Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women Olivier Donnez, M.D., Ph.D., Jacques.

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Presentation transcript:

Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women Olivier Donnez, M.D., Ph.D., Jacques Donnez, M.D., Ph.D., Renan Orellana, Ph.D., Marie-Madeleine Dolmans, M.D., Ph.D. Fertility and Sterility Volume 107, Issue 1, Pages 289-296.e2 (January 2017) DOI: 10.1016/j.fertnstert.2016.09.033 Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Sagittal view of a frozen section from a hysterectomy specimen. A deep anterior defect covered with a thin layer of myometrium (white circle) can be observed at the level of the supposed site of CS. Fertility and Sterility 2017 107, 289-296.e2DOI: (10.1016/j.fertnstert.2016.09.033) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 2 (A) Preoperative sagittal view of a T2-weighted image shows the residual myometrium (RM; white arrow) measuring 1.6 mm, covering a deep cesarean scar defect. (B) Preoperative transversal view of a T2-weighted image from the same patient. The RM covering the scar (white arrow) is very thin. (C) Sagittal view of a T1-weighted image with saturation of fatty tissue showing hypersignals (white arrows) inside the cesarean scar defect, suggestive of blood retention. (D) Sagittal view of a T2-weighted image after laparoscopic repair. The defect is no longer visible, and the RM at the level of the isthmus (white arrow) measures 10 mm. Fertility and Sterility 2017 107, 289-296.e2DOI: (10.1016/j.fertnstert.2016.09.033) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Figure 3 (A) Actin immunostaining in a hysterectomy specimen. The muscular density of the myometrium covering the cesarean scar (green bracket) is similar to adjacent healthy myometrium (red bracket). (B) Actin immunostaining in an excised cesarean scar defect. The muscular density of myometrium covering the cesarean scar (green bracket) is significantly decreased compared with adjacent healthy myometrium (red bracket). (C) Microscopic appearance of a cesarean scar defect (hematoxylin-eosin staining). Endometriotic glands (green triangle) can be seen in the myometrium covering the scar. Fertility and Sterility 2017 107, 289-296.e2DOI: (10.1016/j.fertnstert.2016.09.033) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 1 (A) Laparoscopic view of the cesarean scar defect with a probe inserted into the cervix. The residual myometrium (RM) covering the scar measures 0.8 mm. (B) Laparoscopic view of the anterior wall after resection of fibrotic tissue and the cesarean scar defect. (C) Laparoscopic view of the first layer of suture before the knots are tightened. (D) Final laparoscopic view after covering the double-layer suture with a bladder flap. Fertility and Sterility 2017 107, 289-296.e2DOI: (10.1016/j.fertnstert.2016.09.033) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 2 Muscular density was measured in residual myometrium covering the scar and adjacent healthy myometrium from a laparoscopically repaired cesarean scar defect (A) and a hysterectomy specimen with a cesarean scar but no defect (B). ∗∗∗P < .0001; ∗P < .2786. Fertility and Sterility 2017 107, 289-296.e2DOI: (10.1016/j.fertnstert.2016.09.033) Copyright © 2016 American Society for Reproductive Medicine Terms and Conditions