scholarly journals Isthmocele: an overview of diagnosis and treatment

2019 ◽  
Vol 65 (5) ◽  
pp. 714-721 ◽  
Author(s):  
Thaysa Guglieri Kremer ◽  
Isadora Bueloni Ghiorzi ◽  
Raquel Papandreus Dibi
Keyword(s):  
Cesarean Section ◽  
Surgical Management ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Cost Effective ◽  
Uterine Wall ◽  
Large Defect ◽  
Cesarean Scar ◽  
Incomplete Closure ◽  
Previous Cesarean

SUMMARY An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.

scholarly journals Various Types of Niche Imaging by Sonohysterography: A Pictorial Review

2014 ◽  
Vol 8 (3) ◽  
pp. 311-315 ◽  
Author(s):  
Firoozeh Ahmadi ◽  
Farnaz Akhbari ◽  
Fatemeh Niknejad
Keyword(s):  
Cesarean Section ◽  
Transvaginal Ultrasound ◽  
Subsequent Pregnancy ◽  
Previous Cesarean Section ◽  
Cesarean Section Delivery ◽  
Cesarean Scar ◽  
Pictorial Review ◽  
Scar Region ◽  
Uterine Scar ◽  
Previous Cesarean

ABSTRACT Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. Recently cesarean section delivery has been raised around the world markedly; therefore women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual Spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy. Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs have been used as a powerful tool for detecting the uterine scar of a previous cesarean section. Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently. How to cite this article Ahmadi F, Akhbari F, Niknejad F. Various Types of Niche Imaging by Sonohysterography: A Pictorial Review. Donald School J Ultrasound Obstet Gynecol 2014;8(3):311-315.

scholarly journals Differential Diagnosis of Cesarean Scar Pregnancies and Other Pregnancies Implanted in the Lower Uterus by Ultrasound Parameters

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kangning Li ◽  
Qing Dai
Keyword(s):  
Differential Diagnosis ◽  
Cesarean Section ◽  
Transvaginal Ultrasound ◽  
Previous Cesarean Section ◽  
Cesarean Scar Pregnancy ◽  
Rare Type ◽  
Cesarean Section Delivery ◽  
Cesarean Scar ◽  
The Relationship ◽  
Previous Cesarean

Purpose. Cesarean scar pregnancy is an extremely rare type of ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar. On the other hand, pregnancies are considered low implantations if they are identified in the lower third of the uterus without the sac implanted into the scar and have a better prognosis. Early diagnosis of both types of pregnancies can help avoid serious complications. This study is aimed at investigating the significance of transvaginal ultrasound in the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Methods. Ninety-three patients with an average age of 32.7 years (range, 24–43 years) were enrolled in this study, including 66 cesarean scar pregnancies and 27 other pregnancies implanted in the lower uterus, and they were examined by transvaginal ultrasound. Results. We observed significant differences in the relationship between the cesarean sac and the scar, the source of the trophoblastic blood flow, and the thickness of the residual muscle between the cesarean scar pregnancy group and the lower uterus pregnancy group. We established the logistic model to improve the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Conclusions. Transvaginal ultrasound is recommended in early pregnancy, especially for patients who have undergone a previous cesarean section delivery.

Recurrent large uterine fundal dehiscence during cesarean section after hysteroscopic uterine septum resection with uterine perforation

2016 ◽  
Vol 5 (2) ◽  
pp. 85-87
Author(s):  
İbrahim Alanbay ◽  
Mustafa Öztürk ◽  
Mustafa Ulubay ◽  
Uğur Keskin ◽  
Emre Karaşahin
Keyword(s):  
Cesarean Section ◽  
Uterine Rupture ◽  
Late Complication ◽  
Uterine Wall ◽  
Elective Cesarean Section ◽  
Uterine Perforation ◽  
Elective Cesarean ◽  
Uterine Septum ◽  
Uterine Fundus ◽  
Previous Cesarean

