Why Some Women Develop Cesarean Scar Defect (CSD)?
Cesarean scar defect (CSD), also known as isthmocele or niche, is the result of incomplete healing of isthmic myometrium after a low transverse uterine incision performed for cesarean section. The prevalence of symptomatic or clinically relevant CSD reported in literature ranges from 19% to 84% and in few cases may be also associated with secondary infertility and obstetric complications such as scar tissue dehiscence, scar pregnancy, and abnormally adherent placenta. Premenopausal abnormal uterine bleeding (PAUB) is the most typical and bothersome symptom. CSD can be diagnosed using transvaginal sonography (TVS), sonohysterography (SIS), or hysteroscopy. Some authors identified some risk factors on CSD development that can be divided into surgery-related factors and patient-related factors. Over the years, several surgical treatments have been proposed: laparoscopic excision, a combined laparoscopic-vaginal approach, and a purely vaginal approach. More recently, robotic-assisted laparoscopic repair of isthmocele and hysteroscopic treatment have been introduced. Of the two approaches, hysteroscopic resection is the most commonly reported and the less invasive; however, it cannot restore myometrial thickness; thus we suggest this approach in those women that have completed the reproductive pathway.
KeywordsCesarean scar defect Cesarean section Isthmocele Infertility Hysteroscopy
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