DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222814
Published: 2022-10-28

Caesarean scar defect: a histopathological comparative study

Pooja A. Agrawal, Padmaja Y. Samant, Gwendolyn Fernandes

Abstract


Background: We have evaluated the validity of this syndrome in Indian patients and analysed the gynaecological indications for hysterectomy in women with history of caesarean sections. We have studied pathological changes in the scar area and compared the findings with matched cases without previous caesarean scar.

Methods: A prospective observational case control study was done at tertiary care hospital (Seth GS Medical College and King Edward Memorial Hospital) over two years (December 2018 to December 2020) with universal sampling and enrolled all consenting eligible patients. After hysterectomy histopathological study of the specimens was done. Total cases: 16 hysterectomy samples with history of previous caesarean section. Total controls: 40 hysterectomy samples with history of no previous caesarean section. The difference between the two proportions was analysed using Chi square or Fisher exact test. All analysis was 2 tailed and the significance level was set at 0.05.

Results: Women with history of previous caesarean scar had gynaecological symptoms related to the caesarean scar defect such as abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain, post-menopausal bleeding and the most frequent clinical symptom related to the scar defect was abnormal uterine bleeding. The clinical symptoms were found to be associated with histopathological changes at scar site.

Conclusions: This study compared caesarean cases and no caesarean controls and sheds light on the role of histopathology in detection of caesarean scar site changes. It helped in comparison of various factors affected due to the presence of caesarean scar and its long-term complications, leading to hysterectomy.


Keywords


Caesarean scar, Histopathological, Cases, Controls, Hysterectomy

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References


Tulandi T, Cohen A. Emerging manifestations of caesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol. 2016;23(6):893-902.

Tower AM, Frishman GN. Caesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol. 2013;20(5):562-72.

Morris H. Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms? Int J Gynecol Pathol. 1995;14(1):16-20.

Tower AM, Frishman GN. Caesarean scar defects: an under recognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol. 2013;20(5):562-72.

Vaate AJ, Voet LF, Naji O, Witmer M, Veersema S, Brölmann HA, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following caesarean section: systematic review. Ultrasound Obstet Gynecol. 2014;43(4):372-82.

Alsheemy RI, Eid SM, Karef AAE. Caesarean section niche assessment histopathologically after hysterectomy in symptomatic patients. Life Sci J. 2014;11(10):163-71.

Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in caesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol. 2009;34(1):90-7.

Alshiemy RI. Correlation between caesarean section scar pattern and gynecological symptoms ain shams 17th annual international conference of obstetrics and gynaecology, Cairo, Egypt; 2013.

Wang CB, Chiu WW, Lee CY, Sun YL, Lin YH, Tseng CJ. Caesarean scar defect: correlation between caesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol. 2009;34(1):85-9.

Ofili-Yebovi D, Ben-Nagi J, Sawyer E, Yazbek J, Lee C, Gonzalez J, et al. Deficient lower-segment caesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol. 2008;31(1):72-7.

Roeder HA, Cramer SF, Leppert PC. A look at uterine wound healing through a histopathological study of uterine scars. J Reproduct Sci. 2012;19(5):463-473.

Tanimura S, Funamoto H, Hosono T, Shitano Y, Nakashima M, Ametani Y, et al. New diagnostic criteria and operative strategy for caesarean scar syndrome: Endoscopic repair for secondary infertility caused by caesarean scar defect. J Obstet Gynaecol Res. 2015;41:1363-9.

Tohya T, Imamura Y, Motooka C, Kuwahara S, Matsuo Y. Cesarean scar syndrome: diagnostic imaging and histopathological findings from two women who underwent hysterectomy. Ann Clin Case Rep. 2016;1:1117.