title: Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect.
abstract: OBJECTIVE
  Research suggests that the resectoscopic management of abnormal uterine bleeding (AUB) following cesarean section (CS) is safe and effective. There is, however, a lack of complementary data from routine clinical practice. We aimed to evaluate the efficacy of resectoscopic remodeling of the CS scar in the management of post CS AUB (pCSAUB).
  
  
  METHODS
  The case notes of 57 women with pCSAUB who had undergone a resectoscopic remodeling procedure were reviewed retrospectively. Primary outcome measures were the duration of preoperative and postoperative menstruation, and postoperative menstrual change. Secondary outcome measures were the impact of patient-dependent variables on the success of the resectoscopic remodeling procedure. The CS scar was located using transvaginal ultrasonography and hysteroscopy. The remodeling procedure was performed with a hysteroscopic resectoscope, and commenced with resection of the fibromuscular scar. This started at the roof of the scar pouch and progressed towards the external os. It then continued along a line parallel to the axis of the cervical canal. The exposed dilated blood vessels and endometrial-like tissue in the roof of the remaining pouch were electrocauterized with a roller-ball electrode.
  
  
  RESULTS
  The mean operating time was 30.2 ± 6.6 min. There was a significant difference in the mean duration of preoperative and postoperative menstruation (12.9 ± 2.9 days and 9.4 ± 4.1 days, respectively; p < 0.001). However, only 59.6% of patients (34/57) reported a postoperative improvement in symptoms. A significant postoperative improvement was observed more frequently in patients with anteflexed uteri than in patients with retroflexed uteri, and this difference was significant (90.6% (29/32) and 20.0% (5/25), respectively; p < 0.001). No correlations were found between treatment outcome and age, body weight, parity, number of cesarean deliveries, duration of preoperative menstruation, or operating time.
  
  
  CONCLUSIONS
  Resectoscopic uterine remodeling is an appropriate therapy in patients with pCSAUB and an anteflexed uterus.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan. wang2260@gmail.com
authors.forename: Chin-Jung
authors.initials: CJ
authors.lastname: Wang
authors.forename: Huei-Jean
authors.initials: HJ
authors.lastname: Huang
authors.forename: Angel
authors.initials: A
authors.lastname: Chao
authors.forename: Yu-Pin
authors.initials: YP
authors.lastname: Lin
authors.forename: Yi-Jung
authors.initials: YJ
authors.lastname: Pan
authors.forename: Shang-Gwo
authors.initials: SG
authors.lastname: Horng
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications* / Q000473:pathology / Q000601:surgery; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008598:Menstruation; D008599:Menstruation Disturbances / Q000601:surgery; D008875:Middle Aged; D011184:Postoperative Period; D011247:Pregnancy; D016896:Treatment Outcome; D014463:Ultrasonography; D014591:Uterine Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D014599:Uterus / Q000601:surgery