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Fertil Steril. 2017 Jan;107(1):289-296.e2. doi: 10.1016/j.fertnstert.2016.09.033. Epub 2016 Nov 2.

Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women.

Author information

1
Institut du Sein et de Chirurgie Gynécologique d'Avignon, Polyclinique Urbain V (Groupe Elsan), Avignon, France; Pôle de Recherche en Gynécologie, IREC Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. Electronic address: pr.olivier.donnez@gmail.com.
2
Society for Research into Infertility, Brussels, Belgium.
3
Pôle de Recherche en Gynécologie, IREC Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
4
Pôle de Recherche en Gynécologie, IREC Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Gynecology Department, Cliniques Universitaires Saint Luc, Brussels, Belgium.

Abstract

OBJECTIVE:

To evaluate gynecological and obstetrical outcomes, as well as remaining myometrial thickness, after laparoscopic repair of a cesarean scar.

DESIGN:

Observational study and prospective evaluation of the remaining myometrium before and after repair.

SETTING:

Academic department in a university hospital.

PATIENT(S):

A series of 38 symptomatic women with cesarean scar defects and remaining myometrial thickness of less than 3 mm, according to magnetic resonance imaging.

INTERVENTION(S):

Laparoscopic repair of the defect.

MAIN OUTCOMES MEASURE(S):

Increase in myometrial thickness at the site of cesarean section, gynecological and obstetrical outcomes, and histological analysis of the defect after excision.

RESULT(S):

The mean thickness of the myometrium increased significantly from 1.43 ± 0.7 mm before surgery to 9.62 ± 1.8 mm after surgery. All but three patients were free of symptoms. Among the 18 women with infertility, eight (44%) became pregnant and delivered healthy babies by cesarean section at 38-39 weeks of gestation. Histological analysis, performed in all 38 cases, revealed the presence of endometriosis in eight women (21.1%). Muscle fiber density was significantly lower compared with adjacent myometrium.

CONCLUSION(S):

In symptomatic women with residual myometrial thickness of less than 3 mm who wish to conceive, laparoscopic repair could be considered an appropriate approach.

KEYWORDS:

Cesarean scar defect; hysteroscopy; laparoscopic repair; myometrial thickness; niche

[Indexed for MEDLINE]

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