Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome
Cesarean scar defect often causes postmenstrual abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, and infertility, which are collectively known as cesarean scar syndrome (CSS). Several studies have reported that hysteroscopic surgery can restore fertility in women with CSS. The study aim...
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| description | Cesarean scar defect often causes postmenstrual abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, and infertility, which are collectively known as cesarean scar syndrome (CSS). Several studies have reported that hysteroscopic surgery can restore fertility in women with CSS. The study aimed to identify factors that influence subsequent pregnancy following hysteroscopic surgery. Therefore, we studied 38 women with secondary infertility due to CSS who underwent hysteroscopic surgery at Shiga University of Medical Hospital between July 2014 and July 2019. Our hysteroscopic procedure included inferior edge resection and superficial cauterization of the cesarean scar defect under laparoscopic guidance. Patients were followed up for 3 to 40 months after surgery. Surgery was successful in all cases and no complications were observed. Twenty-seven patients (71%) became pregnant (pregnant group), while 11 (29%) did not (non-pregnant group). Baseline characteristics of age, body mass index, gravidity, parity, previous cesarean section, presence of endometriosis, retroflex uterus, and preoperative residual myometrial thickness were not significantly different between the groups. However, the median residual myometrium thickness was significantly higher after surgery than before surgery in the pregnant group (1.9 [1.1-3.6] vs 4.9 [3.4-6.6] mm, P |
| doi_str_mv | 10.1371/journal.pone.0243421 |
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Several studies have reported that hysteroscopic surgery can restore fertility in women with CSS. The study aimed to identify factors that influence subsequent pregnancy following hysteroscopic surgery. Therefore, we studied 38 women with secondary infertility due to CSS who underwent hysteroscopic surgery at Shiga University of Medical Hospital between July 2014 and July 2019. Our hysteroscopic procedure included inferior edge resection and superficial cauterization of the cesarean scar defect under laparoscopic guidance. Patients were followed up for 3 to 40 months after surgery. Surgery was successful in all cases and no complications were observed. Twenty-seven patients (71%) became pregnant (pregnant group), while 11 (29%) did not (non-pregnant group). Baseline characteristics of age, body mass index, gravidity, parity, previous cesarean section, presence of endometriosis, retroflex uterus, and preoperative residual myometrial thickness were not significantly different between the groups. However, the median residual myometrium thickness was significantly higher after surgery than before surgery in the pregnant group (1.9 [1.1-3.6] vs 4.9 [3.4-6.6] mm, P<0.0001), whereas this difference was not significant in the non-pregnant group. Of those who became pregnant, 85% conceived within 2 years of surgery. Although three pregnancies resulted in abortion and one is ongoing at the time of writing, 23 pregnancies resulted in healthy babies at 35-38 gestational weeks by scheduled cesarean sections with no obstetrical complications due to hysteroscopic surgery. The average birth weight was 3,076 g. Our findings support that hysteroscopic surgery is a safe and effective treatment for secondary infertility due to CSS. The thickness of the residual myometrium may be a key factor that influences subsequent pregnancy in women with CSS.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0243421</identifier><identifier>PMID: 33270754</identifier><language>eng</language><publisher>SAN FRANCISCO: Public Library Science</publisher><subject>Abortion, Spontaneous - epidemiology ; Adult ; Babies ; Biology and Life Sciences ; Birth weight ; Bleeding ; Body mass ; Body mass index ; Body size ; Care and treatment ; Cesarean section ; Cesarean Section - adverse effects ; Cicatrix - etiology ; Cicatrix - pathology ; Cicatrix - surgery ; Complications ; Complications and side effects ; Electrodes ; Endometriosis ; Female ; Fertility ; Gynecology ; Humans ; Hysteroscopy ; Infertility ; Infertility, Female - etiology ; Infertility, Female - pathology ; Infertility, Female - surgery ; Laparoscopy ; Live Birth ; Magnetic resonance imaging ; Medical records ; Medicine and Health Sciences ; Multidisciplinary Sciences ; Myometrium ; Myometrium - pathology ; Myometrium - surgery ; Obstetrics ; Pain ; Patient outcomes ; Patients ; Pregnancy ; Pregnant women ; Retrospective Studies ; Science & Technology ; Science & Technology - Other Topics ; Surgery ; Syndrome ; Thickness ; Treatment Outcome ; Uterine