title: The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy.
abstract: OBJECTIVE
  We sought (1) to describe an anatomic defect of the uterine cavity in the anterior isthmus diagnosed by transvaginal sonography in a group of premenopausal women with previous cesarean deliveries, (2) to establish whether there is an association between the presence of the pouch and a bleeding disturbance, and (3) to compare the diagnostic efficacy of transvaginal sonography versus hysteroscopy for the detection of this defect.
  
  
  METHODS
  We performed a retrospective study of 92 premenopausal women with histories of at least 1 cesarean delivery. Age, number of previous cesarean deliveries, time elapsed between last cesarean delivery and first consultation, and total area of the pouch were recorded in groups of women with and without abnormal bleeding. Hysteroscopy was also performed in 43.8% of the patients who had abnormal bleeding.
  
  
  RESULTS
  In all women, transvaginal sonography revealed the presence of a pouch on the anterior uterine segment at the site of the expected previous cesarean delivery scar. Hysteroscopy showed 100% correlation with transvaginal sonography in detection of this pouch.
  
  
  CONCLUSIONS
  The high correlation between bleeding disturbances and the presence of a pouch, in the absence of other pathologic entities, suggests this anatomic defect as the possible cause, especially in view of the fact that women who had heavier and longer bleeding episodes tended to have a larger pouch. Transvaginal sonography is a very simple, noninvasive, low-cost examination that should be considered as the first choice for screening, because it highly correlates (100%) with hysteroscopy in the diagnosis of this defect and may help rule out other causes.
authors.affiliation: Unit of Reproductive Medicine, Department of Obstetrics and Gynecology, Clínica Las Condes, Santiago, Chile. umrdocencia@clinicalascondes.cl
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fabres
authors.forename: Guillermo
authors.initials: G
authors.lastname: Aviles
authors.forename: Carlos
authors.initials: C
authors.lastname: De La Jara
authors.forename: Juan
authors.initials: J
authors.lastname: Escalona
authors.forename: Jorge Felipe
authors.initials: JF
authors.lastname: Muñoz
authors.forename: Antonio
authors.initials: A
authors.lastname: Mackenna
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández
authors.forename: Fernando
authors.initials: F
authors.lastname: Zegers-Hochschild
authors.forename: Emilio
authors.initials: E
authors.lastname: Fernández
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000209:etiology; D019160:Endosonography; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*