Niche-related outcomes after caesarean section and quality of life: a focus group study and review of literature

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

A niche in the uterus, present in 60% of women after caesarean section (CS), is associated with several gynaecological symptoms and possibly with subfertility. Studies that focus on quality of life (QoL) in relation to a niche are lacking.

Purpose

To identify niche-related outcomes that influence QoL and to compare patient-reported outcomes with outcomes studied in the literature.

Methods

Two focus group discussions (FGDs, N = 8 and 5) were conducted in Amsterdam UMC—location VUmc. Participants were Dutch patients with a large niche, with (planned) surgical treatment for their symptoms. Niche-related symptoms and impact on functioning or participation were fixed topics. The transcripts of the FGDs were coded into outcomes, themes and domains of QoL according to the WHOQOL model. Additionally, participants created a top five important outcomes. Next, we performed a systematic review (SR) on niche-related outcomes and compared the FGDs with niche-related outcomes from the SR.

Results

In four domains (physical health, psychological domain, social relationships and environment), fifteen themes were reported in the FGDs. Abnormal uterine bleeding (AUB), subfertility, sexual activity, abdominal pain and self-esteem were themes prioritised by participants. In the literature, gynaecological symptoms and reproductive outcomes were predominantly studied. Sexuality and self-esteem were prioritised in the FGDs but hardly or never studied in the literature.

Conclusion

We found a broad range of niche-related outcomes influencing QoL. Apart from symptoms evaluated in the literature such as AUB, abdominal pain and subfertility, clinicians and researchers should be more aware of sexual activity and self-esteem in this population.

Electronic supplementary material

The online version of this article (10.1007/s11136-019-02376-6) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 57

Record: found
Abstract: found
Article: not found

The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties.

M Power, B Murphy, W Kuyken … (1998)

This paper reports on the field testing, empirical derivation and psychometric properties of the World Health Organisation Quality of Life assessment (the WHOQOL). The steps are presented from the development of the initial pilot version of the instrument to the field trial version, the so-called WHOQOL-100. The instrument has been developed collaboratively in a number of centres in diverse cultural settings over several years; data are presented on the performance of the instrument in 15 different settings worldwide.

0 comments Cited 430 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata.

D Boyle, James Spies, Sheila M Gonzalves … (2002)

To create and validate a questionnaire for assessing symptom severity and symptom impact on health-related quality of life for women with leiomyomata. The questionnaire was derived from focus groups of women with leiomyomata. Content validity was established through cognitive debriefings of women with leiomyomata and review by expert clinicians. Patients for the validation study were recruited from five gynecologists' offices, an interventional radiology department, and a University campus. Instruments used for validation were the Short Form-36, Menorrhagia Questionnaire, the Revicki-Wu Sexual Function Scale, and a physician and a patient assessment of severity. Item and exploratory factor analysis were performed to assess the subscale structure of the questionnaire. Psychometric evaluation was conducted to assess reliability and validity. Test-retest was performed on a random subset of the sample within 2 weeks of the initial visit. A total of 110 patients with confirmed leiomyomata and 29 normal subjects participated in the validation. The final questionnaire consists of eight symptom questions and 29 health-related quality of life questions with six subscales. Subscale Cronbach's alpha ranged from 0.83 to 0.95, with the overall health-related quality of life score alpha = 0.97. The Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire subscales discriminated not only from normal controls but also among leiomyomata patients with varying degrees of symptom severity. Test-retest reliability was good with intraclass correlation coefficients of 0.76-0.93. The UFS-QOL appears to be a useful new tool for detecting differences in symptom severity and health-related quality of life among patients with uterine leiomyomata. Additional study is underway to determine the responsiveness of the UFS-QOL to therapies for leiomyomata.

0 comments Cited 114 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review.

J. A. F. Huirne, H. Brölmann, Leen-Jan Doorn … (2014)

To review systematically the medical literature reporting on the prevalence of a niche at the site of a Cesarean section (CS) scar using various diagnostic methods, on potential risk factors for the development of a niche and on niche-related gynecological symptoms in non-pregnant women. The PubMed and EMBASE databases were searched. All types of clinical study reporting on the prevalence, risk factors and/or symptoms of a niche in non-pregnant women with a history of CS were included, apart from case reports and case series. Twenty-one papers were selected for inclusion in the review. A wide range in the prevalence of a niche was found. Using contrast-enhanced sonohysterography in a random population of women with a history of CS, the prevalence was found to vary between 56% and 84%. Nine studies reported on risk factors and each study evaluated different factors, which made it difficult to compare studies. Risk factors could be classified into four categories: those related to closure technique, to development of the lower uterine segment or location of the incision or to wound healing, and miscellaneous factors. Probable risk factors are single-layer myometrium closure, multiple CSs and uterine retroflexion. Six out of eight studies that evaluated niche-related symptoms described an association between the presence of a niche and postmenstrual spotting. The reported prevalence of a niche in non-pregnant women varies depending on the method of detection, the criteria used to define a niche and the study population. Potential risk factors can be categorized into four main categories, which may be useful for future research and meta-analyses. The predominant symptom associated with a niche is postmenstrual spotting. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

0 comments Cited 91 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Sanne I. Stegwee:

ORCID: http://orcid.org/0000-0003-1353-5576

s.stegwee@amsterdamumc.nl

Judith A. F. Huirne:

ORCID: http://orcid.org/0000-0002-8248-2677

j.huirne@amsterdamumc.nl

Journal

Journal ID (nlm-ta): Qual Life Res

Journal ID (iso-abbrev): Qual Life Res

Title: Quality of Life Research

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0962-9343

ISSN (Electronic): 1573-2649

Publication date (Electronic): 16 December 2019

Publication date PMC-release: 16 December 2019

Publication date (Print): 2020

Volume: 29

Issue: 4

Pages: 1013-1025

Affiliations

[1 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, , Amsterdam UMC, Vrije Universiteit Amsterdam, ; De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

[2 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, , Amsterdam UMC, Vrije Universiteit Amsterdam, ; De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands

[3 ]GRID grid.413649.d, ISNI 0000 0004 0396 5908, Department of Obstetrics and Gynaecology, , Deventer Hospital, ; Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands

Author information

Sanne I. Stegwee http://orcid.org/0000-0003-1353-5576

Robert A. de Leeuw http://orcid.org/0000-0002-9344-7754

Lidwine B. Mokkink http://orcid.org/0000-0001-6489-2827

Lucet F. van der Voet http://orcid.org/0000-0001-5389-646X

Judith A. F. Huirne http://orcid.org/0000-0002-8248-2677

Article

Publisher ID: 2376

DOI: 10.1007/s11136-019-02376-6

PMC ID: 7142042

PubMed ID: 31845165

SO-VID: 2ae9e6b4-8800-4fdc-aaac-2f4c420a9bb6

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date accepted : 23 November 2019

Custom metadata

ScienceOpen disciplines: Public health

Keywords: caesarean section,niche,quality of life,chronic disease,focus groups

Data availability:

ScienceOpen disciplines: Public health

Keywords: caesarean section, niche, quality of life, chronic disease, focus groups

Niche-related outcomes after caesarean section and quality of life: a focus group study and review of literature

Read this article at

Abstract

Background

Purpose

Methods

Results

Conclusion

Electronic supplementary material

Related collections

IEEE: COVID-19 related research

Most cited references 57

The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties.

The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata.

Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 229

Cited by 10

Most referenced authors 1,125