Cesarean scar defects and abnormal uterine bleeding: a systematic review and meta-analysis

Murji, Ally; Sanders, Ari; Monteiro, Ilza; Haiderbhai, Shabbir; Matelski, John; Walsh, Chris; Abbott, Jason; Munro, Malcolm G.; Maheux-Lacroix, Sarah

doi:10.1016/j.fertnstert.2022.06.031

Cited by 40 publications

(37 citation statements)

References 32 publications

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“…Intermenstrual bleeding may indicate the presence of a focal lesion like a polyp (AUB‐P), and the clinician should consider evaluation for malignancy or endometrial hyperplasia, as appropriate, given the clinical context (AUB‐M) 33 . If IMB is consistently early in the cycle (in the follicular phase) and typically comprises dark spotting or bleeding, a cesarean scar defect may be present and contribute to the symptom 34 . The symptom of HMB in the context of apparently ovulatory cycles likely reflects a disorder of hemostasis, be it systemic (AUB‐C, further discussed in Section 5) or local, and if local, a primary endometrial disorder (AUB‐E) or one secondary to the presence of adenomyosis (AUB‐A) or a leiomyoma (AUB‐L, uterine fibroids), most commonly one that is submucous in location (AUB‐L SM ).…”

Section: Figo Systemmentioning

confidence: 99%

Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2

Jain

Munro

Critchley

2023

Intl J Gynecology & Obste

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Abnormal uterine bleeding (AUB) is common, often debilitating, and may affect over 50% of reproductive‐aged women and girls. Whereas AUB is a collection of symptoms that include intermenstrual bleeding and abnormalities in period duration, cycle length, and regularity, it is heavy menstrual bleeding (HMB) that is most contributory to iron deficiency and related anemia. It is apparent that AUB, in general, and HMB, in particular, remain underrecognized and underreported. FIGO created two systems for assessing and classifying AUB. FIGO System 1 defines the bleeding pattern using four primary descriptors: frequency, duration, regularity, and flow volume. FIGO System 2 provides a structured classification system of possible causes of AUB, using the acronym PALM‐COEIN. “PALM” refers to structural causes of AUB (Polyp, Adenomyosis, Leiomyoma, Malignancy), and “COEI” refers to nonstructural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, and Iatrogenic). The “N” is reserved for those entities that are currently not otherwise classified. Using FIGO System 1 as a gateway to FIGO System 2 streamlines the investigation of reproductive‐aged women and girls with AUB. Understanding the pathogenesis of the FIGO System 2 “PALM‐COEIN” causes helps interpret investigations and the onward management of AUB. Numerous evidence gaps exist concerning AUB; however, if researchers and trialists universally adopt FIGO Systems 1 and 2 for the assessment and diagnosis of AUB, clear translatable research findings can be applied globally.

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Section: Figo Systemmentioning

confidence: 99%

Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2

Jain

Munro

Critchley

2023

Intl J Gynecology & Obste

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“…The most common of these are uterine scar defect, uterine wall diverticulum, isthmocele, pouch, niche, and sacculation; however, a recent systematic review by Murji et al . [5 ▪ ] found that the CSD has additionally been described as anechoic area, triangular shape, disruption/discontinuity, bursa, dome, arch, gap, indentation, and concavity. For the purposes of this discussion, the term cesarean scar defect (CSD) will predominantly be used.…”

Section: Epidemiologymentioning

confidence: 99%

“…These patients also exhibit a specific bleeding pattern, with prolonged menstruation with a mean of 14 days duration, and a mean of 7 days of early cycle bleeding. This is felt to be secondary to inflammation, fibrosis, and necrosis within the defect itself [5 ▪ ]. The presence of a CSD is also associated with secondary infertility, possibly because of the impact of this inflammatory response from menstrual blood and scarring within the defect on cervical mucous quality, sperm transport, and sperm quality [11 ▪▪ ,12 ▪▪ ].…”

Section: Clinical Signs and Symptomsmentioning

confidence: 99%

The presentation and management of cesarean scar defects: an updated review on an evolving diagnosis

McGrattan

Kobylianskii

Thiel

et al. 2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review The purpose of this review is to provide a clinically relevant synthesis of the current literature on cesarean scar defects, focusing on their epidemiology and clinical presentation, diagnosis, treatment, and prevention. Recent findings Cesarean scar defects (CSDs) are an emerging area of gynecologic research, with an influx of higher quality cohorts, randomized controlled trials, and systematic reviews published within the last decade. Recent developments of importance include the European Niche Taskforce consensus on the measurement and diagnosis of CSDs, the proposal of clinical criteria for Cesarean scar disorder (CSDi), as well as the publication of several systematic reviews, which provide enhanced support for clinical decision-making in treatment strategies. Areas for continued research include risks factors for CSDs and preventive strategies, as well as their role in obstetrical complications. Summary CSDs are a common sonographic finding. While those incidentally identified in an asymptomatic population require no treatment, CSDs can cause significant burden in the form of abnormal uterine bleeding, pelvic pain, and infertility. Their role in obstetrical complications has yet to be fully elucidated. Given the high incidence of cesarean sections, many – if not all – providers of uterine care will encounter their sequalae. As such, continued awareness amongst all providers regarding their evaluation and management is key. Video Abstract http://links.lww.com/COOG/A91

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“…In the same year, a systematic review of the role of cesarean scar defect and AUB was published in Fertility and Sterility . A FIGO classification and reporting system for adenomyosis has been developed, and publication will follow a validation exercise sometime in 2023. a Munro and Lukes, 2 Kadir et al, 3 Lukes et al, 4 Fraser et al, 5 Kouides et al 6 b Fraser et al 8 c Munro et al 9 d Munro et al 12 e Munro et al, 28 Munro et al, 29 Munro et al 30 f Murji et al 31 …”

Section: Figurementioning

confidence: 99%

Our path from abnormal uterine bleeding and iron deficiency to impaired fetal development: A long and winding road

Munro

Critchley

2023

Intl J Gynecology & Obste

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Cesarean scar defects and abnormal uterine bleeding: a systematic review and meta-analysis

Cited by 40 publications

References 32 publications

Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2

Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2

The presentation and management of cesarean scar defects: an updated review on an evolving diagnosis

Our path from abnormal uterine bleeding and iron deficiency to impaired fetal development: A long and winding road

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