Diseases - etiology ; Uterine Diseases - pathology ; Uterine Diseases - surgery ; Uterus</subject><ispartof>PloS one, 2020-12, Vol.15 (12), p.e0243421-e0243421, Article 0243421</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Tsuji et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Tsuji et al 2020 Tsuji et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>20</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000597149100001</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c736t-426ec1e1f2da3a194f67eec490dc3b7abc67f8a95268021d1a769ca23ae4e3153</citedby><cites>FETCH-LOGICAL-c736t-426ec1e1f2da3a194f67eec490dc3b7abc67f8a95268021d1a769ca23ae4e3153</cites><orcidid>0000-0001-5698-553X ; 0000-0003-3945-6817</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714235/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714235/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,729,782,786,866,887,2104,2116,2930,23873,27931,27932,28255,53798,53800</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33270754$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Laganà, Antonio Simone</contributor><creatorcontrib>Tsuji, Shunichiro</creatorcontrib><creatorcontrib>Takahashi, Akimasa</creatorcontrib><creatorcontrib>Higuchi, Asuka</creatorcontrib><creatorcontrib>Yamanaka, Akiyoshi</creatorcontrib><creatorcontrib>Amano, Tsukuru</creatorcontrib><creatorcontrib>Kimura, Fuminori</creatorcontrib><creatorcontrib>Seko-Nitta, Ayumi</creatorcontrib><creatorcontrib>Murakami, Takashi</creatorcontrib><title>Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome</title><title>PloS one</title><addtitle>PLOS ONE</addtitle><addtitle>PLoS One</addtitle><description>Cesarean scar defect often causes postmenstrual abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, and infertility, which are collectively known as cesarean scar syndrome (CSS). Several studies have reported that hysteroscopic surgery can restore fertility in women with CSS. The study aimed to identify factors that influence subsequent pregnancy following hysteroscopic surgery. Therefore, we studied 38 women with secondary infertility due to CSS who underwent hysteroscopic surgery at Shiga University of Medical Hospital between July 2014 and July 2019. Our hysteroscopic procedure included inferior edge resection and superficial cauterization of the cesarean scar defect under laparoscopic guidance. Patients were followed up for 3 to 40 months after surgery. Surgery was successful in all cases and no complications were observed. Twenty-seven patients (71%) became pregnant (pregnant group), while 11 (29%) did not (non-pregnant group). Baseline characteristics of age, body mass index, gravidity, parity, previous cesarean section, presence of endometriosis, retroflex uterus, and preoperative residual myometrial thickness were not significantly different between the groups. However, the median residual myometrium thickness was significantly higher after surgery than before surgery in the pregnant group (1.9 [1.1-3.6] vs 4.9 [3.4-6.6] mm, P<0.0001), whereas this difference was not significant in the non-pregnant group. Of those who became pregnant, 85% conceived within 2 years of surgery. Although three pregnancies resulted in abortion and one is ongoing at the time of writing, 23 pregnancies resulted in healthy babies at 35-38 gestational weeks by scheduled cesarean sections with no obstetrical complications due to hysteroscopic surgery. The average birth weight was 3,076 g. Our findings support that hysteroscopic surgery is a safe and effective treatment for secondary infertility due to CSS. The thickness of the residual myometrium may be a key factor that influences subsequent pregnancy in women with CSS.</description><subject>Abortion, Spontaneous - epidemiology</subject><subject>Adult</subject><subject>Babies</subject><subject>Biology and Life Sciences</subject><subject>Birth weight</subject><subject>Bleeding</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Care and treatment</subject><subject>Cesarean section</subject><subject>Cesarean Section - adverse effects</subject><subject>Cicatrix - etiology</subject><subject>Cicatrix - pathology</subject><subject>Cicatrix - surgery</subject><subject>Complications</subject><subject>Complications and side effects</subject><subject>Electrodes</subject><subject>Endometriosis</subject><subject>Female</subject><subject>Fertility</subject><subject>Gynecology</subject><subject>Humans</subject><subject>Hysteroscopy</subject><subject>Infertility</subject><subject>Infertility, Female - etiology</subject><subject>Infertility, Female - pathology</subject><subject>Infertility, Female - surgery</subject><subject>Laparoscopy</subject><subject>Live Birth</subject><subject>Magnetic resonance imaging</subject><subject>Medical records</subject><subject>Medicine and Health Sciences</subject><subject>Multidisciplinary