Clinical Importance of Appearance of Cesarean Hysterotomy Scar at Transvaginal Ultrasonography in Nonpregnant Women

Osser, O. Vikhareva; Valentin, Lil

doi:10.1097/aog.0b013e318209abf0

Cited by 134 publications

(103 citation statements)

References 19 publications

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“…Under such conditions, hysteroscopic surgery is very difficult to perform and is not recommended. Another important point is that a dehiscent defect puts patients at a high risk of uterine rupture in subsequent pregnancies due to the poor quality and structural abnormalities of the residual myometrium [11]. Therefore, CSP resection and simultaneous dehiscent defect repair might be the best treatment.…”

Section: Commentmentioning

confidence: 99%

Treatment Options To Terminate Persistent Cesarean Scar Pregnancy

Zhang

Duan

Cheng

et al. 2012

Gynecol Obstet Invest

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Aims: Persistent Cesarean scar pregnancy (PCSP) is a rare and special type of Cesarean scar pregnancy (CSP) which is resistant to conservative treatment. The treatment option is challenging. We report a case series to provide indications for further treatment. Methods: Ten women diagnosed as having a PCSP, seeking better treatment because of primary treatment failure, were admitted to a gynecologic minimally invasive center. Ultrasound combined with office hysteroscopy was used for preoperative evaluation, and then a further surgical strategy was selected. Clinical data were retrospectively studied. Results: Among ten PCSP patients, 4 were type I and 6 were type II. In the 4 type I cases, 2 were treated by laparoscopy and the other 2 by hysteroscopy; to stop bleeding in 1 of them, the uterine artery was occluded laparoscopically. All type II cases were successfully treated by laparoscopic excision. The mean operating time was 61.5 min. The mean blood loss was 83.5 ml. No complications occurred except one intraoperative hemorrage. Conclusions: Experience from this case series indicates that an individualized surgical plan based on a full preoperative evaluation provides useful information for choosing a suitable treatment for PCSP. Endoscopically guided surgical excision with experienced hands may be considered the most useful treatment.

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Section: Commentmentioning

confidence: 99%

Treatment Options To Terminate Persistent Cesarean Scar Pregnancy

Zhang

Duan

Cheng

et al. 2012

Gynecol Obstet Invest

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“…These complications include cesarean scar pregnancy, morbidly adherent placenta, and CS scar dehiscence and rupture [2,[5][6][7][8]. A growing number of studies suggest that the occurrence of long-term consequences of CS is related to the incomplete healing of the CS scar in the uterus, i.e., the development of a niche within the scar [7][8][9][10]. According to these studies, ultrasonographic assessment of the morphology of the CS scar in women who are not currently pregnant may predict the occurrence of CS scar dehiscence and rupture during subsequent pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Pomorski¹,

Fuchs²,

Rosner-Tenerowicz³

et al. 2017

Ginekol Pol

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Objectives: A growing number of studies suggest that the incomplete healing of the CS scar in the uterus increase the risk of uterine dehiscence or rupture during subsequent pregnancies. Thus, the factors that affect wound healing should be evaluated. We aimed to determine whether the morphology of the CS scar in non-pregnant women after one elective CS was affected by the site of the uterine incision, uterine flexion, maternal age, and fetal birth weight. Material and methods:208 non-pregnant women were invited for participation in the study, but only 101 of them met inclusion criteria. Standardized scar parameters (residual myometrial thickness (RMT), depth (D) and width (W) of the hypoechoic niche) were measured using ultrasonography at least 6 weeks after the CS.Results: Scar defect was detected in 26 of 101 subjects. Women without scar defect had significantly higher RMT values (1.87 vs. 0.87), lower newborn birth weight (3127 g vs. 3295 g), and higher scar location above the internal cervical os (62% vs. 16%), than those with scar defect. Maternal age was significantly correlated with D value (R = 0.40). Uterine retroflexion was significantly correlated with a larger D value (R = 0.63) and a larger D/RMT ratio (R = 0.24). Conclusions:In low-risk women who have undergone one elective CS, several risk factors are associated with development of the scar defect, but only scar location can be modified during surgery. Future research is needed to determine whether a relatively higher incision location in the uterus can ensure optimal healing of the CS scar.

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“…8 Several investigators have attempted to evaluate the integrity and thickness of the cesarean scar and the lower uterine segment by 2-dimensional and 3-dimensional (3D) ultrasound, so as to predict possible obstetric complications of future pregnancies. 9 No conclusive data are yet available to our knowledge; however, Vikhareva Osser and Valentin, 10 in a recent study, suggested an association between large defects in the cesarean scar after CD detected on transvaginal ultrasound in nonpregnant women, and uterine dehiscence or rupture in subsequent pregnancy. Gizzo and colleagues 11 suggest a significant difference in the lower uterine segment size and myometrial thickness between women with multiple CDs and those without.…”

Section: Post-cesarean Complications Uterine Dehiscence and Rupturementioning

confidence: 94%

Imaging Evaluation of Maternal Complications Associated with Repeat Cesarean Deliveries

Moshiri

Osman

Bhargava

et al. 2014

Radiologic Clinics of North America

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Clinical Importance of Appearance of Cesarean Hysterotomy Scar at Transvaginal Ultrasonography in Nonpregnant Women

Abstract: Our results point toward a likely association between large defects in the hysterotomy scar after cesarean delivery detected by transvaginal ultrasonography in nonpregnant women and uterine rupture or dehiscence in subsequent pregnancy.

Cited by 134 publications

References 19 publications

Treatment Options To Terminate Persistent Cesarean Scar Pregnancy

Treatment Options To Terminate Persistent Cesarean Scar Pregnancy

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Imaging Evaluation of Maternal Complications Associated with Repeat Cesarean Deliveries

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