INTRODUCTION:
Cesarean scar defects may cause abnormal uterine bleeding, pelvic pain and infertility. We present our preliminary results after laparoscopic and/or hysteroscopic surgical repair.
METHODS:
We performed a retrospective review of clinical data and preliminary outcomes of patients with cesarean scar defect who underwent surgery at the Camran Nezhat Institute.
RESULTS:
We included a total of 27 women. Average age was 36 years, with an average BMI of 23.1 kg/m2. Most patients (74%) had 1 prior cesarean section, while 26% had 2 or more. The most common presenting symptom was pelvic pain (81%), followed by dysmenorrhea (70%), irregular vaginal bleeding (67%) and infertility (48%). Nearly half (44%) of the patients had a previous diagnosis of endometriosis. Prior to presenting to our center, 52% of patients with infertility had attempted IVF, and 30% attempted IUI. Defect repair was performed by a combined laparoscopic and hysteroscopic approach in 85% of patients, while 7% underwent hysteroscopic repair and 11% a hysterectomy. There were 2 postoperative complications, namely umbilical scar revision and umbilical cellulitis. A diagnosis of endometriosis was established by pathology in 67% of cases. Symptoms resolved in 33% of patients, improved in 44%, and persisted in 18%. In those who desired future fertility, the clinical pregnancy rate after repair was 47% (n=7), with five resulting in live births (33%) and two miscarriages (7%).
CONCLUSION:
Cesarean scar defect repair proved beneficial with improved symptoms in 77% of patients and restored fertility in 47%. Lower pregnancy rates may be related to the increased prevalence of endometriosis in this sample.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.