Surgical treatment and follow-up of women with intermenstrual bleeding due to Cesarean section scar defect
Surgical treatment and follow-up of women with intermenstrual bleeding due to Cesarean section scar defect
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DOI：
10.1016/j.jmig.2004.12.023
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发表时间：
2005-01-01
影响因子：
4.1
通讯作者：
Fernández, E
中科院分区：
文献类型：
--
作者：
Fabres, C;Arriagada, P;Fernández, E
研究目的：既往剖宫产分娩瘢痕（PCDS）缺损被描述为除了剖宫产瘢痕部位子宫前段上的囊袋外无其他子宫病理的女性月经间期出血的原因。本研究的目的是评估宫腔镜手术对一组有此症状的妇女纠正此解剖缺陷和消除出血障碍的有效性。设计：回顾性研究地点：私立医院妇产科。24名女性，年龄29-41岁，报告经间期出血，尤其是经后点滴出血，除存在PCDS缺陷外，无其他妇科病理学。经阴道超声检查发现子宫前峡部有一充满液体的三角形缺损，与剖宫产瘢痕有关。干预措施：宫腔镜下切除三角形囊袋下方的纤维化组织，促进血液通过宫颈引流，电灼子宫内膜腺体和/或扩张的血管。以前剖腹产的平均数量为2.75。21例患者术后随访24个月，另外3例患者至少随访14个月。其中11例有怀孕愿望的患者在宫腔镜检查前尝试至少2年后无法怀孕。不孕症检查显示9例不明原因不孕，1例男性不孕，1例输卵管复通术失败。其中9人在随访14至24个月期间怀孕。84%的患者（20/24）保持无症状（无出血障碍）后surgic.CONCLUSION：以前的剖宫产疤痕缺陷可能是月经间期出血的原因，它也可能损害生育能力，但它可以成功地治疗宫腔镜手术。(c)2005年AAGL。All rights reserved.
STUDY OBJECTIVE: Previous cesarean delivery scar (PCDS) defect has been described as a cause of intermenstrual bleeding in women with no other uterine pathology except for a pouch on the anterior uterine segment at the site of the cesarean scar. The objective of this study was to assess the effectiveness of hysteroscopic surgery to correct this anatomic defect and eliminate the bleeding disturbance in a group of women with this symptom.DESIGN: Retrospective study (Canadian Task Force classification XX).SETTING: Private hospital, department of obstetrics and gynecology.PATIENTS: Twenty-four women, age 29-41 years, who reported intermenstrual bleeding, especially postmenstrual spotting, with no other gynecologic pathology except for the presence of a PCDS defect. Diagnosis was established with transvaginal ultrasound, when a fluid-filled, triangular defect was seen in the anterior uterine isthmus, in relation to the cesarean section scar.INTERVENTION: Hysteroscopic resection of fibrotic tissue that overhangs underneath the triangular pouch, facilitating blood drainage through the cervix and fulguration of endometrial glands and/or dilated blood vessels.MEASUREMENTS AND MAIN RESULTS: The mean number of previous cesarean-section deliveries was 2.75. Postoperative follow-up was 24 months in 21 patients and at least 14 months in the other 3 patients. Eleven of these patients with the desire to become pregnant were unable to conceive after trying for a period of at least 2 years before hysteroscopy. Infertility work-up in the I I patients revealed 9 with unknown infertility, I with male infertility, and I with failed tubal reversal surgery. Nine of them became pregnant between 14- and 24-months of follow-up. Eighty-four percent of patients (20/24) remained asymptomatic (without bleeding disturbances) after surgery.CONCLUSION: Previous cesarean delivery scar defect may be the cause of intermenstrual bleeding, and it is possible that it also may impair fertility, but it can be successfully treated by hysteroscopic surgery. (c) 2005 AAGL. All rights reserved.