Hysteroscopy in the Treatment of Myometrial Scar Defect (Diverticulum) Following Cesarean Section Delivery: A Systematic Review and Meta-Analysis

Abstract

Various management approaches have been developed to treat symptoms and prevent complications of the cesarean diverticulum. This systematic review aims to report the outcomes and fertility-related effects of hysteroscopy on women with myometrial scar defects after the cesarean section. Following the formulation of the patient/population, intervention, comparison, and outcomes (PICO) criteria, a systematic search was conducted on seven databases. Finally, a total of 18 studies were included for this systematic review and meta-analysis. All of the included patients suffered from post-cesarean section scars and presented with abnormal bleeding, pain, or secondary infertility. The overall pooled symptomatic improvement rate was 78.83% (95% CI: 72.46-85.76%); however, there was significant heterogeneity among the analyzed studies (I 2 =87%; p-value: <0.001) and a significant risk of bias (p-value: <0.001). The overall resolution/improvement rate after adjusting for possible bias was higher, 92.82% (95% CI: 85.17-100%). The overall pregnancy rate was 69.77% (95% CI: 59.03-82.48%), while in the individual studies the rates varied, ranging from 25% to 80%. Nevertheless, there was moderate heterogeneity among the included studies (I 2 =56%; p-value=0.011). In contrast, there was no significant risk of bias among the included studies (p-value=0.100). Furthermore, the meta-regression analyses did not show any significant effect of different follow-up durations on the overall effect size for both outcomes. In conclusion, there is still a need for highquality, comparative studies with larger sample sizes and long-term follow-up periods to draw firm conclusions. Moreover, future studies should consider the minimum myometrial thickness that is sufficient to complete a healthy pregnancy.

Effect of Low-Frequency Electric Pulse Technique Combined with Carboprost Methylate Suppositories on Recovery of Gastrointestinal Function and Postoperative Complications of Patients with Scarred Uterus Undergoing Secondary Cesarean Section

“…Compared with the control group, the patients in the experimental group had more desirable gastrointestinal function, which might be closely related to the application of low-frequency electric pulse technique. Such technique can act on the sacrococcygeal region of puerpera, accelerate the pelvic floor blood circulation, and enhance the local water absorption rate, so that pelvic floor muscle contraction ability is promoted and fascial tension is elevated, which can drive the movement of uterine ligaments of patients to accelerate their uterine involution [ 24 ]. C-section requires cutting the uterine muscle bundles and cutting off the intramural vessels, so the blood supply in patients is affected even after suturing.…”

The impact of Cesarean section on female fertility: a narrative review

“…Notably, only women who wanted to get pregnant and suffered from secondary infertility were included. Moreover, in addition to the fertility issue, there was an overall improvement rate of uterine scar defect symptoms (comprising pelvic pain and abnormal bleeding) of 78.83% (95% CI 72.46-85.76%) after a hysteroscopic treatment [30].…”

Novel microarchitecture of human endometrial glands: implications in endometrial regeneration and pathologies

“…The basalis glandular configuration differences may exist in different regions of the uterine cavity, which may alter the impact of operative surgery on endometrial basalis structure and function; this requires urgent investigation. Examination of the endometrial basalis glandular organization in the vicinity of the caesarean section scar may provide information on the pathogenesis of conditions associated with imperfect repair and regeneration of the uterine wall after caesarean scar, such as PAS conditions and the recently described caesarean section niche disorder ( Al Mutairi and Alrumaih, 2020 ).…”