Research Progress on the Treatment of Cesarean Scar Diverticula

doi:10.12280/gjfckx.20210316

Abstract

Abstract:

The incidence rate of cesarean section scar diverticulum, also known as previous cesarean scar diverticula (CSD), which is a major long-term complication of cesarean section, has been increased recently. It is mainly due to the poor healing of uterine incision after cesarean section. CSD has been reported to be associated with abnormal uterine bleeding, prolonged menstruation, chronic pelvic pain and infertility and many other symptoms. At present, clinically surgical approaches for CSD is numerous. Conservative drugs such as oral contraceptives, levonorgestrel intrauterine device and traditional Chinese medicine can improve the symptoms of patients with prolonged menstruation. Hysteroscopy, laparoscopy, transvaginal repair, hysteroscopy combined with laparoscopy, hysteroscopy assisted transvaginal repair and other surgical treatment are the main treatment methods for CSD, which can improve the symptoms of patients after operation and reduce the incidence of CSD combined with secondary infertility and scar pregnancy. However, there is still a lack of a unified selection standard of surgical methods. The choice of surgical methods and the effect of surgical treatment are also controversial and need further study. This paper will review the choice of treatment methods, specific surgical methods and the difference of curative effect between different treatment methods for uterine scar diverticulum.

Key words: Cesarean section, Uterus, Cicatrix, Diverticulum, Uterine hemorrhage, Infertility,female, Therapy, Prognosis

SHENG Rong, WANG Xi-peng. Research Progress on the Treatment of Cesarean Scar Diverticula[J]. Journal of International Obstetrics and Gynecology, 2021, 48(4): 390-394.

