Obstetric and Gynecological Outcomes After the Transvaginal Repair of Cesarean Scar Defect in a Series of 183 Women

Abstract Object : To analyze retrospectively the effect of hysteroscopy combined with transvaginal repair on the cesarean section diverticulum (CSD) and explore the clinical significance of this procedure Design : Retrospective study Setting : A University-affiliated Hospital and a gynecology hospital Patients : A total of 183 patients with scar diverticulum after cesarean section were recruited from the Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan and Shenzhen In Vitro Fertilization Gynecological Hospital. Interventions : In this study, we report a surgical method for repairing uterine scar through uterine therapy and explored its clinical efficacy and pregnancy outcome. Measurements : The time of operation, volume of bleeding, and duration of hospitalization were recorded. The size of the scar diverticulum and the remaining myometrium were examined by B-mode ultrasonography before and after operation. The length of the menstrual cycle and pelvic pain were recorded during follow-up to check the recovery of patients after surgery. The pregnancy of patients with pregnancy needs was recorded to check the pregnancy outcome. Main Result(s) : All 183 patients successfully completed the repair of the transvaginal uterus scar diverticulum with the help of hysteroscopy examination. The mean operation time was 58.61±18.56 min. Mean blood loss was 36.97±22.32 ml. Mean hospital stay was 6.08±1.89 days. In 57.14% of patients, the CSD disappeared completely, while the volume of CSD shrank by at least 50% in 88.95% of patients. The mean menstrual period of patients after surgery was 7.72±2.68 days, which was significantly shorter than that recorded preoperatively (13.45±3.69 days) (t=19.62, p=0.00). The pelvic pain disappeared in 81.08% of the patients. The mean postoperative TRM was 5.30 ± 1.27 mm, which was significantly higher than the preoperative value of 2.25±0.92 mm (t=28.21, p=0.00). The mean postoperative TRM of patients with improved menstrual cycle was 5.40 ±1.27 mm, which was significantly higher than the thickness of 4.88±1.11 mm in patients without improved menstrual cycle (t=2.31, P=0.025). A total of 124 patients attempted to become pregnant, 83 of which were successful. The pregnancy rate was as high as 66.95%, which included 2 scar pregnancies, 4 ectopic pregnancies, and 87 intrauterine pregnancies. No uterine rupture occurred. Conclusion : The transvaginal repair of the uterine diverticulum effectively improved the symptoms and probability of a successful pregnancy. This process is a surgical procedure to increase effectively the thickness of the residual uterine muscle wall.