title: Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect.
abstract: OBJECTIVE
  To review the ability of imaging techniques to predict incomplete healing of uterine cesarean scars before the next pregnancy.
  
  
  METHODS
  A systematic literature review searched for studies on women who underwent previous low-transverse cesarean, evaluated by hysterography, sonohysterography (SHG), or transvaginal ultrasound (TVU). The median prevalence of scar defects was computed with 95% confidence intervals (95% CIs). Odds ratio (OR, 95% CI) identified risk factors of incomplete healing.
  
  
  RESULTS
  The analysis included 21 studies. The proportions of suspected scar defects detected by hysterography, SGH, and TVU were 58% (33 to 70), 59% (58 to 85), and 37% (20 to 65), respectively. Two studies found that women with a large uterine scar defect had a higher risk of uterine rupture or uterine scar dehiscence than those with no scar defect or small scar defect (OR: 26.05 [2.36 to 287.61], p <0.001). The only reported risk factor for scar defect was the occurrence of more than one previous cesarean (OR: 2.24 [1.13, 4.45], p = 0.02).
  
  
  CONCLUSIONS
  Hysterography, SGH, and TVU can detect uterine scar defects in ~50% of women with previous cesarean.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Roberge
authors.forename: Amélie
authors.initials: A
authors.lastname: Boutin
authors.forename: Nils
authors.initials: N
authors.lastname: Chaillet
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: Nicole
authors.initials: N
authors.lastname: Jastrow
authors.forename: Suzanne
authors.initials: S
authors.lastname: Demers
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011859:Radiography; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D014463:Ultrasonography / Q000379:methods; D014597:Uterine Rupture / Q000209:etiology*; D014945:Wound Healing / Q000502:physiology*