Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect

Chin Jung Wang*, Huei Jean Huang, Angel Chao, Yu Pin Lin, Yi Jung Pan, Shang Gwo Horng

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

72 Scopus citations

Abstract

Objective: Research suggests that the resectoscopic management of abnormal uterine bleeding (AUB) following cesarean section (CS) is safe and effective. There is, however, a lack of complementary data from routine clinical practice. We aimed to evaluate the efficacy of resectoscopic remodeling of the CS scar in the management of post CS AUB (pCSAUB). Study design: The case notes of 57 women with pCSAUB who had undergone a resectoscopic remodeling procedure were reviewed retrospectively. Primary outcome measures were the duration of preoperative and postoperative menstruation, and postoperative menstrual change. Secondary outcome measures were the impact of patient-dependent variables on the success of the resectoscopic remodeling procedure. The CS scar was located using transvaginal ultrasonography and hysteroscopy. The remodeling procedure was performed with a hysteroscopic resectoscope, and commenced with resection of the fibromuscular scar. This started at the roof of the scar pouch and progressed towards the external os. It then continued along a line parallel to the axis of the cervical canal. The exposed dilated blood vessels and endometrial-like tissue in the roof of the remaining pouch were electrocauterized with a roller-ball electrode. Results: The mean operating time was 30.2 ± 6.6 min. There was a significant difference in the mean duration of preoperative and postoperative menstruation (12.9 ± 2.9 days and 9.4 ± 4.1 days, respectively; p < 0.001). However, only 59.6% of patients (34/57) reported a postoperative improvement in symptoms. A significant postoperative improvement was observed more frequently in patients with anteflexed uteri than in patients with retroflexed uteri, and this difference was significant (90.6% (29/32) and 20.0% (5/25), respectively; p < 0.001). No correlations were found between treatment outcome and age, body weight, parity, number of cesarean deliveries, duration of preoperative menstruation, or operating time. Conclusions: Resectoscopic uterine remodeling is an appropriate therapy in patients with pCSAUB and an anteflexed uterus.

Original languageEnglish
Pages (from-to)218-222
Number of pages5
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume154
Issue number2
DOIs
StatePublished - 02 2011

Keywords

  • Abnormal uterine bleeding
  • Cesarean section
  • Resectoscopy
  • Transvaginal
  • Ultrasonography

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