In our daily work, we often encounter mothers who have had cesarean sections complaining, “After giving birth, my menstrual periods are so long, and I always have bleeding. I don’t have many clean days in a month, it’s so annoying!”
Usually, we conduct a series of examinations to rule out the causes of bleeding, such as cervical cancer screening, vaginal ultrasound, hormone tests, etc. However, we may not be able to find the specific cause. In this case, we need to pay attention to the condition of the uterine scar after cesarean section, because the “culprit” might be it – a uterine scar diverticulum.
What is a Cesarean Scar Diverticulum?
A Cesarean Scar Diverticulum (CSD), also known as a Previous Cesarean Scar Defect (PCSD), refers to the poor healing of the uterine incision after a cesarean section, leading to thinning of the myometrium at the uterine scar and forming a concave or cavity communicating with the uterine cavity.
As shown in the figure, it is like an additional “rest room” that has been chiseled out in the large flat layer of the uterus.
How is a Cesarean Scar Diverticulum diagnosed?
Physicians need to make a comprehensive judgment based on medical history, symptoms, and imaging examinations. The diagnostic criteria include:
1
A history of one or more cesarean section surgeries.
2
Having
prolonged menstruation and excluding other gynecological diseases, as well as other symptoms such as
chronic pelvic pain.
3
Imaging or
hysteroscopy examination reveals the presence of a diverticulum.
How is a Cesarean Scar Diverticulum treated?
Due to the prolonged menstruation, which is really annoying, it troubles many patients a lot.
“Can it be cured?”
“Is surgery necessary?”
These may be the two most troubling questions for everyone, so what is the truth?
The answer is, it can be cured, and surgery is not necessarily required. The usual treatment methods are divided into two categories: drug therapy and surgical treatment.
01
Pharmacological Treatment
1
Oral contraceptives, mainly suitable for patients with abnormal uterine bleeding as the main manifestation, who currently have no desire for childbirth, and are unwilling to undergo surgery for short-term treatment. It is recommended to use for 3 cycles. However, this method can only improve symptoms and has no effect on the healing of the diverticulum, and recurrence may occur after discontinuation;
2
Levonorgestrel intrauterine system (Mirena IUD), the efficacy of which still needs to be confirmed by large-sample studies. However, the advantage is that it is long-acting, safe, painless, and can also be used for contraception.
02
Surgical Treatment
For patients who have been diagnosed with a cesarean scar diverticulum and have clinical symptoms that affect the quality of life and have a strong desire for surgery, surgical treatment can be considered.
The current surgical methods are mainly minimally invasive, including:
hysteroscopy, laparoscopy, and vaginal surgery.
Can I get pregnant after finding a uterine diverticulum?
The answer is: Yes, you can.
Although it is possible to get pregnant again, it is not without concerns. The following precautions should be taken:
01 Pre-pregnancy
Before pregnancy, consult a
professional gynecologist for assessment to understand the location, size of the scar, and the thickness of the uterine muscle layer.
02
Early Pregnancy
During early pregnancy, an
ultrasound examination should be conducted. If a cesarean scar pregnancy is detected, the pregnancy should be terminated as soon as possible.
03 Pregnancy
During pregnancy, close monitoring of maternal and fetal conditions is necessary, paying attention to the relationship between the placenta and the uterine scar diverticulum, as well as the thickness of the uterine muscle layer. If there are signs of uterine rupture, timely treatment should be given.
It is currently believed that a uterine scar diverticulum is not an absolute contraindication for vaginal delivery, but most scholars believe that cesarean section should be chosen as the mode of delivery for such patients.
Summary
A Cesarean Scar Diverticulum is a common complication after a cesarean section, and most people are asymptomatic. The most common symptom is abnormal vaginal bleeding, which is not much of a health hazard but affects the quality of life. We need to correctly understand it, adjust our mindset, and accept its existence. If the symptoms are very obvious and have interfered with life, drug conservative treatment or surgical treatment can be taken to improve.
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