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Cesarean Section Scar Repair

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Did you know that almost one third of babies in the United States are born by c-section? While c-sections can be wonderful aids to a healthy-mom-healthy-baby delivery, they can pose some issues postpartum if someone develops a cesarean scar defect.

A c-section scar defect is also called an "isthmocele" or a "uterine niche". This defect presents as a pocket in the inner lower segment of the uterus where the incision on the uterus was during c-section. Of course, not all women will have issues from said defect, but a niche can cause inflammation, bothersome bleeding/spotting, and/or fertility issues.

How can we diagnose a cesarean scar defect?

 

In general, a defect is diagnosed by ultrasound. I evaluate the inner cavity of the uterus with a saline-infused sonogram (SIS) which fills the uterus with fluid while we do an ultrasound in order to see the defect. I can then measure its dimensions.

At times, these defects will require repair which can be done hysteroscopically or laparoscopically. The approach depends on the size and depth of the defect as well as future fertility goals.

Here you can see the defect hysteroscopically (camera inside the uterus) which helps me to pinpoint it laparoscopically (inside the abdomen) and fully resect and repair it!

Creighton Model charting can show signs of a uterine niche which is another great reason to chart and track your cycles!!

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