Sciences</subject><subject>Myometrium</subject><subject>Myometrium - pathology</subject><subject>Myometrium - surgery</subject><subject>Obstetrics</subject><subject>Pain</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pregnancy</subject><subject>Pregnant women</subject><subject>Retrospective Studies</subject><subject>Science & Technology</subject><subject>Science & Technology - Other Topics</subject><subject>Surgery</subject><subject>Syndrome</subject><subject>Thickness</subject><subject>Treatment Outcome</subject><subject>Uterine Diseases - etiology</subject><subject>Uterine Diseases - pathology</subject><subject>Uterine Diseases - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tsuji, Shunichiro</au><au>Takahashi, Akimasa</au><au>Higuchi, Asuka</au><au>Yamanaka, Akiyoshi</au><au>Amano, Tsukuru</au><au>Kimura, Fuminori</au><au>Seko-Nitta, Ayumi</au><au>Murakami, Takashi</au><au>Laganà, Antonio Simone</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome</atitle><jtitle>PloS one</jtitle><stitle>PLOS ONE</stitle><addtitle>PLoS One</addtitle><date>2020-12-03</date><risdate>2020</risdate><volume>15</volume><issue>12</issue><spage>e0243421</spage><epage>e0243421</epage><pages>e0243421-e0243421</pages><artnum>0243421</artnum><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Cesarean scar defect often causes postmenstrual abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, and infertility, which are collectively known as cesarean scar syndrome (CSS). Several studies have reported that hysteroscopic surgery can restore fertility in women with CSS. The study aimed to identify factors that influence subsequent pregnancy following hysteroscopic surgery. Therefore, we studied 38 women with secondary infertility due to CSS who underwent hysteroscopic surgery at Shiga University of Medical Hospital between July 2014 and July 2019. Our hysteroscopic procedure included inferior edge resection and superficial cauterization of the cesarean scar defect under laparoscopic guidance. Patients were followed up for 3 to 40 months after surgery. Surgery was successful in all cases and no complications were observed. Twenty-seven patients (71%) became pregnant (pregnant group), while 11 (29%) did not (non-pregnant group). Baseline characteristics of age, body mass index, gravidity, parity, previous cesarean section, presence of endometriosis, retroflex uterus, and preoperative residual myometrial thickness were not significantly different between the groups. However, the median residual myometrium thickness was significantly higher after surgery than before surgery in the pregnant group (1.9 [1.1-3.6] vs 4.9 [3.4-6.6] mm, P<0.0001), whereas this difference was not significant in the non-pregnant group. Of those who became pregnant, 85% conceived within 2 years of surgery. Although three pregnancies resulted in abortion and one is ongoing at the time of writing, 23 pregnancies resulted in healthy babies at 35-38 gestational weeks by scheduled cesarean sections with no obstetrical complications due to hysteroscopic surgery. The average birth weight was 3,076 g. Our findings support that hysteroscopic surgery is a safe and effective treatment for secondary infertility due to CSS. The thickness of the residual myometrium may be a key factor that influences subsequent pregnancy in women with CSS.</abstract><cop>SAN FRANCISCO</cop><pub>Public Library Science</pub><pmid>33270754</pmid><doi>10.1371/journal.pone.0243421</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-5698-553X</orcidid><orcidid>https://orcid.org/0000-0003-3945-6817</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-12, Vol.15 (12), p.e0243421-e0243421, Article 0243421 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_crossref_primary_10_1371_journal_pone_0243421 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Abortion, Spontaneous - epidemiology Adult Babies Biology and Life Sciences Birth weight Bleeding Body mass Body mass index Body size Care and treatment Cesarean section Cesarean Section - adverse effects Cicatrix - etiology Cicatrix - pathology Cicatrix - surgery Complications Complications and side effects Electrodes Endometriosis Female Fertility Gynecology Humans Hysteroscopy Infertility Infertility, Female - etiology Infertility, Female - pathology Infertility, Female - surgery Laparoscopy Live Birth Magnetic resonance imaging Medical records Medicine and Health Sciences Multidisciplinary Sciences Myometrium Myometrium - pathology Myometrium - surgery Obstetrics Pain Patient outcomes Patients Pregnancy Pregnant women Retrospective Studies Science & Technology Science & Technology - Other Topics Surgery Syndrome Thickness Treatment Outcome Uterine Diseases - etiology Uterine Diseases - pathology Uterine Diseases - surgery Uterus |
| title | Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome |
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