1514 Impact of Hysteroscopic Surgical Management of Cesarean Scar Syndrome on Pregnancy Rate: A Prospective Observational Study

Study Objective To evaluate fertility outcomes following hysteroscopic treatment of ishmoceles women with cesarean scar syndrome. Design Prospective observational study. Setting Academic department in a university hospital. Patients or Participants A series of 36 patient who had undergone hysteroscopic surgery for secondary infertility due to defects with retention of bloody fluid in the uterine cavity between July 2014 and Dec 2018. Interventions In the first step, the inferior edge of the isthmocele was resected using a cutting loop electrode. Next, the bottom of the isthmocele containing the dendritic vessels was cauterized using a ball electrode. Measurements and Main Results After a mean follow up of 12.5 months the overall pregnancy rate was 44.4% (n=16). Fifteen of those patients delivered healthy babies by cesarean section at 37-38 weeks of gestation, and 1 case was an early abortion. Among those patients who conceived, 5 patients conceived spontaneously and 11 patients by assisted reproductive techniques. The mean thickness of the myometrium and volume of isthmocele significantly increased from 2.85 ± 1.8 mm and 2138 ± 1960 mm3before surgery to 4.73 ± 2.4 mm and 1183 ± 1383 mm3after surgery(p=0.014, and p Conclusion Hysteroscopic treatment with cesarean scar defect was effective in improving the fertility. Therefore, we propose that hysteroscopic surgery might be applied as first line treatment in secondary infertility women with cesarean scar defect.