The effect of surgery on subsequent pregnancy outcomes among patients with cesarean scar diverticulum

Abstract

Objective: To determine whether surgical treatment of cesarean scar diverticulum (CSD) reduced adverse outcomes during the subsequent pregnancy.

Methods: A retrospective observational study was conducted using the medical records of pregnant women with CSD who attended a single hospital in Hangzhou, China, between January 1, 2014, and December 31, 2016. Baseline characteristics and pregnancy outcomes were compared between the surgery group and the no surgery group.

Results: There were 106 patients included in the study, 83 in the surgery group and 23 in the no surgery group. The CSD size was greater in all dimensions for the surgery group versus the no surgery group: length (P<0.001), width (P=0.001), and depth (P=0.030). The remaining myometrium was thinner among women in the surgery group than those in the no surgery group (P=0.011). In all, 76 (91.6%) women in the surgery group were symptomatic. The incidence of live delivery pregnancy was higher (P=0.033) and the incidence of cesarean scar pregnancy was lower (P=0.019) in the surgery group versus the no surgery group. Surgery increased the thickness of the lower uterine segment (P<0.001); however, it did not reduce the risks of placenta previa or placenta accreta (P=0.683) and uterine dehiscence or uterine rupture (P=0.458).

Conclusion: Surgical intervention reduced the incidence of cesarean scar pregnancy and increased the number of live deliveries.

Keywords: Cesarean scar diverticulum; Placenta accreta; Placenta previa; Pregnancy outcome; Surgery; Uterine Rupture; Uterine dehiscence.