Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome.
Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome.
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DOI：
10.1371/journal.pone.0243421
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Murakami T
中科院分区：
文献类型：
--
作者：
Tsuji S;Takahashi A;Higuchi A;Yamanaka A;Amano T;Kimura F;Seko-Nitta A;Murakami T
剖宫产瘢痕缺损常引起经后异常子宫出血、痛经、慢性盆腔痛和不孕，统称为剖宫产瘢痕综合征（CSS）。一些研究报告称，宫腔镜手术可以恢复CSS女性的生育能力。该研究旨在确定影响宫腔镜手术后再次妊娠的因素。因此，我们研究了2014年7月至2019年7月期间在滋贺医科大学医院接受宫腔镜手术的38名因CSS继发不孕的女性。我们的宫腔镜手术包括在腹腔镜引导下对剖宫产瘢痕缺损进行下缘切除和浅表烧灼。术后随访3 ~ 40个月。所有病例手术均成功，未观察到并发症。27例患者（71%）妊娠（妊娠组），11例（29%）未妊娠（非妊娠组）。两组之间的年龄、体重指数、妊娠次数、产次、既往剖腹产、子宫内膜异位症、子宫翻转和术前残余子宫肌层厚度等基线特征没有显着差异。然而，妊娠组术后残留子宫肌层厚度中位数显著高于术前（1.9 [1.1-3.6] vs 4.9 [3.4-6.6] mm，P<0.0001），而非妊娠组的差异不显著。在那些怀孕的人中，85%的人在手术后2年内怀孕。尽管在撰写本文时，有3例妊娠导致流产，1例妊娠正在进行中，但有23例妊娠在孕35-38周时通过计划剖宫产获得了健康婴儿，没有因宫腔镜手术引起的产科并发症。平均出生体重为3，076克。我们的研究结果支持宫腔镜手术是一种安全有效的治疗继发性不孕症的CSS。子宫残余肌层的厚度可能是影响CSS妇女再次妊娠的关键因素。
Cesarean scar defect often causes postmenstrual abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, and infertility, which are collectively known as cesarean scar syndrome (CSS). Several studies have reported that hysteroscopic surgery can restore fertility in women with CSS. The study aimed to identify factors that influence subsequent pregnancy following hysteroscopic surgery. Therefore, we studied 38 women with secondary infertility due to CSS who underwent hysteroscopic surgery at Shiga University of Medical Hospital between July 2014 and July 2019. Our hysteroscopic procedure included inferior edge resection and superficial cauterization of the cesarean scar defect under laparoscopic guidance. Patients were followed up for 3 to 40 months after surgery. Surgery was successful in all cases and no complications were observed. Twenty-seven patients (71%) became pregnant (pregnant group), while 11 (29%) did not (non-pregnant group). Baseline characteristics of age, body mass index, gravidity, parity, previous cesarean section, presence of endometriosis, retroflex uterus, and preoperative residual myometrial thickness were not significantly different between the groups. However, the median residual myometrium thickness was significantly higher after surgery than before surgery in the pregnant group (1.9 [1.1–3.6] vs 4.9 [3.4–6.6] mm, P<0.0001), whereas this difference was not significant in the non-pregnant group. Of those who became pregnant, 85% conceived within 2 years of surgery. Although three pregnancies resulted in abortion and one is ongoing at the time of writing, 23 pregnancies resulted in healthy babies at 35–38 gestational weeks by scheduled cesarean sections with no obstetrical complications due to hysteroscopic surgery. The average birth weight was 3,076 g. Our findings support that hysteroscopic surgery is a safe and effective treatment for secondary infertility due to CSS. The thickness of the residual myometrium may be a key factor that influences subsequent pregnancy in women with CSS.
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DOI：
10.1016/j.ejogrb.2019.02.023
发表时间：
2019-05-01
影响因子：
2.6
作者：
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DOI：
10.1111/1471-0528.12542
发表时间：
2014-01-01
影响因子：
5.8
作者：
van der Voet, L. F.;de Vaate, A. M. Bij;Huirne, J. A. F.
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