Abstract Septum resection using hysterescopy is safe, rapid and efective, but some late complication of it may be seen as uterine rupture or dehiscence of uterine wall during pregnancy due to myometrial damage. We present a case of recurrent large uterine fundal dehiscence conscecutive to cesarean section in a patient who had previously undergone a uterine septum resection. The patient was a 35-year-old who presented at 39 weeks of gestation (Gravida 2, Parity 1) and was admitted for an elective cesarean section. Her reproductive history included a septum resection which resulted in uterine perforation, and one previous cesarean section in which a large fundal defect was found and repaired. Then the examination had shown an aproximately 5 cm large uterine fundus defect including all three layers of uterus which had been repaired. Perforation or excessively deep incision of uterine fundus during hysteroscopic metroplasty may cause chronic weakness of the uterine wall especially at fundal localization. Our case was an incidental uterine wall dehiscence during cesarean section. Patients with an uterine septum resection history should be followed up carefully for uterine rupture during pregnancy.

Evaluation of uterine scar healing by transvaginal ultrasound in 607 nonpregnant women with a history of cesarean section

2020 ◽  
Author(s):  
Xingchen Zhou ◽  
Tao Zhang ◽  
Huayuan Qiao ◽  
Yi Zhang ◽  
Xipeng Wang
Keyword(s):  
Cesarean Section ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Cesarean Scar ◽  
Female Reproductive Health ◽  
Position Detection ◽  
The Difference ◽  
Uterine Scar ◽  
Group B ◽  
Scar Healing

Abstract Background: Caesarean scar defect (CSD) seriously affects female reproductive health. In this study, we aim to evaluate uterine scar healing by transvaginal ultrasound（TVS）in nonpregnant women with cesarean section（CS）history and to build a predictive model for cesarean section defects is very necessary. Methods: A total of 607 nonpregnant women with previous CS who have transvaginal ultrasound measurements of the thickness of the lower uterine segment . The related clinical data were recorded and analyzed. Results: All patients were divided into two groups according to their clinical symptoms: Group A (N=405) who had no cesarean scar symptoms, and Group B (N=141) who had cesarean scar symptoms. The difference in frequency of CS, uterine position, detection rate of CSD and the the residual muscular layer (TRM) of the CSD were statistically significant between groups; the TRM measurements of the two groups were (mm) 5.39±3.34 vs 3.22±2.33, P<0.05.All patients were divided into two groups according to whether they had CSDs: Group C (N=337) who had no CSDs , Group D (N=209) who had CSDs on ultrasound examination. The differences in frequency of CS, uterine position, TRM between groups were statistically significant (P<0.05). In the model predicting CSDs by TRM with TVS, the area under the ROC curve was 0.771, the cut-off value was 4.15 mm. The sensitivity and specificity were 87.8% and 71.3%,respectively.Conclusions: Patients with no clinical symptoms had a mean TRM on transvaginal ultrasonography of 5.39 ± 3.34 mm, which could be used as a good reference to predict the recovery of patients with CSDs after repair surgery.

scholarly journals Live Cesarean Scar Pregnancy: A Case Report

2020 ◽  
pp. 1-4
Author(s):  
Zohra Amin ◽  
Anu Dua ◽  
Arzoo Amin ◽  
Zohra Amin
Keyword(s):  
Surgical Management ◽  
Medical Management ◽  
Cesarean Scar Pregnancy ◽  
Initial Management ◽  
Cesarean Scar ◽  
Threatening Condition ◽  
Life Threatening ◽  
Specific Symptoms ◽  
Previous Cesarean

Introduction: The overall incidence of Cesarean scar pregnancy is increasing due to Cesarean rates. This life-threatening condition has been historically managed in various ways as no single modality is reliable enough. We report this case of live CSP managed initially with Fetocide followed by Methotrexate but requiring Surgical management later on. Presentation: A 32 years old para 5 with four previous Cesarean sections was diagnosed with live CSP. HCG level was 76,619. The initial management was fetocide with KCL followed by Methotrexate. The treatment was considered successful in view of appropriate reduction in serum HCG levels. The woman required surgical management 10 weeks after the initial management, but the blood loss was minimal. Discussion: A CSP may be asymptomatic or present with non-specific symptoms. The rate of initial misdiagnosis is as high as 76%. TVUSS enables correct CSP diagnosis and implementation of minimally invasive effective treatment. HCG levels can affect the overall outcome, but medical management can be considered even with high HCG levels. Conclusion: CSP is a life-threatening condition, therefore timely diagnosis and appropriate management is crucial. Medical management can be considered in most cases even with high HCG, but management has to be tailored according to the patient. Close follow up of patient after Medical treatment is important as they may require further intervention.

