2960 An Overview of Uterine Scar Defects Post Cesarean Section

Abstract

Study Objective Using a patient's obstetrical history, symptomatology, and radiologic findings of cesarean scar defects (CSD) to establish criteria to triage patients who require surgical repair. Additionally, to outline surgical technique for successful Robotic-assisted laparoscopic repair of CSDs. Design Comprehensive overview of diagnosis, radiological findings and repair of CSD. Setting Two large tertiary care academic medical centers. Patients or Participants Patients with previous cesarean section who are referred for possible surgical intervention for CSD. Interventions Robotic-assisted laparoscopic approach after proper multidisciplinary planning with Radiologist, Maternal fetal medicine specialist, and minimally-invasive gynecologic surgeon. Measurements and Main Results Cesarean scar defects are readily visible on ultrasound evaluation, and is a finding in many patients following cesarean section. Currently, there are no accepted guidelines to aid in the decision for when surgical management is required. The study will combine obstetrical history, symptomatology, and, most importantly, radiologic findings to aid clinicians in designing a treatment plan. Radiologic findings include degree of myometrial thinning and presence/width of the serosal dehiscence. If surgical intervention is necessary, outline the steps to robotic assisted laparoscopic repair of CSD. Included in this analysis are radiographic images of defects and video of surgical repairs. Conclusion There are numerous reports of the minimally invasive repair of CSD; however, it remains unknown in the obstetrical literature when interventions are required. Patients with minimal myometrial thinning and without evidence of serosal dehiscence may not require repair of the defect. More evidence is needed to observe obstetrical outcomes with or without repair.