title: Prospective evaluation of five methods used to treat cesarean scar defects.
abstract: OBJECTIVE
  To evaluate operative and nonoperative therapies for cesarean scar defects (CSDs).
  
  
  METHODS
  A prospective study was conducted among patients who underwent treatment of CSDs at a hospital in Shanghai, China, between April 1, 2010, and December 31, 2014. Treatment included laparoscopy (group 1), vaginal surgery (group 2), hysteroscopy (group 3), combined oral contraceptives (group 4), and the levonorgestrel intrauterine system (group 5).
  
  
  RESULTS
  Among 142 participants, 119 patients underwent surgical repair and 23 received nonsurgical (conservative) treatment. Operation time, blood loss, and length of hospital stay reported for patients in group 3 (n=19) were all lower than those reported for patients in group 1 (n=86) and group 2 (n=14; P<0.001 for all comparisons). Patients who underwent surgery and those in group 4 (n=18) experienced shortened menstrual periods after treatment (P<0.001 for all comparisons). For group 5 (n=5), the duration of menstruation was similar before and after therapy (P=0.89). All 32 women who desired fertility underwent laparoscopy; 12 (37.5%) became pregnant after this procedure.
  
  
  CONCLUSIONS
  All treatments for CSDs other than the levonorgestrel intrauterine system shortened menstrual periods. Laparoscopic surgery was effective for patients with fertility requirements.
authors.affiliation: Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Xuyin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Mengyi
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Pudong New Area, Shanghai, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China; Department of Obstetrics and Gynecology, First People's Hospital of Xiaoshan Area, Hangzhou, China.
authors.forename: Jianliang
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Jingxin
authors.initials: J
authors.lastname: Ding
authors.affiliation: Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Electronic address: huakeqinjiaoshou@163.com.
authors.forename: Keqin
authors.initials: K
authors.lastname: Hua
mesh_terms: D000328:Adult; D002585:Cesarean Section; D002681:China; D002921:Cicatrix / Q000473:pathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D015907:Hysteroscopy; D007902:Length of Stay; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery*
keywords: Cesarean scar defect; Combined oral contraceptives; Hysteroscopy; Laparoscopy; Levonorgestrel intrauterine system; Vaginal surgery