Transvaginal Ultrasonographic Assessment of Post-Cesarean Section Scar Defects

Objective: To evaluate post cesarean section scars by transvaginal ultrasonography (TVS) and analyze its relationship to menstrual disturbances. Study Design: Cross sectional study. Settings: Kasr El-Aini Obstetrics and Gynecology Department, Ultrasound Unit. Patients: 60 non-pregnant women with regular cycles and a history of one or more cesarean sections at least 6 months from last cesarean section. Methods: Cesarean section scars were examined by TVS for the presence of defects and measuring thickness of residual myometrium. Menstrual irregularities were investigated with history and vaginal examination to detect cause of bleeding, if present. Results: Scar defects were found in 29 patients (48.3%). The mean thickness of residual myometrium was 0.69 ±0.13 cm. The mean size of CS defect in the 29 women was 0.36±0.16 cm. Eight patients (13.3%) had postmenstrual vaginal spotting, which was significantly associated with the presence of CS scar defects (p=0.002). Conclusion: TVS is highly accurate in detecting CS scar defects. Defects are seen in nearly half of the patients and were significantly associated with thin residual myometrium and higher frequency of postmenstrual spotting.