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Chapter 16 - Unusual Hysteroscopic Situations: Caesarean Niche and Retained Placental Tissue

Published online by Cambridge University Press:  10 September 2020

By
Lucet van der Voet ,
Sebastiaan Veersema ,
Benidictus Schoot  and
Judith Huirne
Edited by
Mary E. Connor  and
T. Justin Clark
Mary E. Connor
Affiliation:
Royal Hallamshire Hospital, Sheffield
T. Justin Clark
Affiliation:
Birmingham Women’s Hospital
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Summary

With the rising rate of caesarean sections (CS) and the increasing capabilities of ultrasound and hysteroscopy, there is growing interest in the caesarean scar in the non-pregnant woman. A caesarean scar is visible with transvaginal ultrasound (TVS) (Figure 16.1), hysterosalpingography (HSG) (Figure 16.2), magnetic resonance imaging (MRI) (Figure 16.3), sonohysterography (SHG) (Figure 16.4) or hysteroscopy (Figure 16.5)

Type
Chapter
Information
Diagnostic and Operative Hysteroscopy , pp. 193 - 203
Publisher: Cambridge University Press
Print publication year: 2020

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References

Naji, O, Abdallah, Y, Bij De Vaate, AJ, et al. Standardized approach for imaging and measuring cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol 2012; 39: 252–9.Google Scholar
Roberg, S, Boutin, A, Chaillet, N, et al. Systematic review of cesarean scar assessment in the non-pregnant state: imaging techniques and uterine scar defect. Am J Perinatol 2012; 29: 465–72.Google Scholar
Bij, VAJ, van der Voet, LF, Naji, O, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section: systematic review. Ultrasound Obstet Gynecol 2014; 43: 372–82.Google Scholar
Osser, OV, Jokubkiene, L, Valentin, L. Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement. Ultrasound Obstet Gynecol 2010; 35: 75–83.Google Scholar
Bij, VAJ, Brolmann, HA, van der Voet, LF, et al. Ultrasound evaluation of the cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol 2011; 37: 93–9.Google Scholar
van der Voet, LF, Bij, VAJ, Veersema, S, Brolmann, HA, Huirne, JA. Long term complications of caesarean section, the niche in the scar: a prospective cohort study on niche prevalence and relation with abnormal uterine bleeding. BJOG 2014; 121: 236–44.Google Scholar
El-Mazny, A, Abou-Salem, N, El-Khayat, W, Farouk, A. Diagnostic correlation between sonohysterography and hysteroscopy in the assessment of uterine cavity after cesarean section. Middle East Fertil Soc J 2011; 16: 72–6.Google Scholar
Borges, LM, Scapinelli, A, de Baptista Depes, D, Lippi, UG, Coelho Lopes, RG. Findings in patients with postmenstrual spotting with prior cesarean section. J Minim Invasive Gynecol 2010; 1: 361–4.Google Scholar
Jordans, IPM, De, Leeuw, Stegwee, SI, et al. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure. Ultrasound Obstet Gynecol 2019; 53: 107–15.Google Scholar
Armstrong, V, Hansen, WF, Van Voorhis, BJ, Syrop, CH. Detection of cesarean scars by transvaginal ultrasound. Obstet Gynecol 2003; 101: 61–5.Google Scholar
Hayakawa, H, Itakura, A, Mitsui, T, et al. Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography. Acta Obstet Gynecol Scand 2006; 85: 429–34.CrossRefGoogle ScholarPubMed
Roberge, S, Demers, S, Berghella, V, et al. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and meta-analysis. Am J Obstet Gynecol 2014; 211: 453–60.CrossRefGoogle Scholar
Tinor-Tritsch, I, Monteagudo, A. Unforseen consequence of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 2010; 207: 14–29.Google Scholar
Tower, AM, Frishman, GN. Casarean scar defects: an under recognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol 2013; 20: 562–72.Google Scholar
Wang, CB, Chiu, WW, Lee, CY, et al. Cesarean scar defect: correlation between cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol 2009; 34: 85–9.CrossRefGoogle ScholarPubMed
