Hysteroscopic and laparoscopic management of uterine defects on previous cesarean delivery scars

Abstract

Women with a history of cesarean delivery combined with irregular perimenstrual bleeding should undergo combined hysteroscopy and ultrasound examination to detect latent scar defects. In diagnosed cases, in those who desired future pregnancies and had a residual myometrial thickness of <3.5 mm or a defect that accounted for ≥50% of the anterior uterine wall, laparoscopic surgical repair was performed with good postoperative anatomic outcomes. Women with residual myometrial thickness of ≥3.5 mm or a defect that accounted for <50% of the anterior uterine wall were treated with hysteroscopic surgery and had a relief of symptoms.

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

“…The mean reported reduction in spotting in one prospective and one retrospective cohort study varied between 2 and 4 days 15, 17. Two recent non‐comparative studies in 144 women reported a resolution of spotting in 80% of women; however, a reduction in the number of days of spotting was not reported 22, 23…”

“…The cut‐off value of the residual myometrium in various studies varies between 2.5 and 4.0 mm, as measured using sonohysterography 13, 22, 23…”

“…A hysteroscopic niche resection can be performed in different ways: the lower rim (closest to the external cervical os) can be resected to facilitate menstrual outflow (Figure1);14, 15, 16, 17 both the lower and the upper part of the niche can be resected;18, 19, 20, 21 and this can be combined with coagulation of the vessels in the niche,16, 18, 19, 20, 21 or the entire niche surface 14, 15. Previous cohort studies reported a reduction of postmenstrual spotting in 80–90% of women, and a reduction in pain in 97% of women, in the absence of complications 13, 22, 23. The mean reduction in the number of days of spotting compared with baseline was reported in two studies, and varied between 2 and 4 days in 119 women.…”

The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

“…Several case reports, case series and small prospective cohort studies with a maximum of 38 included women and one larger retrospective comparative study ( n  = 59) have been reported 5, 12, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35. Eleven articles (including a total of 65 women) reported a reduction or complete resolution of postmenstrual spotting; however, this was mostly not measured in a standardised way 5, 16, 18, 20, 21, 24, 26, 27, 29.…”

“…Eleven articles (including a total of 65 women) reported a reduction or complete resolution of postmenstrual spotting; however, this was mostly not measured in a standardised way 5, 16, 18, 20, 21, 24, 26, 27, 29. Pelvic pain and/or dysmenorrhoea was reported to be resolved after laparoscopic niche resection in 36 women 5, 18, 21, 29. The residual myometrial thickness was increased after laparoscopic niche resection in all studies, but only three studies compared the outcomes with baseline measurements 15, 16, 17.…”