Is Vaginal Repair a Good Option for Severe Cesarean Scar Defect? Comparison of Women With or Without Residual Myometrium.

J Minim Invasive Gynecol

Department of Gynecology and Obstetrics, Bicetre Hospital, Le Kremlin Bicetre, France (all authors); Faculty of Medicine, University Paris Saclay, Le Kremlin Bicetre, France (Drs. Fernandez and Capmas); Research Center in Epidemiology and Population Health (Drs. Fernandez and Capmas), U1018, Inserm, Villejuif, France. Electronic address:

Published: December 2024

AI Article Synopsis

  • The study aimed to assess the outcomes of vaginal surgery for women with symptomatic cesarean scar defects, comparing those with moderate and severe defects.
  • The findings showed significant improvement in myometrial thickness and reduced abnormal uterine bleeding after surgery in both groups, though pelvic pain alleviation was only noted in the moderate group.
  • Pregnancy rates and complications were comparable between the moderate and severe defect groups, with no cases of uterine rupture reported post-surgery.

Article Abstract

Study Objective: To compare outcomes of vaginal surgery in women with moderate or severe symptomatic cesarean scar defect (with or without residual myometrium).

Design: Retrospective cohort study.

Setting: Gynecology department of a teaching hospital.

Patients: Fifty-three women, between January 2014 and December 2019, underwent vaginal surgery for symptomatic cesarean scar defect: 20 women with moderate defect (with residual myometrium) and 33 with severe defect (without residual myometrium).

Interventions: Vaginal surgical approach to repair cesarean scar defect.

Measurements And Main Results: surgery by comparing the myometrial residual thickness before and after surgery. The secondary objectives were evaluation of vaginal surgery efficacy on symptoms resolution, per and postoperative courses, and subsequent fertility. Failure rate was evaluated as the need for a second surgery. After vaginal surgery, the residual myometrium significantly increased from 2.4 mm ± 0.9 mm to 6.6 mm ± 2.4 mm (p <.01) in the moderate group and from 0 mm to 4.4 mm ± 2.2 mm (p <.01) in the severe group. The prevalence of abnormal uterine bleeding was significantly reduced after surgery in both groups (p <.01). Pelvic pain was significantly reduced only in the moderate group (p <.01). The rate of complications (5% vs 9.1%) and second surgery (15% vs 24.2%) were not significantly different between moderate and severe groups, respectively. The median time to conceive (7 months vs 12 months); pregnancy rates (84.6% vs 68.2%); and live birth rates (76.9% vs 50%) were not statistically significant in the moderate and severe groups respectively, with 90% of pregnancies occurring naturally. Women delivered by cesarean section at 38 weeks of gestation in both groups, and no uterine rupture was reported.

Conclusion: Despite the absence of residual myometrium, vaginal repair of severe cesarean scar defect was effective in increasing myometrial thickness, in relieving bleeding symptoms, and in allowing to achieve pregnancy.

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Source
http://dx.doi.org/10.1016/j.jmig.2024.10.023DOI Listing

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