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

Abstract

Objective: To examine the treatment of previous cesarean delivery scar defect after cesarean delivery and the feasibility of laparoscopic uterine repair or hysteroscopic scar excision. Study Design: A retrospective clinical study that took place from June 2009 to March 2013 and included 41 women who had previously had cesarean deliveries. Results: Seventeen women underwent a laparoscopic approach for the repair of scar diverticula, and 24 women underwent a hysteroscopic resection of fibrotic tissue overhanging underneath the diverticula. Most women remained free of symptoms over a 3- to 16-month follow-up and 6 women became pregnant without pregnancy complications. Conclusion: 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.