Cesarean section defect had been found to be one of the causes of prolonged bleeding in women with previous cesarean delivery. Lin’s hysteroscopy (TCR)-metroplasty method had focused on 4 predisposed anatomical defects, which ensured correction of the cesarean section defect. With this simple procedure, the patients had greatly improved their quality of life, as well as discomfort.
Problem: protracted bleeding
Some women find that after undergoing a cesarean section delivery, menstruation is prolonged so much that quality of life is diminished. Recent studies indicate that one possible cause of extended periods after cesarean delivery is a scar defect. Certain distinct clinical scenarios have been noted. Usually, the patient reports that, after a second cesarean delivery, she menstruates for twice as long as she had been before giving birth. Her periods occur regularly, and the normal amount of blood is discharged, but spotting occurs for up to 2 weeks.
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Our solution
The cause of prolonged bleeding can be identified easily with sonography or hysteroscopy. Sonograms display a triangular anechoic filling defect; hysteroscopy shows the uterine anterior wall defect at the isthmus, just below the internal os.
A simple and effective procedure can solve the anatomic problem and greatly improve the patient’s quality of life. In our institution, we correct the defect using Lin’s method of hysteroplasty, which is hysteroscopic transcervical resection; the results are generally good ( Figure ). The technique focuses on the 4 anatomic points that predispose these patients to prolonged bleeding: (1) granulation over the anatomic internal orifice, (2) fibrotic tissue at the proximal side of the diverticulum, (3) small hollows or depressions in the diverticulum of the scar defect, and (4) other regions of the defect. Blood can adhere to these sites and form clots, so corrections are needed if an optimal resolution is to be provided.
