[UTERINE SCAR DEFECT IN WOMEN AFTER CESAREAN SECTION - ULTRASOUND AND HYSTEROSCOPIC DIAGNOSI.]

The aim of our study was to determine the frequency of defect scar in women with clinical complaints after Cesarean section (CS) diagnosed by transvaginal ultrasonography and diagnostic hysteroscopy as well as to determine the degree of match between the data obtained by the two methods.

The study was retrospective and was conducted in the Department of General Oncology and Gynecology, MMA for the period from 2014 to 2016 years. Included are 25 non-pregnant premenopausal women aged 29 to 45 years with clinical symptoms. The main inclusion criteria were delivery by CS, overt clinical gynecological symptoms and positive imaging findings of a defect in the scar. The main gynecological symptoms are: postmenstrual and breakthrough bleeding, dysmenorrhea, dispaureny and idiopathic pain over the symphysis. Imaging studies were performed using two-dimensional transvaginal sonography and diagnostic hysteroscopy. The data are processed by Social statistic STAT 10. We used Chi square statistic test 12.5 (Pearson). Data were compared to two independent groups. Results were statistically significant at values of p<0. 05.

The most common symptom in women included in the study was a post-menstrual bleeding - 22 (88 %). In 15 (60 %) of them we found out ultrasound signs of a defect in uterine scar (p =0, 00407). In 10 (40%) of those patients by diagnostic hysteroscopy we found defective scar (p=0, 000004). There has been no significant difference between the two methods in terms of accuracy of diagnosis (isthmocele) (p=0.1572) although the hysteroscopy there was a statistically higher one.

With increasing frequency of cesarean section (CS) increases and frequency of early and late complications of this surgery. Irregular uterine bleeding in women after CS and a lack of other organic causes are the result of a defect in uterine scar. First choice for the diagnosis of this type of pathology is ultrasonography examination followed by diagnostic hysteroscopy. It is conducting further studies on the etiology of this complication.