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. 2012 Jun;29(6):465-71.
doi: 10.1055/s-0032-1304829. Epub 2012 Mar 7.

Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect

Stéphanie Roberge  1 , Amélie Boutin, Nils Chaillet, Lynne Moore, Nicole Jastrow, Suzanne Demers, Emmanuel Bujold
Affiliations

Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect

Stéphanie Roberge et al. Am J Perinatol. 2012 Jun.

Abstract

Objective: To review the ability of imaging techniques to predict incomplete healing of uterine cesarean scars before the next pregnancy.

Study design: A systematic literature review searched for studies on women who underwent previous low-transverse cesarean, evaluated by hysterography, sonohysterography (SHG), or transvaginal ultrasound (TVU). The median prevalence of scar defects was computed with 95% confidence intervals (95% CIs). Odds ratio (OR, 95% CI) identified risk factors of incomplete healing.

Results: The analysis included 21 studies. The proportions of suspected scar defects detected by hysterography, SGH, and TVU were 58% (33 to 70), 59% (58 to 85), and 37% (20 to 65), respectively. Two studies found that women with a large uterine scar defect had a higher risk of uterine rupture or uterine scar dehiscence than those with no scar defect or small scar defect (OR: 26.05 [2.36 to 287.61], p <0.001). The only reported risk factor for scar defect was the occurrence of more than one previous cesarean (OR: 2.24 [1.13, 4.45], p = 0.02).

Conclusion: Hysterography, SGH, and TVU can detect uterine scar defects in ~50% of women with previous cesarean.

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