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

Sanne I Stegwee, Astrid Beij, Robert A de Leeuw, Lidwine B Mokkink, Lucet F van der Voet, Judith A F Huirne, Sanne I Stegwee, Astrid Beij, Robert A de Leeuw, Lidwine B Mokkink, Lucet F van der Voet, Judith A F Huirne

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.

Keywords: Caesarean section; Chronic disease; Focus groups; Niche; Quality of life.

Conflict of interest statement

All authors report that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Connection of domains and themes reported by niche patients. Size indicates relevance of the theme for QoL, with larger themes being reported more frequently or prioritised in the focus groups
Fig. 2
Fig. 2
Discrepancies and similarities in themes reported by patients and in the literature. Size indicates relevance in focus group discussions or frequency of reporting in the literature, with larger themes being reported more often

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