Abstract
Objectives: This study focused on evaluating the value of transvaginal 3D ultrasound for the diagnosis and prognostic assessment of post-cesarean section uterine diverticulum. Materials and Methods: We retrospectively analyzed the data from 32 patients with post-cesarean section uterine diverticulum over three recent years. In all patients, transvaginal 3D ultrasound was used to measure the size of the uterine diverticulum and the thickness of the lower uterine segment (LUS) and myometrium. Patients with a LUS with a myometrial thickness under 4 mm underwent resection and repair surgery; those with a LUS with a myometrial thickness over 4 mm underwent hysteroscopic resection. The postoperative sonograms were compared with preoperative images to evaluate the efficacy of various treatments. Results: The mean length, width and depth of the uterine diverticula were 18.30 ± 2.80 mm, 9.14 ± 3.20 mm and 11.49 ± 2.71 mm, respectively. The average LUS myometrial thickness was 3.40 ± 0.80 mm (with a range of 1.6 mm - 6.3 mm). After surgery, two patients’ sonograms still showed diverticula at the post-cesarean section scar, measuring 6 mm × 7 mm × 6 mm and 6 mm × 8 mm × 4 mm. There were significant differences in the size of uterine diverticula between preoperative and postoperative sonograms (P < 0.05) and the effective rate of surgery was 93.75% (30/32). Conclusions: Transvaginal 3D ultrasound is an accurate method for detecting post-cesarean section uterine diverticulum and is helpful for assessing surgical options and prognosis. The LUS myometrial thickness, which is considered as an optional index of post-cesarean section uterine diverticulum, should be measured routinely.
Highlights
Concern is growing over the association between delivery by cesarean section and long-term maternal morbidity, as the use of cesarean section delivery has increased markedly worldwide over the last several decades [1] [2]
Previous studies have shown that a uterine diverticulum is present in most women with a history of cesarean section when examined by ultrasound, and this is associated with postmenstrual spotting [4]
Thirty-two women aged 25 - 49 years who were diagnosed with post-cesarean section uterine diverticulum were included in the study
Summary
Concern is growing over the association between delivery by cesarean section and long-term maternal morbidity, as the use of cesarean section delivery has increased markedly worldwide over the last several decades [1] [2]. Post-cesarean section uterine diverticulum is defined as a triangular anechoic structure at the site of the scar or a gap in the myometrium of the anterior lower uterine segment (LUS) at the site of a previous cesarean section [5]-[7]. We reviewed the data of 32 patients with symptomatic previous cesarean delivery scar defects who were diagnosed by 3D ultrasonography We measured their ultrasonic LUS myometrial thickness and the size of the uterine diverticulum to assess the value of transvaginal 3D ultrasound in the diagnosis, treatment, and prognosis of post-cesarean section uterine diverticulum
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