Abstract
BackgroundAlthough vaginal repair has been conducted to manage caesarean scar diverticula, most studies evaluated only the gynaecological outcomes post-surgery, and their obstetrical outcomes were unknown. This study aimed to evaluate the obstetrical outcomes in vaginal repair-treated caesarean scar diverticula patients.MethodsA series of 51 symptomatic women with caesarean scar defects or a thickness of the remaining muscular layer of less than 3 mm according to transvaginal ultrasound were included. We retrospectively evaluated the gynaecological and obstetrical outcomes after vaginal repair and histologically analysed the defect.ResultsTransvaginal ultrasound revealed that the thickness of the remaining muscular layer significantly increased from 2.24 ± 0.81 mm to 6.10 ± 1.43 mm 3 months after vaginal repair. The duration of menstruation significantly decreased from 14.29 ± 3.13 days to 8.31 ± 2.14 days post-vaginal repair. Notably, 26 of the 51 (50.98%) women who were followed for more than 15.04 months post-surgery achieved pregnancy. A total of 6 of the 26 pregnancies (23.08%) resulted in miscarriages, including 5 early miscarriages and 1 late miscarriage. Among the 20 women who achieved pregnancy without miscarriage, 18 had term deliveries, 2 had preterm birth, and none reported uterine rupture. Histological analysis was performed in all 51 cases. Muscle fibre density was significantly lower in the scar than in the myometrium adjacent to the scar and collagen expression was markedly increased in the scar tissue.ConclusionSatisfactory gynaecological and subsequent obstetrical outcomes can be achieved in vaginal repair-treated caesarean scar diverticula patients.
Highlights
Vaginal repair has been conducted to manage caesarean scar diverticula, most studies evaluated only the gynaecological outcomes post-surgery, and their obstetrical outcomes were unknown
First Maternity and Infant Hospital, Tongji University. he presence of remaining myometrium (TRM) was determined by transvaginal ultrasound (TVU), which was clearly described in our previous studies [10, 11] To measure the thickness of the residual muscle layer of the diverticulum, the patient’s should be a cursor was placed at the interface between the uterine and the bladder wall, and another cursor was positioned at the bottom of the caesarean scar diverticula (CSD)
CSD disappeared in 68.63% of patients (35/51) at the 3-month follow-up
Summary
Vaginal repair has been conducted to manage caesarean scar diverticula, most studies evaluated only the gynaecological outcomes post-surgery, and their obstetrical outcomes were unknown. This study aimed to evaluate the obstetrical outcomes in vaginal repair-treated caesarean scar diverticula patients. The subsequent pregnancy outcome in vaginal repair-treated women was not included in our previous studies. To address this deficiency, women who had undergone vaginal repair of CSD, whose TRM was less than 3 mm and who attempted pregnancy were followed long term in our institution. Women who had undergone vaginal repair of CSD, whose TRM was less than 3 mm and who attempted pregnancy were followed long term in our institution Their clinical characteristics were analysed, and obstetrical outcomes were recorded
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