Gurol-Urganci, I, Bou-Antoun, S, Lim, CP, et al. Impact of caesarean section on subsequent fertility: a systematic review and meta-analysis. Hum Reprod 2013; 28: 1943–52.Google Scholar
Fabres, C, Aviles, G, De La Jara, C, et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med 2003; 22: 695–700.CrossRefGoogle ScholarPubMed
Thurmond, AS, Harvey, WJ, Smith, SA. Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultrasound Med 1999; 18: 13–16.CrossRefGoogle ScholarPubMed
Fabres, C, Arriagada, P, Fernandez, C, et al. Surgical treatment and follow-up of women with intermenstrual bleeding due to Cesarean section scar defect. J Minim Invasive Gynecol 2005; 12: 25–8.CrossRefGoogle ScholarPubMed
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: 16–20.Google Scholar
Van der Voet, L, Vervoort, AJ, Veersema, S, et al. Minimally invasive therapy for gynaecological symptoms related to a niche in the caesarean scar: a systematic review. BJOG 2014; 121: 145–56.Google Scholar
Chang, Y, Tsai, EM, Long, CY, Lee, CL, Kay, N. Resectoscopic treatment combined with sonohysterographic evaluation of women with postmenstrual bleeding as a result of previous cesarean delivery scar defects. Am J Obstet Gynecol 2009; 200: 370–4.Google Scholar
Gubbini, G, Centini, G, Nascetti, D, et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol 2011; 18: 234–7.CrossRefGoogle ScholarPubMed
Feng, YL, Li, MX, Liang, XQ, Li, XM. Hysteroscopic treatment of postcesarean scar defect. J Minim Invasive Gynecol 2012; 19: 498–502.CrossRefGoogle ScholarPubMed
Wang, CJ, Huang, HJ, Chao, A, et al. Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect. Eur J Obstet Gynecol Reprod Biol 2011; 154: 218–22.CrossRefGoogle ScholarPubMed
Talamonte, VH, Gazi Lippi, U, Lopes, RGC, Stabile, SAB. Hysteroscopic findings in patients with post-menstrual spotting with prior cesarean section. Einstein (Sao Paulo) 2012; 10: 53–6.Google Scholar
Florio, P, Gubbini, G, Marra, E, et al. A retrospective case-control study comparing hysteroscopic resection versus hormonal modulation in treating menstrual disorders due to isthmocele. Gynecol Endocrinol 2011; 27: 434–8.CrossRefGoogle ScholarPubMed
Gubbini, G, Casadio, P, Marra, E. Resectoscopic correction of the ‘isthmocele’ in women with postmenstrual abnormal uterine bleeding and secondary infertility. J Minim Invasive Gynecol 2008; 15: 172–5.CrossRefGoogle ScholarPubMed
Fernandez, E, Fernandez, C, Fabres, C, Alam, V. Hysteroscopic correction of cesarean section scars in women with abnormal uterine bleeding. J Am Assoc Gynecol Laparosc 1996; 3: S13.Google Scholar
Shih, CL, Chang, YY, Ho, M, Lin, WC, Wang, AMM. Hysteroscopic transcervical resection: straightforward method corrects bleeding related to cesarean section scar defects. Am J Obstet Gynecol 2011; 204: 278.e1–2.Google Scholar
Marra, E, Casadio, P, Armilotta, F, et al. Resectoscopic treatment of ‘Isthmocele’: ‘Isthmoplasty’. Gynecol Surg 2009; 6: S108–9.Google Scholar
Raimondo, G, Grifone, G, Raimondo, D, et al. Hysteroscopic treatment of symptomatic caesarean-induced isthmocele: a prospective study. J Minim Invasive Gynecol 2014; 22: 297–301.CrossRefGoogle ScholarPubMed
Golan, A, Dishi, M, Shalev, A, et al. Operative hysteroscopy to remove retained products of conception: novel treatment of an old problem. J Minim Invasive Gynecol 2011; 18: 100–3.Google Scholar
Luise, C, Jermy, K, May, C, et al. Outcome of expectant management of spontaneous first trimester miscarriage: observational study. BMJ 2002; 324: 873–5.Google Scholar
Zhang, J, Gilles, JM, Barnhart, K, et al. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med 2005; 353: 761–9.CrossRefGoogle ScholarPubMed
