Cesarean scar defect – manifestation, diagnostics, treatment

Česká verzia

Authors: V. Pešková; M. Kacerovský
Authors place of work: Porodnická a gynekologická klinika FN, Hradec Králové, přednosta kliniky prof. MUDr. J. Špaček, Ph. D., IFEPAG
Published in the journal: Ceska Gynekol 2020; 85(4): 282-287
Category: Přehledový článek

Summary

Objective: To summarize current knowledge concerning cesarean scar defects and it’s manifestation, diagnostics and treatment possibilities.

Design: Review.

Setting: Department of Obstetrics and Gynecology, University Hospital Hradec Kralove.

Methodology: Research from available literature works and studies regarding facts about cesarean scar defects.

Conclusion: Cesarean scar defect is one of known complication after cesarean section which has become more common in consequence of rising cesarean delivery rate. It is associated with sundry gynecological and obstetric difficulties like abnormal uterine bleeding, pelvic pain, infertility, cesarean scar defect pregnancy or uterine rupture. The most common diagnostic way is using transvaginal ultrasound, sonohysterography or hysteroscopy. Treatment choice is due to a size of cesarean scar defect and also pregnancy planning. Alternatives of treatment including hormonal contraception and various surgery such as hysteroscopy, laparoscopy, laparotomy and transvaginal procedures.

Keywords:

cesarean scar defect – abnormal uterine bleeding – pelvic pain – infertility – uterine rupture – vaginal ultrasound – hysteroscopy – laparoscopy

Zdroje

1. Abacjew-Chmylko, A., Wydra, DG., Olszewska, H. Hysteroscopy in the treatment of uterine cesarean section scar diverticulum: a systematic review. Adv Med Sci, 2017, 62(2), p. 230–239.

2. Bij de Vaate, AJ., Van der Voet, LF., Naji, O., et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section: systematic review. Ultrasound Obstet Gynecol, 2014, 43(4), p. 372–382.

3. Di Spiezio Sardo, A., Saccone, G., McCurdy, R., et al. Ultrasound Obstet Gynecol, 2017, 50, p. 578–583.

4. Donnez, O., Donnez, J., Orellana, R., Dolmans, MM. Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women. Fertil Steril, 2017, 107(1), p. 289–296.

5. Fabres, C., Aviles, G., De La Jara, C., et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med, 2003, 22(7), p. 695–700.

6. Florio, P., Filippeschi, M., Moncini, I., et al. Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility. Curr Opin Obstet Gynecol, 2012, 24(3), p. 180–186.

7. Florio, P., Gubbini, G., Marra, E., et al. A retrospective case– control study comparing hysteroscopic resection versus hormonal modulation in treating menstrual disorders due to isthmocele. Gynecol Endocrinol, 2011, 27(6), p. 434–438.

8. Futyma, K., Gałczyński, K., Romanek, K., et al. When and how should we treat cesarean scar defect – isthmocoele? Ginekol Pol, 2016, 87(9), p. 664–668.

9. Gubbini, G., Centini, G., Nascetti, D., et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol, 2011, 18(2), p. 234–237.

10. https://doi.org/10.1002/uog.19049.

11. Kaelin Agten, A., Cali, G., Monteagudo, A., et al. The clinical outcome of cesarean scar preg- nancies implanted “on the scar” versus “in the niche.” Am J Obstet Gynecol, 2017, 216, p. 510.e1–6.

12. Kok, N., Wiersma, IC., Opmeer, BC., et al. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: a meta-analysis. Ultrasound Obstet Gynecol, 2013, 42(2), p. 132–139.

13. Li, C., Tang, S., Gao, X., et al. Efficacy of combined laparoscopic and hysteroscopic repair of post-cesarean section uterine diverticulum: a retrospective analysis. Biomed Res Int, 2016, 2016, p. 1765624.

14. Luo, L., Niu, G., Wang, Q., et al. Vaginal repair of cesarean section scar diverticula. J Minim Invasive Gynecol, 2012, 19(4), p. 454–458.

15. Marotta, ML., Donnez, J., Squifflet, J., et al. Laparoscopic repair of post-cesarean section uterine scar defects diagnosed in nonpregnant women. J Minim Invasive Gynecol, 2013, 20(3), p. 386–391.

16. Mathai, M., Hofmeyr, GJ., Mathai, NE. Abdominal surgical incisions for caesarean section. Cochrane Database Syst Rev, 2013(5), p. CD004453.

17. Morris, H. Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms? Int J Gynecol Pathol, 1995, 14(1), p. 16–20.

18. Tekiner, NB., Cetin, BA., et al. Arch Gynecol Obstet, 2018, 297, p. 1137–1143.

19. Ofili-Yebovi, D., Ben Nagi, J., Sawyer, E., et al. Deficient lower segment Caesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol, 2008, 31, p. 72–77.

20. Osser, OV., Jokubkiene, L., Valentin, L. High prevalence of defects in cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol, 2009, 34(1), p. 90–97.

21. Osser, OV., Jokubkiene, L., Valentin, L. Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement. Ultrasound Obstet Gynecol., 2010, 35(1), p. 75–83.

22. Regnard, C., Nosbusch, M., Fellmans, C., et al. Cesarean section scar evaluation by saline contrast sonohysterography. Ultrasound Obstet Gynecol, 2004, 23(3), p. 289–292.

23. Sipahi, S., Sasaki, K., Miller, CE. The minimally invasive approach to the symptomatic isthmocele – what does the literature say? A step-by-step primer on laparoscopic isthmocele – excision and repair. Curr Opin Obstet Gynecol, 2017, 29(4), p. 257–265.

24. Sholapurkar, SL. Etiology of cesarean uterine scar defect. J Clin Med Res, 2018, 10(3), p. 166–173.

25. Sholapurkar, SL. Increased incidence of placenta praevia and accreta with previous caesareans—a hypothesis for causation. J Obstet Gynaecol, 2013, 33(8), p. 806–809.

26. Sholapurkar, SL. Surgical techniques at caesarean might modify placenta accreta risk. BJOG, 2015, 122(1), p. 143.

27. Thurmond, AS., Harvey, WJ., Smith, SA. Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultrasound Med, 1999, 18(1), p. 13–16.

28. Tulandi, T., Cohen, A. Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol, 2016, 23(6), p. 893–902.

29. Turan, GA., Gur, EB., Tatar, S., et al. Uterine closure with unlocked suture in cesarean section: Safety and Quality. Pak J Med Sci, 2014, 30, p. 530–534.

30. Van der Voet, LF., Bij de Vaate, AM., et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG, 2014, 121(2), p. 236–244.

31. Vervoort, AJ., Uittenbogaard, LB., Hehenkamp, WJ., et al. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod, 2015, 30(12), p. 2695–2702.

32. Vervoort, A., Vissers, J., Hehenkamp, W., et al. 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. BJOG, 2018, 125(3), p. 317–325.

33. Wang, CB., Chiu, WW., Lee, CY., et al. Cesarean scar defect: correlation between cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol, 2009, 34(1), p. 85–89.

34. Woźniak, A., Pyra, K., Tinto, HR., Woźniak, S. Ultrasonographic criteria of cesarean scar defect evaluation. J Ultrasono, 2018, 18(73), p. 162–165.

35. Zhang, Y. A comparative study of transvaginal repair and laparoscopic repair in the management of patients with previous cesarean scar defect. J Minim Invasive Gynecol, 2016, 23(4), p. 535–541.