Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure.
- Jordans IPM Department of Obstetrics and Gynecology, Amsterdam Cardiovascular Sciences, VU Medical Centre, Amsterdam, The Netherlands.
- de Leeuw RA Department of Obstetrics and Gynecology, Amsterdam Cardiovascular Sciences, VU Medical Centre, Amsterdam, The Netherlands.
- Stegwee SI Department of Obstetrics and Gynecology, Amsterdam Cardiovascular Sciences, VU Medical Centre, Amsterdam, The Netherlands.
- Amso NN Department of Obstetrics and Gynecology, Cardiff University, Cardiff, UK.
- Barri-Soldevila PN Department of Obstetrics and Gynecology, Hospital Universitari Dexeus, Barcelona, Spain.
- van den Bosch T Department of Obstetrics and Gynecology, KU Leuven, Leuven, Belgium.
- Bourne T Department of Obstetrics and Gynecology, Imperial College London, London, UK.
- Brölmann HAM Department of Obstetrics and Gynecology, Amsterdam Cardiovascular Sciences, VU Medical Centre, Amsterdam, The Netherlands.
- Donnez O Institut du sien et de Chirurgie Gynécologique d'Avignon, Polyclinique Urbain V (Elsan Group), Avignon, France.
- Dueholm M Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
- Hehenkamp WJK Department of Obstetrics and Gynecology, Amsterdam Cardiovascular Sciences, VU Medical Centre, Amsterdam, The Netherlands.
- Jastrow N Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Genève, Genève, Switzerland.
- Jurkovic D Department of Obstetrics and Gynaecology, University College Hospital, London, UK.
- Mashiach R Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.
- Naji O Department of Obstetrics and Gynecology, Imperial College London, London, UK.
- Streuli I Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Genève, Genève, Switzerland.
- Timmerman D Department of Obstetrics and Gynecology, KU Leuven, Leuven, Belgium.
- van der Voet LF Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, The Netherlands.
- Huirne JAF Department of Obstetrics and Gynecology, Amsterdam Cardiovascular Sciences, VU Medical Centre, Amsterdam, The Netherlands.
- 2018-03-15
Published in:
- Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - 2019
Cesarean section
Delphi technique
cicatrix
ultrasonography
Adult
Cicatrix
Consensus
Delphi Technique
Female
Humans
Practice Guidelines as Topic
Ultrasonography
Urogenital Abnormalities
Uterus
English
OBJECTIVE
To generate guidance for detailed uterine niche evaluation by ultrasonography in the non-pregnant woman, using a modified Delphi procedure amongst European experts.
METHODS
Twenty gynecological experts were approached through their membership of the European Niche Taskforce. All experts were physicians with extensive experience in niche evaluation in clinical practice and/or authors of niche publications. By means of a modified Delphi procedure, relevant items for niche measurement were determined based on the results of a literature search and recommendations of a focus group of six Dutch experts. It was predetermined that at least three Delphi rounds would be performed (two online questionnaires completed by the expert panel and one group meeting). For it to be declared that consensus had been reached, a consensus rate for each item of at least 70% was predefined.
RESULTS
Fifteen experts participated in the Delphi procedure. Consensus was reached for all 42 items on niche evaluation, including definitions, relevance, method of measurement and tips for visualization of the niche. A niche was defined as an indentation at the site of a Cesarean section with a depth of at least 2 mm. Basic measurements, including niche length and depth, residual and adjacent myometrial thickness in the sagittal plane, and niche width in the transverse plane, were considered to be essential. If present, branches should be reported and additional measurements should be made. The use of gel or saline contrast sonography was preferred over standard transvaginal sonography but was not considered mandatory if intrauterine fluid was present. Variation in pressure generated by the transvaginal probe can facilitate imaging, and Doppler imaging can be used to differentiate between a niche and other uterine abnormalities, but neither was considered mandatory.
CONCLUSION
Consensus between niche experts was achieved regarding ultrasonographic niche evaluation. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
To generate guidance for detailed uterine niche evaluation by ultrasonography in the non-pregnant woman, using a modified Delphi procedure amongst European experts.
METHODS
Twenty gynecological experts were approached through their membership of the European Niche Taskforce. All experts were physicians with extensive experience in niche evaluation in clinical practice and/or authors of niche publications. By means of a modified Delphi procedure, relevant items for niche measurement were determined based on the results of a literature search and recommendations of a focus group of six Dutch experts. It was predetermined that at least three Delphi rounds would be performed (two online questionnaires completed by the expert panel and one group meeting). For it to be declared that consensus had been reached, a consensus rate for each item of at least 70% was predefined.
RESULTS
Fifteen experts participated in the Delphi procedure. Consensus was reached for all 42 items on niche evaluation, including definitions, relevance, method of measurement and tips for visualization of the niche. A niche was defined as an indentation at the site of a Cesarean section with a depth of at least 2 mm. Basic measurements, including niche length and depth, residual and adjacent myometrial thickness in the sagittal plane, and niche width in the transverse plane, were considered to be essential. If present, branches should be reported and additional measurements should be made. The use of gel or saline contrast sonography was preferred over standard transvaginal sonography but was not considered mandatory if intrauterine fluid was present. Variation in pressure generated by the transvaginal probe can facilitate imaging, and Doppler imaging can be used to differentiate between a niche and other uterine abnormalities, but neither was considered mandatory.
CONCLUSION
Consensus between niche experts was achieved regarding ultrasonographic niche evaluation. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1002/uog.19049
- PMID 29536581
- Persistent URL
- https://sonar.ch/global/documents/116425
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