Pregnancy outcomes in women with cesarean section scar defects and secondary infertility after vaginal repair: a multicenter observational cohort analysis

TL;DR

This study shows that vaginal repair surgery for cesarean section scar defects improves pregnancy outcomes in women with secondary infertility.

Contribution

The study provides new evidence on how vaginal repair affects fertility and pregnancy success in women with cesarean section scar defects.

Findings

44.04% of women with CSD desiring fertility achieved pregnancy after vaginal repair.

75.43% of pregnancies resulted in live births with no uterine ruptures.

Women who conceived naturally had better post-surgery healing and thicker myometrium.

Abstract

Secondary infertility following cesarean section is associated with the presence of cesarean section scar defects (CSD). Vaginal repair (VR) is an effective reconstructive surgery for excising CSD, with previous evidence confirming its ability to alleviate menstrual symptoms. To study the pregnancy outcomes of CSD women after VR, we conducted an observational cohort study and analyzed the relationship between clinical characteristics and pregnancy outcomes.

495 women desiring fertility among 1,085 women with CSD who underwent VR was enrolled between June 2014 and December 2021 in Xinhua Hospital and Shanghai First Maternity & Infant Hospital. All participants had undergone VR and were followed up postoperatively to document menstrual patterns and assess CSD imaging parameters. Additionally, patients’ intentions to conceive post-surgery were recorded, together with follow-up data on pregnancy outcomes.

In 495 CSD women desiring fertility, 44.04% achieved subsequent pregnancies following VR. The outcomes included a live birth rate of 75.43%, a miscarriage rate of 18.10%, and no instances of uterine rupture. 58.87% of CSD patients with prior secondary infertility achieved pregnancy. Patients with prior secondary infertility who achieved pregnancy exhibited a higher proportion of optimal healing postoperatively compared to those without pregnancy. Among pregnant women with prior infertility, 78.31% conceived naturally, while 21.69% resorted to in vitro fertilization (IVF). Notably, a higher percentage of the spontaneously pregnancy (SP) group experienced a menstrual duration of less than 7 days and demonstrated the residual myometrium thickness (TRM) exceeding 5.39 mm post-VR.

VR surgery might improve fertility and increase IVF efficacy in CSD patients with secondary infertility. Reaching optimal healing after VR may increase the probability of successful pregnancy and natural conception.

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