{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T06:33:40Z","timestamp":1792305220382,"version":"4.4.0"},"reference-count":50,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2013,12,26]],"date-time":"2013-12-26T00:00:00Z","timestamp":1388016000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001826","name":"The Netherlands Organization for Health Research and Development","doi-asserted-by":"crossref","award":["80-82305-97-12030"],"award-info":[{"award-number":["80-82305-97-12030"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Various therapies are currently used to treat symptoms related to the niche (an anechoic area) in the caesarean scar, in particular to treat abnormal uterine bleeding (\n                      <jats:styled-content style=\"fixed-case\">AUB<\/jats:styled-content>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically review the available literature reporting on the effect of various therapies on niche\u2010related symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Search strategy<\/jats:title>\n                    <jats:p>\n                      A systematic search of\n                      <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>\n                      , Embase, Cochrane, trial registers and congress abstracts from\n                      <jats:styled-content style=\"fixed-case\">AAGL<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">ESGE<\/jats:styled-content>\n                      was performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Selection criteria<\/jats:title>\n                    <jats:p>\n                      Articles reporting on the effectiveness of therapies other than hysterectomy in women with niche\u2010related symptoms were included. Studies were included if they reported one of the following outcomes: effect on\n                      <jats:styled-content style=\"fixed-case\">AUB<\/jats:styled-content>\n                      , pain relief, sexual function, quality of life (\n                      <jats:styled-content style=\"fixed-case\">QOL<\/jats:styled-content>\n                      ), and surgical, anatomic, fertility, or pregnancy outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data collection and analysis<\/jats:title>\n                    <jats:p>\n                      Two authors independently selected the articles to be included. The Meta\u2010analysis of Observational Studies in Epidemiology (\n                      <jats:styled-content style=\"fixed-case\">MOOSE<\/jats:styled-content>\n                      ) guidelines were followed. A standardised checklist was used to score the methodological quality of the included studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main results<\/jats:title>\n                    <jats:p>\n                      Twelve studies were included, reporting on hysteroscopic niche resection (eight studies, 384 patients), laparoscopic repair (one study, 13 patients), (laparoscopic assisted) vaginal repair (two studies, 47 patients), and oral contraceptives (\n                      <jats:styled-content style=\"fixed-case\">OC<\/jats:styled-content>\n                      s) (one study, 11 patients). Reported\n                      <jats:styled-content style=\"fixed-case\">AUB<\/jats:styled-content>\n                      improved in the vast majority of the patients after these interventions, ranging from 87 to 100%. The rate of complications was low. Pregnancies were reported after therapy; however, sample sizes and follow\u2010up were insufficient to study fertility or pregnancy outcome. The methodological quality of the selected papers was considered to be moderate to poor, and was therefore insufficient to make solid conclusions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Author's conclusions<\/jats:title>\n                    <jats:p>More evidence is needed before (surgical) niche interventions are implemented in daily practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.12537","type":"journal-article","created":{"date-parts":[[2013,12,26]],"date-time":"2013-12-26T05:28:29Z","timestamp":1388035709000},"page":"145-156","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":117,"title":["Minimally invasive therapy for gynaecological symptoms related to a niche in the caesarean scar: a systematic review"],"prefix":"10.1111","volume":"121","author":[{"given":"LF","family":"van der Voet","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Deventer Hospital Deventer The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AJ","family":"Vervoort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology VU University Medical Centre Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Veersema","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology St Antonius Hospital Nieuwegein The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AJ","family":"BijdeVaate","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology VU University Medical Centre Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HAM","family":"Br\u00f6lmann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology VU University Medical Centre Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JAF","family":"Huirne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology VU University Medical Centre Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,12,26]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"GibbonsL Beliz\u00e1nLM LauerJA Betr\u00e1nAP MerialdiM lthabeF.The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage. 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