Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women (original) (raw)
Related papers
Surgical Management of Cesarean Scar Defect in Restoring Fertility
2018
Cesarean scar defect, niche, or isthmocele is commonly detected as an incidental finding on transvaginal ultrasound as a wedge-shaped anechoic area. The presence of a uterine scar defect is usually asymptomatic or relates to postmenstrual spotting and dark red or brown discharge, pelvic pain or infertility. Surgical repair or isthmoplasty is associated with an improvement in uterine bleeding in 59% to 100% of cases and a pregnancy rate of 77.8% to 100%. Therefore, treatment of isthmocele should be offered to women with symptoms or if it is causing infertility. Hysteroscopic isthmoplasty appears to be the most popular and less invasive treatment. However, in the absence of randomized trials, the efficacy of different surgical approaches remains to be evaluated.
Post-cesarean scar endometriosis
Journal of Turkish Society of Obstetric and Gynecology, 2017
PRECIS: Scar endometriosis is a condition seen in women during their reproductive period, excision is required by obtaining secure margins in the treatment. Öz Amaç: Endometriozis reprodüktif dönemdeki kadınlarda fonksiyonel endometriyal gland ve stromal dokunun uterus kavitesi dışında görülmesidir. Bu çalışmada skar endometriozis nedeniyle opere edilen hastalarımızın klinik özelliklerini tanımlamayı ve cerrahi sonuçlarını literatür ışığında tartışmayı amaçladık. Gereç ve Yöntemler: Patolojik inceleme sonucu endometriozis tanısı alan ve opere edilen 24 hasta retrospektif olarak incelenmiştir. Bulgular: Çalışmaya alınan hastaların yaş ortalaması 31 olup 13'ü genel cerrahi polikliniğine 11'i ise jinekoloji polikliniğine başvurmuştur. On dokuz hastada siklik ağrı vardı. Dokuz hastada 1 kez, 12 hastada 2 kez ve 3 hastada 3 kez sezaryen öyküsü vardı. Ultrasonografide lezyonların çapının ortalaması 39,1 mm, manyetik rezonans görüntülemede 37,5 mm idi. On üç hastada insizyonun sol tarafında, 11 hastada sağ tarafında endometriozis saptandı. Lezyonların ortalama ağırlığı 61,6 gramdı. Sonuç: Endometriozisin oluşumu iatrojenik implantasyon teorisi ile desteklenmektedir. Batın duvarında kitle şikayeti ile gelen olgularda öncesinde obstetrik ve jinekolojik operasyon, menstruasyon dönemlerinde artan ağrılı kitle öyküsü iyice sorgulanmalıdır. Skar endometriozisinin tedavisinde güvenli marj sınırı elde edilerek eksizyon gerekmektedir. Skar endometrioziste teşhis önceden konulabilirse gereğinden daha az veya fazla ameliyat yapılması engellenmiş olacaktır.
The Egyptian Journal of Hospital Medicine, 2022
Background: Cesarean section complications are becoming more common as cesarean scar defects. Objective: This study aimed to evaluate the anatomical characteristics of cesarean scar niche by diagnostic hysteroscopy and sonohysterography in women with unexplained secondary infertility. Patients and methods: This observational cross-sectional study included 100 women who attended our outpatient clinic, complaining of unexplained secondary infertility with a history of at least one CS and showing scar niche in office hysteroscopy followed by re-assessment by saline infusion sonohysterography with the evaluation of scar depth, width, and shape in both methods. Results: The present work revealed that 45 cases had unhealthy (fibrotic) scars, 41 cases had collected blood in the niche, 24 cases had infected scars, 5 cases had endometritis, and 4 cases had a small submucosal polyp, as well as one case, had a small uterine septum. There were 32 cases with post-menstrual spotting, the mean duration of post-menstrual spotting was 2.5 days (±0.9 SD), 19 cases had chronic pelvic pain, 15 cases had both post-menstrual spotting and chronic pelvic pain, 12 cases had dyspareunia. There were 25, 31, and 44 cases that had 2ry infertility ≥ 1, ≥ 2, and ≥ 3 years respectively. There was a non-significant correlation between features of the niche through diagnostic hysteroscopy and correlated symptoms. Conclusion: Cesarean scar may play an intermediate role in fertility. Hysteroscopy is considered the golden standard tool for the diagnosis of different intrauterine lesions, however; the procedure of sonohysterography is well-tolerated, cost-effective, and can be performed in an office-based gynecological practice, and doesn't require special training.
