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© 2003 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 22:695-700 • 0278-4297

The Cesarean Delivery Scar Pouch

Clinical Implications and Diagnostic Correlation Between Transvaginal Sonography and Hysteroscopy

Cecilia Fabres, MD, Guillermo Aviles, MD, Carlos De La Jara, MD, Juan Escalona, MD, Jorge Felipe Muñoz, MD, Antonio Mackenna, MD, Carlos Fernández, MD, Fernando Zegers-Hochschild, MD and Emilio Fernández, MD

Units of Reproductive Medicine (C.F., J.E., J.F.M., A.M., C.F., F.Z.-H., E.F.) and Perinatal Medicine (G.A., C.D.L.J.), Department of Obstetrics and Gynecology, Clínica Las Condes, Santiago, Chile.

Address correspondence to Cecilia Fabres, MD, Department of Obstetrics and Gynecology, Clínica Las Condes, Lo Fontecilla 441, Santiago, Chile; e-mail: umrdocencia{at}clinicalascondes.cl.

Objective. We sought (1) to describe an anatomic defect of the uterine cavity in the anterior isthmus diagnosed by transvaginal sonography in a group of premenopausal women with previous cesarean deliveries, (2) to establish whether there is an association between the presence of the pouch and a bleeding disturbance, and (3) to compare the diagnostic efficacy of transvaginal sonography versus hysteroscopy for the detection of this defect. Methods. We performed a retrospective study of 92 premenopausal women with histories of at least 1 cesarean delivery. Age, number of previous cesarean deliveries, time elapsed between last cesarean delivery and first consultation, and total area of the pouch were recorded in groups of women with and without abnormal bleeding. Hysteroscopy was also performed in 43.8% of the patients who had abnormal bleeding. Results. In all women, transvaginal sonography revealed the presence of a pouch on the anterior uterine segment at the site of the expected previous cesarean delivery scar. Hysteroscopy showed 100% correlation with transvaginal sonography in detection of this pouch. Conclusions. The high correlation between bleeding disturbances and the presence of a pouch, in the absence of other pathologic entities, suggests this anatomic defect as the possible cause, especially in view of the fact that women who had heavier and longer bleeding episodes tended to have a larger pouch. Transvaginal sonography is a very simple, noninvasive, low-cost examination that should be considered as the first choice for screening, because it highly correlates (100%) with hysteroscopy in the diagnosis of this defect and may help rule out other causes.

Key Words: abnormal bleeding • cesarean delivery scar • metrorrhagia • spotting

Abbreviations: PCDS, previous cesarean delivery scar




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[Abstract] [Full Text] [PDF]


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