic paininfertilitypostmenstrual spottinguterine niche

Identifiers

PMID40836782
PMCPMC12451200

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.