Vaginal ultrasonographic and hysterosonographic evaluation of the low transverse incision after caesarean section: correlation with gynaecological symptoms.
OBJECTIVE
We investigated whether there is a correlation between morphological changes of the lower uterine segment after caesarean section (CS), visualized by means of either a transvaginal sonography (TVS) or a sonohysterography (SHG), and the frequency of abnormal uterine bleedings reported by the women.


METHODS
By means of a random selection of our population, anamnesis, medical records, and TVS and SHG images of the lower uterine segment were collected in 217 women (116 with previous CS and 101 with previous vaginal birth), and an observational case-control study was performed.


RESULTS
The uterine incision was identified in almost all women after CS (102/116) using TVS. It was observed that abnormal uterine bleeding was significantly more frequent in the CS group in comparison with the group of women who delivered vaginally. A correlation between the presence of abnormal uterine bleeding and the presence of significant sonographic findings in the lower uterine transverse incision in the women after CS was found. In the CS group, TVS findings were confirmed by those obtained by SHG, and, with this technique, a triangular anechoic area at the presumed site of incision (the niche) was identified in 69 of the 116 women (59.5%).


CONCLUSIONS
In this study, we found a correlation between abnormal uterine bleeding and sonographic findings in women after CS. This correlation appears to be more significant in women who had CS 5-10 years ago. A significant difference exists between the CS group and the group of women who delivered vaginally for both frequency of abnormal uterine bleeding and sonographic findings.
Department of Obstetrics and Gynaecology, University of Genova, San Martino Hospital, Genova, Italy.
Mario
M
Menada Valenzano
Davide
D
Lijoi
Emanuela
E
Mistrangelo
Sergio
S
Costantini
Nicola
N
Ragni
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000209:etiology; D019160:Endosonography; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D011247:Pregnancy; D014592:Uterine Hemorrhage / Q000209:etiology*; D014599:Uterus / Q000000981:diagnostic imaging / Q000473:pathology*; D014621:Vagina / Q000000981:diagnostic imaging*