Clinical-Morphological Evaluation of the Quality of the Uterine Scar Tissue After Caesarean Section
Journal of IMAB - Annual Proceeding (Scientific Papers)
Caesarean section (C.S.) is the most commonly performed operative procedure of the uterus in women of reproductive age. Each of these women increases their likelihood of complications in subsequent pregnancies. There is an obsolete law in obstetrics: once a cesarean, always a cesarean, due to the danger of failure of the uterine scar tissue and the greatly increased possibility of uterine rupture. This necessitates the application of various methods of assessing the sufficiency of the scar tissue before planning further deliveries. The most accurate methods for determining the structure of a tissue are histological, which by their nature can not be used during the pregnancy but they can correlate to clinical ones. Materials/ Methods: Prospective study of 40 pregnant women with previous C.S., divided into groups according to the interval between the operations. Another subsequent division of subgroups to the number of Caesarean sections was made. The morphological indicators were compared to a control group of dermal scar from the same patients. The results of the clinical methods were to be compared with the results of the same patients from the morphological studies. We used clinical methods such as the history of the previous pregnancies and puerperal period, history of previous operations and the recovery after them, ultrasound examination and evaluation of the anterior uterine wall preoperatively. The morphological methods used are: Hematoxylin & eosin staining (H&E), followed by Masson Trichrome for collagen; Weigert-Van Gieson staining for elasticity; staining of immunohistochemistry MIB-1 (Ki-67) for cell proliferation. Results: The study group was presented by patients with one or more previous C.S. that were divided in subgroups. The shortest inter-delivery interval was 14 months, the longest-19 years. The shorter the period between the C.S.s was, the thinner the myometrium. Cases of abnormal healing have been observed, including: myometrial hyperplasia, adenomyosis, myofiber disarray, elastosis, inflammation, fibroids, keloids. These results can be compared to clinical data from patients but mainly with the number of previous C.S. or those with a brief period
Determinants of uterine scarring
Romanian Medical Journal
Despite current recommendations to encourage vaginal birth, the rate of cesarean sections has increased significantly in recent years, leading to an increase in the rate of uterine scar defects. The association between these defects and multiple maternal comorbidities motivates their study for prevention. Using various online library search engines such as PubMed, Medscape, UpToDate, Cochrane, we selected studies on the factors that cause deficient uterine scarring. In literature, it has various names, such as: isthmocele, niche, uterine scar dehiscence or uterine diverticulum. For this paper, 11 scientific articles were selected, choosing only the factors for which a positive statistical link was observed, meaning the increase of the risk of uterine scar defect. Currently, there is no unanimity on the factors that influence the quality of uterine scarring, for many of the factors analyzed there are also other contradictory studies.
Navigating uterine niche 360 degree: a narrative review
Middle East Fertility Society Journal/Middle East Fertility Society Journal, 2024
Background The increasing prevalence of cesarean section (CS) deliveries globally has sparked apprehension regarding potential long-term complications, notably the emergence of uterine niches. CS results in a scar that in certain patients, inadequate healing of that scar results in the development of a uterine niche. While most small niches show no symptoms, large cesarean scar niches in nonpregnant women can give rise to cesarean scar disorder syndrome. This syndrome is characterized by abnormal uterine bleeding, dysmenorrhea, and secondary infertility. In pregnant women, the presence of substantial niches may be linked to potentially life-threatening complications, including cesarean scar dehiscence, uterine rupture, placenta accreta spectrum disorders, placenta previa, and cesarean scar ectopic pregnancy. Main body Given the potential dangers associated with uterine niche occurrence, numerous studies in recent years have delved into the concept of cesarean scar niche, exploring its risk factors, diagnostic approaches, and treatment options. Various diagnostic modalities, such as two-or three-dimensional transvaginal ultrasonography, twoand three-dimensional sono-hysterography, hysterosalpingography, hysteroscopy, or magnetic resonance imaging, can be employed to detect uterine niches. However, none of these diagnostic methods is universally accepted as the "gold standard, " and there remains a lack of unequivocal guidelines on certain aspects related to the diagnosis of cesarean scar niche. These niches, characterized by hypoechoic regions within the myometrium at the site of a previous CS scar, pose diagnostic complexities and provoke inquiries into their prevalence, factors influencing their development, clinical presentations, and appropriate therapeutic approaches. Conclusion As CS rates rise, this review aims to understand and address uterine niches and mitigate their impact on maternal health and reproductive outcomes.
Pregnancy in the scar after myomectomy
Clinical and Experimental Obstetrics & Gynecology, 2018
The pregnancy in the scar after myomectomy is a rare form of ectopic pregnancy. There has been only 34 cases presented in the recent literature so far. [1] In this paper, we describe our experience with this life-threatening disease. Case Report This report describes the case of a 33-year-old female. The patient underwent a c-section at 27 weeks of gestation due to the diagnosis of premature separation of the placenta in 2003 and laparoscopic myomectomy in 2013. The details regarding laparoscopic procedure in the time of examination were not known. The patient was referred from the specialized ultrasonographic Department to Gynaecology and Obstetrics clinic and afterwards she was taken to the hospital for a suspected pregnancy in the scar after myomectomy at the 12 th week of pregnancy. At the time of admission, the patient was without any problems, pain,temperature and even no bleeding was discovered. Initially ultrasound scan of the uterus was described in retroversion without the apparent echoes of embryo in the uterine cavity. In the maternal fundus, a part of the chorion with the visible formed placenta was discovered. Moreover, the communication of uterine cavity with the adjacently gestational sac was outside the uterine cavity and in which the fetus was alive with heart functions. The CRL was 47 mm and the estimated pregnancy age was 11 + 4 weeks. The myometrium closer gestation sac was extremely depleted to 1.7 mm. On the basis of the ultrasound scan, the patient was sent to confirm the diagnosis by magnetic resonance examination. The result of this examination was that the fundus of the uterus with cystic formation (vs. chorionic sac) emanating from the back wall of the uterus had an hourglass shape. In the dorsal stored part of the uterus, the fetus was displayed. The placenta