scholarly journals Purse String Double Layer Closure in Cesarean Section (Turan Technique) : a Novel Approach to Reduce Cesarean Scar Defect

2020 ◽  
pp. 129-134
Author(s):  
Aditya Prabawa ◽  
A A Ngurah Jayakusuma ◽  
A A Gede P. Wiradnyana
Keyword(s):  
Cesarean Section ◽  
Double Layer ◽  
Transvaginal Ultrasound ◽  
Control Group ◽  
Study Group ◽  
Purse String ◽  
Cesarean Scar ◽  
Uterine Incision ◽  
Number Of Patients ◽  
Closure Method

Objective : To compare cesarean scar defect incidence and other parameters between Turan technique and Conventional techniqueMethod : Literature ReviewResult : The Turan technique uses a purse-string double-layer closure method, which can shorten the incision length and reduce the incidence of postpartum cesarean scar defect that can be detected by ultrasound. Uterine incisional defects are etiologic factor of postoperative pelvic adhesion, placenta previa and accreta, uterine rupture, abnormal uterine bleeding and dysmenorrhea. This means that decrease in the incidence of uterine incisional defects is essential to prevent cesarean-related complications. In 51 patients in the study group (closure the uterine incision with Turan technique) and 65 patients in the control group collected within 6 weeks postoperative for transvaginal ultrasound, the length of the uterine incision closure in the study group shorter than control group (p= 0.0001, 95% IK = 2,854-6,876). Significantly, the number of patients with cesarean scar defect was 12 (23.5%) in the study group and 39 in the control group (76.5%) with P = 0.0001.Conclusion : Turan technique is new uterine closure method technique on CS. This technique can reduce the incidence of cesarean scar defect.Keyword : Turan Technique, Cesarean Section, uterine incision Abstrak Tujuan : Untuk membandingkan angka kejadian defek jaringan parut uterus dan parameter lain antara teknik Turan dan teknik konvensionalMetode : Kajian PustakaHasil : Teknik Turan menggunakan metode penutupan purse-string double layer, dimana dapat memperpendek insisi dan mengurangi insidensi defek jaringan parut uterus postpartum yang dapat dideteksi dengan ultrasonografi. Defek insisional uterus merupakan faktor etiologi dari adhesi pelvis paska operasi, plasenta previa dan akreta, ruptur uteri, kehamilan ektopik pada parut uterus, perdarahan uterus abnormal dan dismenore. Ini berarti penurunan kejadian defek insisional uterus sangat penting untuk mencegah terjadinya komplikasi terkait seksio sesarea. Pada 51 pasien kelompok studi (teknik Turan) dan 65 pasien pada kelompok kontrol yang dilakukan pemeriksaan ultrasonografi transvaginal 6 minggu paska operasi didapatkan data bahwa panjang insisi uterus lebih pendek pada kelompok studi (P = 0.0001, 95% IK = 2.854–6.876). Secara signifikan, jumlah pasien dengan defek parut bekas operasi (Cesarean Scar Defect) adalah 12 orang (23.5%) pada kelompok studi dan 39 orang pada kelompok kontrol (76.5%) dengan nilai P = 0.0001Kesimpulan : Teknik Turan adalah teknik baru mengenai metode penjahitan pada insisi operasi SC. Secara signifikan tehnik ini mampu menurunkan insidensi defek parut bekas operasi.Kata kunci : Teknik Turan, Seksio Sesarea, Insisi uterus  

scholarly journals Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Sharad M. Malvadkar ◽  
Madhuri S. Malvadkar ◽  
Shilpa V. Domkundwar ◽  
Shariq Mohd
Keyword(s):  
Spontaneous Rupture ◽  
Rare Complication ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Uterine Wall ◽  
Transvaginal Sonography ◽  
Inflammatory Cell Infiltrate ◽  
Emergency Laparotomy ◽  
First Case ◽  
Enhanced Computed Tomography

Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS) which was later confirmed on contrast enhanced computed tomography (CECT). An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge,this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis.

