What is a C-section defect (CSD)?
A CSD is a defect in the muscle layer of the uterus that has the appearance of a pouch over a previous C-section scar.
How common is CSD ?
The prevalence of CSD is not known, but may be more common than realised. It has been reported amongst 20 to 80% women after 1 or more previous C-Section.
What are the potential clinical implications of CSD?
The majority of women who are found to have a CSD defect on ultrasound do not encounter or report any problem. However, in a small percentage of women with CSD, they may encounter a variety of clinical problems such as:
- Abnormal uterine bleeding: post-menstrual spotting
- Pain: pelvic pain, period pain, painful sex
- CSD-related abnormal implantation: ectopic pregnancy in the CSD, placenta previa, accreta, percreta, scar rupture.
- Secondary infertility and failed IVF: blood inside the CSD could affect the cervical mucus and sperm quality, obstruct sperm transport and impair embryo implantation
Although the causal relationship between C-Section defects and related symptoms has not been established, treatment has been reported to be successful in the resolution of symptoms.
How can C-section defect be corrected?
There are a number of ways of correcting a C-section defect:
- Laparoscopic or Robotic surgery
- Hysteroscopic surgery
- Vaginal surgery
A systemic review of the above-mentioned methods concluded that laparoscopic surgery was superior in reducing abnormal uterine bleeding and scar depth than the other surgical interventions.
In the largest prospective study reported in the literature to date, laparoscopic surgery was found to improve the main presenting symptom in 80% , resolved intra-uterine fluid in 87% of women, and significantly increased residual myometrium (Vervoort BJOG 2017).
- Yunan He et al. Four Surgical Strategies for the Treatment of Cesarean Scar Defect: A Systematic Review and Network Meta-analysis. Journal of Minimally Invasive Gynecology 2019.
- Vervoort AJMW et al. The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study. BJOG 2017.
- Murat Api et al. Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature. Journal of Minimally Invasive Gynecology 2015.