Guillem, P, Racinet, C, Leynaud, A, Benbassa, A, Cans, C. Evaluation of maternal morbidity after drug-induced termination of pregnancy (TOP) after 12 gestation weeks [in French]. J Gynecol Obstet Biol Reprod (Paris) 2003; 32: 227–38.Google Scholar
Acharya, G, Morgan, H, Paramanantham, L, Fernando, R. A randomized controlled trial comparing surgical termination of pregnancy with and without continuous ultrasound guidance. Eur J Obstet Gynecol Reprod Biol 2004; 114: 69–74.CrossRefGoogle ScholarPubMed
Hoveyda, F, MacKenzie, IZ. Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG 2001; 108: 927–30.Google ScholarPubMed
King, PA, Duthie, SJ, Dong, ZG, Ma, HK. Secondary postpartum haemorrhage. Aust N Z J Obstet Gynaecol 1989; 29: 394–8.CrossRefGoogle ScholarPubMed
Rome, RM. Secondary postpartum haemorrhage. Br J Obstet Gynaecol 1975; 82: 289–92.CrossRefGoogle ScholarPubMed
Dewhurst, CJ. Secondary post-partum haemorrhage. J Obstet Gynaecol Br Commonw 1966; 73: 53–8.Google Scholar
Van den Bosch, T, Daemen, A, Van Schoubroeck, D, et al. Occurrence and outcome of residual trophoblastic tissue. J Ultrasound Med 2008; 27: 357–61.Google Scholar
Tchabo, JG Use of contact hysteroscopy in evaluating postpartum bleeding and incomplete abortion. J Reprod Med 1984; 29: 749–51.Google Scholar
Goldfarb, HA D&C results improved by hysteroscopy. New Jersey Med 1989; 86: 277–9.Google Scholar
Goldenberg, M, Schiff, E, Achiron, R, Lipitz, S, Mashiach, S. Managing residual trophoblastic tissue: hysteroscopy for directing curettage. J Reprod Med 1997; 42: 26–8.Google ScholarPubMed
Cohen, SB, Kalter-Ferber, A, Weisz, BS, et al. Hysteroscopy may be the method of choice for management of residual trophoblastic tissue. J Am Assoc Gynecol Laparosc 2001; 8: 199–202.Google Scholar
Hatfield, JL, Brumsted, JR, Cooper, BC. Conservative treatment of placenta accreta. J Minim Invasive Gynecol 2006; 13: 510–13.Google Scholar
Dankert, T, Vleugels, M. Hysteroscopic resection of retained placental tissue: a feasibility study. Gynecol Surg 2008; 5: 121–4.Google Scholar
Faivre, E, Deffieux, X, Mrazguia, C, et al. Hysteroscopic management of residual trophoblastic tissue and reproductive outcome: a pilot study. J Minim Invasive Gynecol 2009; 16: 487–90.Google Scholar
Nicopoullos, JDM, Treharne, A, Raza, A, Richardson, R. The use of a hysteroscopic resectoscope for repeat evacuation of retained products of conception procedures: a case series. Gynecol Surg 2010; 7: 163–6.Google Scholar
Rein, DT, Schmidt, T, Hess, AP, et al. Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. J Minim Invasive Gynecol 2011; 18: 774–8.Google Scholar
Kuzel, D, Horak, P, Hrazdirova, L, et al. ‘See and treat’ hysteroscopy after missed abortion. Minim Invasive Ther Allied Technol 2011; 20: 4–17.Google Scholar
Greenberg, JA, Miner, JD, O’Horo, SK. Uterine artery embolization and hysteroscopic resection to treat retained placenta accreta: a case report. J Minim Invasive Gynecol 2006; 13: 342–4.CrossRefGoogle ScholarPubMed
Hamerlynck, TW, Blikkendaal, MD, Schoot, BC, Hanstede, MM, Jansen, FW. An alternative approach for removal of placental remnants: hysteroscopic morcellation. J Minim Invasive Gynecol 2013; 6: 796–802.Google Scholar
Al-Inany, H. Intrauterine adhesions: an update. Acta Obstet Gynecol Scand 2001; 80: 986–93.Google Scholar
Westendorp, IC, Ankum, WM, Mol, BW, Vonk, J. Prevalence of Asherman’s syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Hum Reprod 1998; 13: 3347–50.Google Scholar
Hooker, AB, Thurkow, A. Asherman’s syndrome after removal of placenta remnants: a serious clinical problem. Gynecol Surg 2011; 8: 449–53.Google Scholar
Hrazdirova, L, Svabik, K, Zizka, Z, Germanova, A, Kuzel, D. Should hysteroscopy be provided for patients who have undergone instrumental intrauterine intervention after delivery? Acta Obstet Gynecol Scand 2012; 91: 514–17.Google Scholar

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