Chronic endometritis and an incompetent uterine scar after cesarean section: long-term outcomes of metroplasty

Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum.Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery.Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up.Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

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Short- and long-term outcomes after cesarean section

Expert Review of Obstetrics & Gynecology ◽

10.1586/eog.11.5 ◽

2011 ◽

Vol 6 (2) ◽

pp. 205-215 ◽

Cited By ~ 20

Author(s):

Rosalie M Grivell ◽

Jodie M Dodd

Keyword(s):

Cesarean Section ◽

Long Term Outcomes ◽

Short And Long Term

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The niche in the uterine cesarean scar: a new problem of women’s reproductive health

Journal of obstetrics and women s diseases ◽

10.17816/jowd69153-62 ◽

2020 ◽

Vol 69 (1) ◽

pp. 53-62

Author(s):

Olga N. Nozhnitseva ◽

Vitaliy F. Bezhenar

Keyword(s):

Cesarean Section ◽

Pregnant Women ◽

Ultrasound Examination ◽

Suture Repair ◽

Resonance Imaging ◽

Complicated Course ◽

Uterine Scar ◽

Significant Factors

Hypothesis/aims of study. In the recent decades, the quality of uterine suture repair after a cesarean section is widely discussed, as local thinning of the myometrium forming uterine scar defects, or the so-called scar niche, are relatively common after the operation. The aim of this study was to identify the causes of local thinning of the uterine scar after cesarean section, to determine the effectiveness of existing methods for assessing the uterine scar in non-pregnant women, and to develop a method for surgical correction of this pathology. Study design, materials and methods. Over 4 years, 175 non-pregnant women with a uterine scar were examined. The 50 of them were diagnosed with the uterine scar niche, with a laparoscopic metroplasty performed in these patients. The effectiveness of the operation was evaluated in the long-term postoperative period. Results. Performing cesarean section because of weakness of labor activity and a complicated course of the postpartum period are significant factors in the formation of a uterine scar niche (p 0.05). Ultrasound examination and magnetic resonance imaging of the pelvic organs can be used to detect local thinning of the myometrium with a sensitivity of 82% and 96%, and a specificity of 85% and 90%, respectively. Conclusion. Metroplasty for patients with a diagnosed scar niche can significantly increase the thickness of the myometrium (p 0.05) and reduce the frequency of complaints of such menstrual irregularities as postmenstrual vaginal bleeding, dysmenorrhea, and hypermenorrhea (p 0.05).

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Short-term and long-term outcomes of ewes and their offspring after elective cesarean section

Theriogenology ◽

10.1016/j.theriogenology.2012.11.001 ◽

2013 ◽

Vol 79 (3) ◽

pp. 486-494 ◽

Cited By ~ 5

Author(s):

Steinar Waage ◽

Guri Wangensteen

Keyword(s):

Cesarean Section ◽

Elective Cesarean Section ◽

Long Term Outcomes ◽

Short Term ◽

Elective Cesarean

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Comparative analysis of long-term outcomes of Misgav Ladach technique cesarean section and traditional cesarean section

Journal of Obstetrics and Gynaecology Research ◽

10.1111/j.1447-0756.2011.01777.x ◽

2012 ◽

Vol 38 (10) ◽

pp. 1235-1239 ◽

Cited By ~ 12

Author(s):

Ata Ghahiry ◽

Farimah Rezaei ◽

Reza Karimi Khouzani ◽

Mansoor Ashrafinia

Keyword(s):

Comparative Analysis ◽

Cesarean Section ◽

Long Term Outcomes

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A CLINICAL CASE OF AN UNDEVELOPED PREGNANCY IN A UTERINE SCAR AFTER A CESAREAN SECTION

Acta medica Eurasica ◽

10.47026/2413-4864-2021-3-26-34 ◽

2021 ◽

pp. 26-34

Author(s):

Mikhail E. Shchepelev ◽

Tatyana V. Deripasko ◽

Anastasiya A. Sidorova ◽

Elena G. Drandrova ◽

Evgeny V. Moskvichev ◽

...

Keyword(s):

Cesarean Section ◽

Clinical Case ◽

Reproductive Function ◽

Childbearing Age ◽

Pregnancy And Childbirth ◽

First Child ◽

Anatomical Classification ◽

Uterine Scar ◽

Ectopic Pregnancies

Over the past twenty-five years, the average age of a woman giving birth to the first child has grown significantly around the world. So, in Russia, currently, women begin to bring their reproductive function into action on average at the age of 26-35. This leads to the fact that obstetricians and gynecologists in their practice increasingly face with pregnancy and childbirth complicated by a uterine scar after a previous cesarean section or myomectomy. The formation of a uterine scar after any intervention entails the likelihood of long-term complications, such as a rupture of the uterus along the scar and pregnancy in the uterine scar. According to the latest clinical recommendations for ectopic pregnancy, pregnancy in the uterine scar has been added to the anatomical classification of ectopic pregnancies. The article describes a clinical case of an undeveloped pregnancy in the uterine scar after a cesarean section, it shows the difficulty of timely diagnosis of such pregnancy, which often results in improper management of patients and loss of fertility by women of childbearing age. In the described case, late diagnosis of pregnancy in the uterine scar necessitated organ-resecting surgery – extirpation of the uterus with fallopian tubes.

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Traumatic Brain Injury: A Trauma Surgeon's Perspective

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld22.3.82 ◽

2012 ◽

Vol 22 (3) ◽

pp. 82-89

Author(s):

Oscar D. Guillamondegui

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Multidisciplinary Approach ◽

Trauma Team ◽

The United States ◽

Long Term Outcomes ◽

Term Care ◽

Injured Brain ◽

The Moment

Traumatic brain injury (TBI) is a serious epidemic in the United States. It affects patients of all ages, race, and socioeconomic status (SES). The current care of these patients typically manifests after sequelae have been identified after discharge from the hospital, long after the inciting event. The purpose of this article is to introduce the concept of identification and management of the TBI patient from the moment of injury through long-term care as a multidisciplinary approach. By promoting an awareness of the issues that develop around the acutely injured brain and linking them to long-term outcomes, the trauma team can initiate care early to alter the effect on the patient, family, and community. Hopefully, by describing the care afforded at a trauma center and by a multidisciplinary team, we can bring a better understanding to the armamentarium of methods utilized to treat the difficult population of TBI patients.

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