Hysteroscopic treatment of postcesarean scar defect.

Study Objective: To estimate the usefulness of hysteroscopy in the diagnosis and treatment of postcesarean scar defect.

Design: Retrospective study (Canadian Task Force classification III).

Setting: Two university-affiliated hospitals.

Patients: Sixty-two patients with postcesarean scar defects were retrospectively analyzed.

Interventions: All patients with postcesarean scar defects diagnosed using ultrasonography and hysteroscopy underwent hysteroscopic surgery, and were followed up for longer than 1 year.

Measurements And Main Results: Hysteroscopy revealed that 38 patients had valve-like motions at the incision sites, 22 had dome-like defects, and 2 with a history of 2 previous deliveries via cesarean section had umbilications of 2 different shades. Fifty-seven of 62 patients underwent corrective surgery via hysteroscopy. In another 3 patients, because the left wall of the fundus of the uterus was too thin (<2 mm at ultrasonography) to undergo corrective surgery, only clearance of residual blood and/or suture materials was performed. Of these 57 patients, 5 underwent removal of residual suture materials and endometrial fulguration. No complications were observed in these patients. Furthermore, after surgery, abnormal vaginal bleeding stopped in 38 patients, and its duration was shortened in 20 patients. In addition, dysmenorrhea was alleviated in 15 patients, and resolved in 7 patients.

Conclusion: Hysteroscopy is an accurate means of diagnosis apart from surgical correction.