Figures/Tables 3

References 35

[1]	Li HT, Hellerstein S, Zhou YB, et al. Trends in Cesarean Delivery Rates in China, 2008-2018[J]. JAMA, 2020, 323(1):89-91. doi: 10.1001/jama.2019.17595. doi: 10.1001/jama.2019.17595
[2]	Sandall J, Tribe RM, Avery L, et al. Short-term and long-term effects of caesarean section on the health of women and children[J]. Lancet, 2018, 392(10155):1349-1357. doi: 10.1016/S0140-6736(18)31930-5. doi: S0140-6736(18)31930-5 pmid: 30322585
[3]	Donnez O, Donnez J, Orellana R, et al. Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women[J]. Fertil Steril, 2017, 107(1):289-296.e2. doi: 10.1016/j.fertnstert.2016.09.033. doi: 10.1016/j.fertnstert.2016.09.033
[4]	李健, 白文佩. 剖宫产切口愈合不良的治疗方法[J]. 国际妇产科学杂志, 2017, 44(5):543-546. doi: 10.3969/j.issn.1674-1870.2017.05.015. doi: 10.3969/j.issn.1674-1870.2017.05.015
[5]	Tahara M, Shimizu T, Shimoura H. Preliminary report of treatment with oral contraceptive pills for intermenstrual vaginal bleeding secondary to a cesarean section scar[J]. Fertil Steril, 2006, 86(2):477-479. doi: 10.1016/j.fertnstert.2006.01.020. doi: 10.1016/j.fertnstert.2006.01.020
[6]	Chen YY, Tsai CC, Lan KC, et al. Preliminary report on the use of a levonorgestrel intrauterine system for the treatment of intermenstrual bleeding due to previous cesarean delivery scar defect[J]. J Obstet Gynaecol Res, 2019, 45(10):2015-2020. doi: 10.1111/jog.14060. doi: 10.1111/jog.14060
[7]	Deng J, Li S, Peng Y, et al. Chinese herbal medicine for previous cesarean scar defect: A protocol for systematic review and meta-analysis[J]. Medicine (Baltimore), 2020, 99(50):e23630. doi: 10.1097/MD.0000000000023630. doi: 10.1097/MD.0000000000023630
[8]	吕霄, 王雄虎, 陈泺, 等. 中药周期疗法治疗子宫切口憩室所致经期延长临床观察[J]. 实用中医药杂志, 2020, 36(7):830-832.
[9]	梁晓璐, 洪丽美. 子宫憩室的中西医治疗进展[J]. 中外医学研究, 2020, 18(2):183-185. doi: 10.14033/j.cnki.cfmr.2020.02.079. doi: 10.14033/j.cnki.cfmr.2020.02.079
[10]	He Y, Zhong J, Zhou W, et al. Four Surgical Strategies for the Treatment of Cesarean Scar Defect: A Systematic Review and Network Meta-analysis[J]. J Minim Invasive Gynecol, 2020, 27(3):593-602. doi: 10.1016/j.jmig.2019.03.027. doi: 10.1016/j.jmig.2019.03.027
[11]	刘琳琳, 黄晓武, 夏恩兰, 等. 宫腔镜治疗有症状剖宫产切口憩室103例分析[J]. 国际妇产科学杂志, 2018, 45(3):291-294. doi: 10.3969/j.issn.1674-1870.2018.03.013. doi: 10.3969/j.issn.1674-1870.2018.03.013
[12]	Tsuji S, Takahashi A, Higuchi A, et al. Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome[J]. PLoS One, 2020, 15(12):e0243421. doi: 10.1371/journal.pone.0243421. doi: 10.1371/journal.pone.0243421
[13]	Shapira M, Mashiach R, Meller N, et al. Clinical Success Rate of Extensive Hysteroscopic Cesarean Scar Defect Excision and Correlation to Histologic Findings[J]. J Minim Invasive Gynecol, 2020, 27(1):129-134. doi: 10.1016/j.jmig.2019.03.001. doi: 10.1016/j.jmig.2019.03.001
[14]	Zhang NN, Wang GW, Yang Q. Endoscopic Treatment of Previous Cesarean Scar Defect in Women with Postmenstrual Bleeding: A Retrospective Cohort Study[J]. J Invest Surg, 2020:1-9. doi: 10.1080/08941939.2020.1766161. doi: 10.1080/08941939.2020.1766161
[15]	Sanders AP, Murji A. Hysteroscopic repair of cesarean scar isthmocele[J]. Fertil Steril, 2018, 110(3):555-556. doi: 10.1016/j.fertnstert.2018.05.032. doi: S0015-0282(18)30433-3 pmid: 30098702
[16]	Zeller A, Villette C, Fernandez H, et al. Is Hysteroscopy a Good Option to Manage Severe Cesarean Scar Defect?[J]. J Minim Invasive Gynecol, 2021, 28(7):1397-1402. doi: 10.1016/j.jmig.2020.11.005. doi: 10.1016/j.jmig.2020.11.005
[17]	Zou Z, Xiao S, Xue M. Clinical analysis of the preoperative condition and operative prognosis of post-cesarean section scar diverticulum: a case series[J]. J Perinat Med, 2020, 48(8):803-810. doi: 10.1515/jpm-2020-0008. doi: 10.1515/jpm-2020-0008
[18]	Casadio P, Gubbini G, Franchini M, et al. Comparison of Hysteroscopic Cesarean Scar Defect Repair with 26 Fr Resectoscope and 16 Fr Mini-resectoscope: A Prospective Pilot Study[J]. J Minim Invasive Gynecol, 2021, 28(2):314-319. doi: 10.1016/j.jmig.2020.06.002. doi: 10.1016/j.jmig.2020.06.002