Comparative Study of Ultrasound Signs of Scar Pregnancy in Patients with Cesarean Section and Their Clinical Outcomes

2021 ◽  
Vol 11 (3) ◽  
pp. 886-893
Author(s):  
Shasha Xie ◽  
Wei Dong ◽  
Yeting Liu ◽  
Haixiao Gao
Keyword(s):  
Cesarean Section ◽  
Uterine Cavity ◽  
Clinical Work ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Clinical Value ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
First Choice ◽  
New Type

Caesarean scar pregnancy is the implantation of fertilized eggs in the scar of the previous cesarean section in the lower uterus. It is a serious long-term complication after cesarean section. Ultrasound examination, as the first choice to evaluate cesarean scar pregnancy plays an important role in its diagnosis, treatment and follow-up. This study first tried to propose new ultrasound diagnostic indicators to distinguish cesarean scar pregnancy from non-scar pregnancy of the lower uterine cavity; Logistic regression analysis was used to screen for risk factors related to scar pregnancy bleeding, with a view to providing clinical ultrasound indicators to predict bleeding risk; Secondly, the use of contrast-enhanced ultrasound and three-dimensional ultrasound to observe the scar diverticulum of cesarean section more than six months after the different surgical treatments of scar pregnancy, and to evaluate whether surgical scar repair can improve the scar diverticulum. Finally, using ultrasound to predict the position of the embryonic placenta, the new type of scar pregnancy in cesarean section is divided into three types: anterior wall placenta, anterior wall posterior placenta and posterior wall placental. The three types of CSP have significant differences in the thickness of the muscular layer in the scar of the lower part of the anterior wall of the uterus, the blood flow in the scar of the lower part of the anterior wall of the uterus, the number of days of hospitalization, the treatment method, and the treatment effect, which indicate that the new type is used for the diagnosis of CSP. Treatment and prognosis evaluation have high clinical value, can be used to guide clinical work, and provide a new idea for clinical diagnosis and treatment.

scholarly journals Magnetic Resonance Imaging as an Adjunct to Ultrasound in Evaluating Cesarean Scar Ectopic Pregnancy

2013 ◽  
Vol 3 ◽  
pp. 16 ◽  
Author(s):  
Rebecca Wu ◽  
Michelle A. Klein ◽  
Sabrina Mahboob ◽  
Mala Gupta ◽  
Douglas S. Katz
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cesarean Section ◽  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Doppler Imaging ◽  
Resonance Imaging ◽  
Cesarean Scar ◽  
Number Of Patients ◽  
Adjacent Structures

Cesarean scar pregnancies (CSPs) are a relatively rare form of ectopic pregnancy in which the embryo is implanted within the fibrous scar of a previous cesarean section. A greater number of cases of CSPs are currently being reported as the rates of cesarean section are increasing globally and as detection of scar pregnancy has improved with use of transvaginal ultrasound (TVUS) with color Doppler imaging. Delayed diagnosis and management of this potentially life-threatening condition may result in complications, predominantly uterine rupture and hemorrhage with significant potential maternal morbidity. Diagnosis of a cesarean scar pregnancy (CSP) requires a high index of clinical suspicion, as up to 40% of patients may be asymptomatic. TVUS has a reported sensitivity of 84.6% and has become the imaging examination of choice for diagnosis of a CSP. Magnetic resonance imaging (MRI) has been used in a small number of patients as an adjunct to TVUS. In the present report, MRI is highlighted as a problem-solving tool capable of more precisely identifying the relationship of a CSP to adjacent structures, thereby providing additional information critical to directing appropriate patient management and therapy.

Sign in / Sign up

Export Citation Format

Share Document