Is hysteroscopy a good option to manage severe caesarean scar defect

Abstract Study objective To compare outcomes of hysteroscopic management in both women with severe or non-severe symptomatic defect (residual myometrium equal or less than 3mm versus more than 3mm). Design Retrospective cohort study Setting Gynaecologic department of a teaching hospital Patients 71 women with an operative hysteroscopy for symptomatic defect (49 with severe defects and 22 with non-severe ones) Interventions Operative hysteroscopy for caesarean scar defect in women with a severe defect (residual myometrium equal or less than 3mm) and with non-severe defect (residual myometrium more than 3mm). Measurements The main objective was to compare success rates between the two groups. Secondary objectives were the comparison of the number of women who required more than one procedure, of the rate of complications, of the number of subsequent pregnancies and of the evolution of residual myometrium thickness between groups. Main results The success rates were not significantly different between groups (73.5% in the severe group and 63.6% in the non-severe group (p=0.40). The number of women requiring more than one procedure was also similar as well as the rate of complications and the mean increase of myometrium thickness. The rate of subsequent pregnancies in infertile women was significantly higher in women with a severe defect (p=0.04). Conclusion The hysteroscopic approach seems to be a good way to manage caesarean scar defects even when residual myometrium is thin. A prospective study is however necessary to confirm these findings