The Scar on the Uterus After Cesarean Section and the Optimal Algorithm for Diagnostics

Abstract

Introduction. The technique of visualization, the definition of «anomalies» of the uterine scar differ in all of publications devoted to the study of morphological changes of the uterine scar after cesarean section (CS) in non-pregnant women. The aim of our study was to determine the optimal algorithm for the diagnosis of uterine scar local thinning. Materials and methods. The ultrasound examination of pelvic organs was performed for thepatients not less than 6 months after CS. 40 women had scar thinning creating the shape of «niche». Next there was performedthe MRI study. One patient had ultrasound the contrast examination with the intrauterine introduction of the physiological solution and for the other one we performed the contrast examination with microbubble preparation of the sulfur hexafluoride. All the patients with the«niche» detectedunderwent the hysteroscopy. Results. The ultrasound examination revealed that the residual thickness of the myometrium of the uterine scar was 3,3±1,54 mm. The sensitivity of the method was 63% and specificity was 62%. The MRI revealed the residual thickness of the myometrium 3,44±1,64 mm. The sensitivity of the method was 80% and the specificity was 71% (p<0,05). During the hysteroscopy the «niche» was visualized in 95% of cases. Conclusion. To reduce the measurement error and to detect the necessity of surgical treatment there is necessary to apply at least two different studies (routine ultrasound, ultrasound with contrast agent and MRI). In the severe cases there is important to use hysteroscopy as the additional technique, which allows to visualize the defect accurately.

Echohysterosalpingography: pros and cons. A systematic review

“…2) дополнительные (отсутствие наступления беременности более 12 месяцев, оценка возможных аномалий развития матки, М-эхо полости матки более 8 мм в постменопаузальном периоде, внутриматочная патология, определение состоятельности рубца на матке после кесарева сечения) [15,16,26,42].…”