Cesarean scar defects

Abstract

With a rising rate of cesarean delivery around the world, complications related to uterine scarring are expected to increase. Cesarean scar defects (CSDs) are an often underrecognized cause of abnormal uterine bleeding, pelvic pain, and secondary infertility. However, no consensus exists in regard to diagnosis and optimal timing of surgical interventions aimed at repairing these iatrogenic defects. Herein we explore the prevalence and risk factors associated with the development of CSDs and discuss modalities for diagnosing and providing further characterization of CSDs. We discuss symptomatology and recognition of CSD with focus on contribution to secondary infertility. In addition to reviewing implications for future fertility, we discuss options for medical management of symptomatic CSDs. Finally, surgical management across three main modalities including hysteroscopic, laparoscopic, and vaginal revision of CSDs is described.