Publication:

Caesarean scar defect: a histopathological comparative study

Background We have evaluated the validity of this syndrome in Indian patients and analysed the gynaecological indications for hysterectomy in women with history of caesarean sections. We have studied pathological changes in the scar area and compared the findings with matched cases without previous caesarean scar.

Methods A prospective observational case control study was done at tertiary care hospital (Seth GS Medical College and King Edward Memorial Hospital) over two years (December 2018 to December 2020) with universal sampling and enrolled all consenting eligible patients. After hysterectomy histopathological study of the specimens was done. Total cases: 16 hysterectomy samples with history of previous caesarean section. Total controls: 40 hysterectomy samples with history of no previous caesarean section. The difference between the two proportions was analysed using Chi square or Fisher exact test. All analysis was 2 tailed and the significance level was set at 0.05.

Results Women with history of previous caesarean scar had gynaecological symptoms related to the caesarean scar defect such as abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain, post-menopausal bleeding and the most frequent clinical symptom related to the scar defect was abnormal uterine bleeding. The clinical symptoms were found to be associated with histopathological changes at scar site.

Conclusions This study compared caesarean cases and no caesarean controls and sheds light on the role of histopathology in detection of caesarean scar site changes. It helped in comparison of various factors affected due to the presence of caesarean scar and its long-term complications, leading to hysterectomy.