[19]	Setúbal A, Alves J, Osório F, et al. Demonstration of Isthmocele Surgical Repair[J]. J Minim Invasive Gynecol, 2021, 28(3):389-390. doi: 10.1016/j.jmig.2020.09.007. doi: 10.1016/j.jmig.2020.09.007
[20]	Zhao W, Liu G, Yang Q, et al. A new method using a Foley Catheter to locate the diverticulum in laparoscopic repair of uterine cesarean scar defects[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 223:14-17. doi: 10.1016/j.ejogrb.2018.01.033. doi: 10.1016/j.ejogrb.2018.01.033
[21]	Ma Y, Kohn J, Zhang Y, et al. Single-incision laparoscopic repair of a cesarean scar defect[J]. Fertil Steril, 2019, 111(3):607-608. doi: 10.1016/j.fertnstert.2018.11.039. doi: 10.1016/j.fertnstert.2018.11.039
[22]	Candiani M, Ferrari SM, Marotta E, et al. Mini-invasive transvaginal repair of isthmocele: a video case report[J]. Fertil Steril, 2019, 111(4):828-830. doi: 10.1016/j.fertnstert.2018.12.010. doi: S0015-0282(18)32296-9 pmid: 30853089
[23]	Zhang D, Liang S, Zhu L. Comparison of transvaginal repair versus laparoscopic repair of lower-segment cesarean scar defects[J]. Int J Gynaecol Obstet, 2019, 145(2):199-204. doi: 10.1002/ijgo.12797. doi: 10.1002/ijgo.12797
[24]	Zhou X, Yang X, Chen H, et al. Obstetrical outcomes after vaginal repair of caesarean scar diverticula in reproductive-aged women[J]. BMC Pregnancy Childbirth, 2018, 18(1):407. doi: 10.1186/s12884-018-2015-7. doi: 10.1186/s12884-018-2015-7
[25]	Deng K, Liu W, Chen Y, et al. Obstetric and Gynecologic Outcomes after the Transvaginal Repair of Cesarean Scar Defect in a Series of 183 Women[J]. J Minim Invasive Gynecol, 2021, 28(5):1051-1059. doi: 10.1016/j.jmig.2020.12.009. doi: 10.1016/j.jmig.2020.12.009
[26]	Lu X, Ma Y, Wang Y. Cesarean scar epithelial defect: an underrecognized defect associated with abnormal uterine bleeding[J]. Am J Obstet Gynecol, 2020, 223(6):923-924. doi: 10.1016/j.ajog.2020.04.018. doi: 10.1016/j.ajog.2020.04.018
[27]	Vigueras Smith A, Cabrera R, Zomer MT, et al. Combined Laparoscopic-Hysteroscopic Isthmoplasty Using the Rendez-vous Technique Guided Step by Step[J]. J Minim Invasive Gynecol, 2020, 27(7):1469-1470. doi: 10.1016/j.jmig.2019.12.017. doi: 10.1016/j.jmig.2019.12.017
[28]	Zhao W, Yang Q, Zhang N, et al. An Effective Assisted Method Using Hysteroscopy Transmittance Test and a Foley Catheter to Repair Previous Cesarean Scar Defect by Laparoscopy[J]. J Minim Invasive Gynecol, 2019, 26(4):605-606. doi: 10.1016/j.jmig.2018.08.020. doi: 10.1016/j.jmig.2018.08.020
[29]	Guan Z, Liu J, Bardawil E, et al. Surgical Management of Cesarean Scar Defect: The Hysteroscopic-Assisted Robotic Single-Site Technique[J]. J Minim Invasive Gynecol, 2020, 27(1):24-25. doi: 10.1016/j.jmig.2019.06.007. doi: 10.1016/j.jmig.2019.06.007
[30]	Zhou D, Wu F, Zhang Q, et al. Clinical outcomes of hysteroscopy-assisted transvaginal repair of cesarean scar defect[J]. J Obstet Gynaecol Res, 2020, 46(2):279-285. doi: 10.1111/jog.14161. doi: 10.1111/jog.14161
[31]	Zhang YL, Wang GC, Qu JJ, et al. Single-port laparoscopy-assisted vaginal repair of a cesarean scar defect: a single-center retrospective study[J]. Chin Med J (Engl), 2020, 133(3):285-291. doi: 10.1097/CM9.0000000000000622. doi: 10.1097/CM9.0000000000000622
[32]	韩乔, 周星辰, 汪希鹏. 剖宫产后子宫瘢痕憩室形成因素的研究进展[J]. 国际妇产科学杂志, 2021, 48(1):95-98. doi: 10.12280/gjfckx.20200559. doi: 10.12280/gjfckx.20200559
[33]	Chen H, Wang H, Zhou J, et al. Vaginal Repair of Cesarean Section Scar Diverticula Diagnosed in Non-pregnant Women[J]. J Minim Invasive Gynecol, 2019, 26(3):526-534. doi: 10.1016/j.jmig.2018.06.012. doi: 10.1016/j.jmig.2018.06.012
[34]	Xu HY, Yang MY, Zhang X, et al. Efficacy of caesarean scar defect repair in improving postmenstrual bleeding and factors associated with poor effect[J]. J Obstet Gynaecol, 2017, 37(8):1076-1081. doi: 10.1080/01443615.2017.1324833. doi: 10.1080/01443615.2017.1324833
[35]	Sammour H, Elkholy A, Rasheedy R, et al. The effect of alpha lipoic acid on uterine wound healing after primary cesarean section: a triple-blind placebo-controlled parallel-group randomized clinical trial[J]. Arch Gynecol Obstet, 2019, 299(3):665-673. doi: 10.1007/s00404-018-5011-2. doi: 10.1007/s00404-018-5011-2 pmid: 30564928