| Objectives:u1) To determine the correlation between uterine position and clinical symptoms associated with previous cesarean scar defect.2) To substantiate the fact the associated clinical symptoms can be effectively relieved using hysteroscopic resection of the scar tissue.Methods:The study was carried out prospectively in the Department of Gynecology of the Third Xiangya Hospital of Central South University, China. Sixty patients with a confirmed diagnosis of previous cesarean scar defect and associated symptoms of prolonged menstrual bleeding and (or) dysmenorrhea were enrolled into the study. The anatomic features of the uterus and the scar were noted intraoperatively before the resection was carried out. All sixty patients underwent hysteroscopic resection of the cesarean scar tissue. Six months after the hysteroscopic resection, each patient was contacted to inquire about the above mentioned symptoms; that is dysmenorrhea and prolonged menstrual bleeding. The patients were then followed up for one year to confirm the presence or absence of the symptoms.Results:1) At the end of the one year follow-up, dysmenorrhea was absent in58out of the60patients representing96.67%of the cases. However before the hysteroscopic resection,6out of the60patients had dysmenorrhea. The analysis gave p<0.05implying that hysteroscopy resection is effective in alleviating dysmenorrheal.2) The duration of menstrual flow for all60cases was7.33±1.71days at the end of the one year follow-up as compared to the duration of13.15±3.82days before the hysteroscopic resection. The reduction in the duration of menstrual flow is statistically remarkable, implying that hysteroscopic resection is effective in reducing the prolonged menstrual flow associated with PCSD.3) Fifty five percent of the cases had retroflexed uteri and the remaining45%had anteflexed uteri. Before the hysteroscopic resection, the duration of menstrual flow in the retroflexed uteri was12.21±3.516days and that of anteflexed uteri was14.30±3.921days (p<0.05). This showed that anteflexed uteri had a longer duration of menstrual flow. In the follow-up results, the group with the anteflexed uteri had an duration of menstrual flow of7.22±1.739days whilst that in the group with the retroflexed uteri was7.42±1.714days, implying that there is no remarkable difference in duration of menstrual flow in both retroflexed and anteflexed uteri after hysteroscopicresection(p>0.05). Subtracting the duration of menstrual flow before and after hysteroscopic resection in both anteflexed and retroflexed uteri, the difference in that of retroflexed uteri before and after was4.79±3.008days and that of anteflexed uteri was7.07±3.485days (p<0.05). Statistically, an anteflexed uterus has a better efficacy than a retroflexed uterus. Four patients had dysmenorrhea before the hysteroscopic resection. After the hysteroscopic resection, there were2cases of dysmenorrhea in those with retroflexed uteri whilst there was no reported case of dysmenorrhea in the group with anteflexed uteri. This implies that an anteflexed uterus has a better outcome for dysmenorrhea than a retroflexed uterus.4) The duration of menstrual flow before the resection in level I scar was12.56±3.537days, level II scar was13.65±4.029days and level III scar was16.00±5.657days (p>0.05). The duration of menstrual flow after the resection in patients who had level I scar was7.28±1.782days, level II scar was7.46±1.655days and level III scar was6.50±2.121days (p>0.05). The difference in duration of menstrual flow with respect to level of scar (subtracting the duration after resection from the duration before resection) was as follows:level I scar-5.28±2.738days, level Ⅱ scar-6.19±3.742days and level Ⅲ scar-9.50±7.778days. The result of Kruskal-Wallis H Analysis, p>0.05. Statistically, there was no association between the level of the scar and the duration of menstrual flow both before and after the hysteroscopic resection.5) Thirty eight patients had a history of one previous C/S and the duration of their menstrual flow before hysteroscopic resection was12.53±3.415days. After the hysteroscopic resection, these patients had a duration of menstrual flow of7.05±1.69days. Twenty two had a history of two previous C/S and these had a mean duration of menstrual flow of14.23±4.298days. After the hysteroscopic resection, they had a flow of7.82±1.68days. The difference in duration of menstrual flow (subtracting the duration after hysteroscopic resection from the duration before) for those with one previous C/S was5.47±3.375days and for those with two previous C/S, the duration was6.41±3.446days. With a p>0.05, there was no association between the number cesarean deliveries and duration of menstrual flow both before and after hysteroscopic resection.Conclusion:1) Previous cesarean scar defect is associated mainly with symptoms such as abnormal uterine bleeding and dysmenorrhea.2) It is evident that hysteroscopic resection which is a minimally invasive procedure is effective in alleviating the symptoms associated with PCSD.3) It is also evident that there is a correlation between uterine position and the clinical symptoms associated with PCSD in that anteflexed uteri generally have a better outcome than retroflexed uteri after hysteroscopic resection.4) There is no association between the number of cesarean deliveries and the duration of menstrual flow both before and after the hysteroscopic resection in PCSD. |
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