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      Transvaginal Management of Cesarean Scar Section Diverticulum: A Novel Surgical Treatment

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          Abstract

          Background

          The aim of this study was to investigate the clinical value of transvaginal management of cesarean section scar diverticulum.

          Material/Methods

          We evaluated 64 patients receiving transvaginal management of previous cesarean scar defect (PCSD).

          Results

          The PCSD was successfully treated by transvaginal surgery, without evident complications. The mean operation time was 33.6±4.1 min, blood loss was 37.9±16.8 ml, and the mean hospital stay after surgery was 6±2.9 days. Symptoms related to the prolonged menstruation in 53 patients were improved after surgery, vaginal bleeding time was reduced by an average of 7.3±2.8 days, and a significant difference was noted between the mean pre- and post-operative duration of menstruation (P<0.01). Of 11 patients with guttate between menstrual periods, guttate was absent in 9 patients and improved in 2. Clinical improvement was observed in 85.9% (55/64).

          Conclusions

          Transvaginal intervention is feasible and safe for the management of PCSD.

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          Most cited references17

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          Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications.

          Amanda M. Tower, Gary N Frishman (2013)
          The gynecologic sequelae due to deficient uterine scar healing after cesarean section are only recently being identified and described. These include conditions such as abnormal bleeding, pelvic pain, infertility, and cesarean scar ectopic pregnancy, as well as a potentially higher risk of complications and difficulties during gynecologic procedures such as uterine evacuation, hysterectomy, endometrial ablation, and insertion of an intrauterine device. The proposed mechanism of abnormal uterine bleeding is a pouch or "isthmocele" in the lower uterine segment that causes delayed menstrual bleeding. The prevalence of symptomatic or clinically relevant cesarean scar defects (CSDs) ranges from 19.4% to 88%. Possible risk factors for CSD include number of cesarean sections, uterine position, labor before cesarean section, and surgical technique used to close the uterine incision. There are no accepted guidelines for the diagnostic criteria of CSD. We propose that a CSD be defined on transvaginal ultrasound or saline infusion sonohysterography as a triangular hypoechoic defect in the myometrium at the site of the previous hysterotomy. We also propose a classification system to aid in standardized classification for future research. Surgical techniques for repair of CSD include laparoscopic excision, resectoscopic treatment, vaginal revision, and endometrial ablation.
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            Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect.

            Cecilia Fabres, Pablo Arriagada, Carlos Fernández-Fernández … (2016)
            Previous cesarean delivery scar (PCDS) defect has been described as a cause of intermenstrual bleeding in women with no other uterine pathology except for a pouch on the anterior uterine segment at the site of the cesarean scar. The objective of this study was to assess the effectiveness of hysteroscopic surgery to correct this anatomic defect and eliminate the bleeding disturbance in a group of women with this symptom. Retrospective study (Canadian Task Force classification XX). Private hospital, department of obstetrics and gynecology. Twenty-four women, age 29-41 years, who reported intermenstrual bleeding, especially postmenstrual spotting, with no other gynecologic pathology except for the presence of a PCDS defect. Diagnosis was established with transvaginal ultrasound, when a fluid-filled, triangular defect was seen in the anterior uterine isthmus, in relation to the cesarean section scar. Hysteroscopic resection of fibrotic tissue that overhangs underneath the triangular pouch, facilitating blood drainage through the cervix and fulguration of endometrial glands and/or dilated blood vessels. The mean number of previous cesarean-section deliveries was 2.75. Postoperative follow-up was 24 months in 21 patients and at least 14 months in the other 3 patients. Eleven of these patients with the desire to become pregnant were unable to conceive after trying for a period of at least 2 years before hysteroscopy. Infertility work-up in the 11 patients revealed 9 with unknown infertility, 1 with male infertility, and 1 with failed tubal reversal surgery. Nine of them became pregnant between 14- and 24-months of follow-up. Eighty-four percent of patients (20/24) remained asymptomatic (without bleeding disturbances) after surgery. Previous cesarean delivery scar defect may be the cause of intermenstrual bleeding, and it is possible that it also may impair fertility, but it can be successfully treated by hysteroscopic surgery.
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              The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy.

              Cecilia Fabres, Guillermo Avilés L, Carlos Veiga de la Jara … (2003)
              We sought (1) to describe an anatomic defect of the uterine cavity in the anterior isthmus diagnosed by transvaginal sonography in a group of premenopausal women with previous cesarean deliveries, (2) to establish whether there is an association between the presence of the pouch and a bleeding disturbance, and (3) to compare the diagnostic efficacy of transvaginal sonography versus hysteroscopy for the detection of this defect.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Sci Monit
                Journal ID (iso-abbrev): Med. Sci. Monit
                Journal ID (publisher-id): Medical Science Monitor
                Title: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                Publisher: International Scientific Literature, Inc.
                ISSN (Print): 1234-1010
                ISSN (Electronic): 1643-3750
                Publication date Collection: 2014
                Publication date (Electronic): 08 August 2014
                Volume: 20
                Pages: 1395-1399
                Affiliations
                [1 ]Department of Gynecology and Obstetrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
                [2 ]Reproductive Medicine Research Centre, Sixt Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
                Author notes
                Corresponding Author: Yuqing Chen, e-mail: fangchenyq@ 123456163.com
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                Publisher ID: 890642
                DOI: 10.12659/MSM.890642
                PMC ID: 4136942
                PubMed ID: 25104647
                SO-VID: a475ae62-d52a-4c61-87f4-f49757c393af
                Copyright © © Med Sci Monit, 2014
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License

                History
                Date received : 06 March 2014
                Date accepted : 14 April 2014
                Categories
                Subject: Clinical Research

                Keywords: cesarean section,diverticulum,uterine diseases
                Data availability:
                Keywords: cesarean section, diverticulum, uterine diseases

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