Reevaluating the variation of cesarean scar defect

Area of Science:

• Reproductive Medicine and Surgery
• Gynecologic Pathology
• Obstetric Complications

Background:

• Rising cesarean section rates correlate with increased prevalence of cesarean scar defects (CSDs).
• CSDs present with diverse morphologies, including myometrial defects and cystic protrusions.
• Pathophysiology and clinical manifestations of CSDs require further elucidation.

Purpose of the Study:

• To review the pathogenesis and histopathological features of cesarean scar defects (CSDs).
• To emphasize the clinical diversity and morphological characteristics of CSDs.
• To identify challenges and directions for future research in CSDs.

Main Methods:

• A comprehensive narrative review of literature was performed.
• Searches were conducted in PubMed and Google Scholar databases.
• 41 relevant articles published up to December 31, 2023, were included.

Main Results:

• Myometrial defects in CSDs involve disruptions in the inner and outer myometrial layers.
• Symptomatic CSDs may be associated with uterine scar endometriosis, cystic adenomyosis, or endometrial cysts.
• CSDs requiring surgery may involve iatrogenic endometriosis or adenomyosis, worsening symptoms.

Conclusions:

• This review offers an updated perspective on CSD histopathology and classification.
• Emphasis is placed on understanding the underlying pathogenesis of cesarean scar defects.
• Further research is needed to fully comprehend CSDs and their clinical implications.