Hysteroscopic treatment of cesarean scar defect
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GENERAL GYNECOLOGY
Hysteroscopic treatment of cesarean scar defect Yingyu Dou1 · Da Zeng1 · Zi’ang Zou1 · Yajun Wan1 · Dabao Xu1 · Songshu Xiao1 Received: 17 March 2020 / Accepted: 6 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To investigate the effect of hysteroscopic surgery on the outcomes of obstetrics and gynecology among patients with cesarean section diverticulum. Methods Ninety-nine infertile patients with cesarean section diverticulum received hysteroscopic treatment and were retrospectively analyzed. Patients were followed for 1 year. Results The study included ninety-nine symptomatic patients with cesarean section diverticulum. After surgery, the menstrual periods of patients were improved from 11.15 ± 4.44 to 7.69 ± 2.85 days. Forty-seven (47/99) women became pregnant after surgery. The number of patients who became pregnant with an anteflexion uterus after hysteroscopic surgery is 32 (32/57), and the number of women who became pregnant with a retroflexion uterus is 15 (15/42). Conclusion Hysteroscopic surgery could improve the PCSD-associated prolonged menstrual bleeding, and satisfactory obstetrical outcomes could be achieved by the surgery treatment in women with cesarean defect. Keywords Hysteroscopic surgery · Cesarean scar diverticulum · Prolonged menstrual bleeding · Obstetrics outcomes
Introduction Cesarean section has become an important surgical method for handling obstetric complications in the third trimester of pregnancy. Every year, there are approximately 1.5 million cesarean sections performed around the world [1]. Data from 1990 to 2014 show that the global cesarean section rate rose from 6.7 to 19.1%, with an absolute growth rate of 12.4% [2]. Poor healing of cesarean section incisions promotes the formation of depressions and fluid-filled sacs in cesarean section scars [3]. Cesarean scar defect (CSD) is a dome at the anterior lower uterine after cesarean section, also known as previous cesarean section scar defect (PCSD), uterine scar defect, uterine diverticulum niche, pouch, sacculation or isthmocele, which refers to poor healing of the uterine scar after cesarean section or scar split, which is a serious complication of cesarean section [4–6]. These defects tend to accumulate menstrual blood during menstruation. Studies * Songshu Xiao [email protected] 1
Department of Gynecology and Obstetrics, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, China
have shown that the incidence of CSD in women with cesarean section is 24–84%, among which 30% of women have abnormal vaginal bleeding 6 months after cesarean section [7–9]. Accumulated menstrual blood in the diverticulum of cesarean section incision may not only cause abnormal bleeding, but also lead to secondary infertility [6, 10, 11]. Some studies have suggested that women with CSD may experience secondary infertility but some of them could successfully achieve to become pregnant after surgery treatment [11–13]. There is no unified clinica
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