Laparoscopic repair of caesarean scar defect (CSD): does it improve the fertility outcome?

ABSTRACT

Objective. The rising rate of caesarean sections has been linked to potential complications that could impact subsequent pregnancies, including caesarean scar defects (CSDs). Subfertility is a common issue among women diagnosed with CSD. Various theories have been proposed to explain the connection between CSDs and secondary infertility. Several interventions have shown promise in enhancing fertility outcomes following caesarean sections, potentially reducing the reliance on assisted reproductive technology (ART) interventions. This study aimed to investigate the impact of laparoscopic repair of CSDs on fertility results.

Materials and Methods. The retrospective cohort study was conducted at the infertility and endoscopy unit at Zagazig University Hospitals between June 2020 and February 2023. All patients enrolled in the study reported subfertility and underwent transvaginal ultrasound (TVUS) with saline infusion sonography (SHG) before the laparoscopic repair procedure. Following the imaging assessments, laparoscopic repair of CSDs was performed within a few days. Subsequently, all patients were followed up for at least 24 months.

Results. In this study, twenty cases were included. Post-menstrual spotting was observed in eighteen cases (90%), while continuous bleeding occurred in two cases (10%). Among the cases, fourteen patients (70%) achieved spontaneous pregnancy within 24 months. Out of these, two patients (14.28%) experienced a miscarriage, one patient (7.14%) had an ectopic pregnancy, one patient (7.14%) delivered prematurely at 32 weeks, and ten patients (71.43%) had a term delivery.

Conclusions. Laparoscopic repair of CSDs may be a promising intervention for women with secondary infertility, leading to enhanced chances of achieving pregnancy.