Abstract
BackgroundDelayed childbearing has been noted in a high percentage of women with a previous Caesarean section (CS). Many women with CS scar defects (CSDs) present with clinical symptoms of irregular vaginal bleeding. The present study aimed to investigate bacterial colonies at CSDs in women suffering from secondary infertility.MethodsThis observational study included 363 women with secondary infertility who visited the Assisted Reproduction Unit between 2008 and 2013. Among them, 172 women with a previous CS and 191 women with no previous CS were approached. The women with a previous CS had their CS operations in the past 1 to 14 years, with a mean of 3.5 years. The presence of CSDs was detected by vaginal ultrasonography. Bacteriology cultures of specimens taken from the uterine niches in those with CSDs were collected during Day 7 to Day 10 of the follicular phase. Specimens were obtained from the endocervical canal for bacterial culture in those without CSDs. The main outcome measure was the detection of the growth of bacterial colonies.ResultsCSDs were found in 60.4% (96 of 159) of women with a previous CS. In women with a previous CS, bacterial colonies were identified in 89.6% (86 of 96) and 69.8% (44 of 63) of women with and without CSDs, respectively. In women with no previous CS, 49.7% (88 out of 177) of bacterial cultures of endocervical samples showed bacterial colony growth. Gram-positive cocci (P = 0.0017, odds ratio (OR) = 1.576, 95% confidence intervals (CI) -22.5 to − 5.4) and Gram-negative rods (P = 0.0016, OR = 1.74, CI − 20.8 to − 5.0) were the most commonly isolated bacteria and contributed to approximately 90% of all microorganisms found in those with a previous CS. In women with a previous CS, more Gram-negative rods were isolated (P = 0.01, OR = 1.765, CI − 27.2 to − 3.8), especially Pseudomonas species (P = 0.02, OR = 1.97, CI − 16.7 to − 1.0), in those with visible CSDs than in those without CSDs.ConclusionsBacterial colonization at CSDs was found in a high percentage of women with secondary infertility.
Highlights
Delayed childbearing has been noted in a high percentage of women with a previous Caesarean sec‐ tion (CS)
Participants were divided into three groups: Group A,women who had a previous CS and a detectable uterine niche; Group B,women who had a previous CS but no detectable uterine niche; and Group C,women who presented with secondary infertility without a history of CS or any uterine lesions
Among 363 women enrolled, 27 were further excluded from this study due to difficulty obtaining an adequate amount of specimen owing to stenotic endocervical canals
Summary
Delayed childbearing has been noted in a high percentage of women with a previous Caesarean sec‐ tion (CS). A recent meta-analysis including 750,407 women showed an increased waiting time to the pregnancy and risk of subfertility among women with a previous Caesarean delivery compared to women who delivered vaginally only [7]. The same authors further carried out a retrospective national population-based cohort study including over 1 million primiparous low-risk women and concluded that there is no, or only a slight, effect of CS on future fertility [9]. Their results suggested that unmeasured clinical and social factors during pregnancy and the intrapartum period that led to the decision to undergo a CS might explain the apparent effect of CS on future fertility
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
