Objective

To review the existing literature on uterine cesarean scar defect repair in pregnancy and describe an approach to minimally invasive surgical repair in early pregnancy to facilitate a term live birth.

Design

A case study and literature review, followed by a demonstration of the procedure with surgical video and concurrent ultrasound footage.

Setting

Academic medical center.

Patient(s)

This video is a case presentation of a 35-year-old, gravida 2, para 1 woman with a previous cesarean section. She presented at 10 weeks and 3 days gestational age with complete uterine dehiscence at the site of her previous cesarean section scar, which was diagnosed by ultrasound. Surgical video and medical images have been extracted from this patient’s chart after consent was obtained.

Intervention(s)

Ultrasound-guided laparoscopic repair of cesarean scar defect at 11 weeks and 3 days of gestation.

Main Outcome Measure(s)

The video showed a large 2.6-cm uterine scar defect in early pregnancy confirmed using ultrasound and magnetic resonance imaging. This diagnosis was confirmed by direct visualization at the time of surgery. This video demonstrates our surgical approach as follows: careful uterine manipulation and identification of the defect with laparoscopy and concurrent transvaginal ultrasound; reflection of the bladder using an ultrasound-guided approach to confirm the borders of the defect; and repair with a running 2-layer closure under transvaginal ultrasound guidance.

Result(s)

Through ultrasound-guided laparoscopic repair, we were able to demonstrate a restoration of approximately 8 mm of myometrial thickness across the cesarean scar defect on antenatal follow-up. The patient had a term live birth via cesarean section.

Conclusion(s)

With an increased number of cesarean sections and improved quality of ultrasound imaging, an increase in the incidental findings of cesarean scar defects has been observed. The risk of spontaneous prelabor uterine rupture remains unknown. There is a literature gap in this area regarding the appropriate standard of care. This video demonstrates that ultrasound-guided laparoscopic repair was possible, safe, and effective in our patient. However, further studies are required to establish the safety and efficacy of this approach.

中文翻译：

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子宫裂开：早期妊娠腹腔镜子宫修复术

客观的

回顾关于妊娠期子宫剖宫产瘢痕缺损修复的现有文献，并描述一种在妊娠早期进行微创手术修复以促进足月活产的方法。

设计

案例研究和文献综述，然后通过手术视频和同步超声镜头演示该过程。

环境

学术医疗中心。

病人）

该视频是一名 35 岁、妊娠 2、第 1 段妇女的案例介绍，该妇女之前曾接受过剖宫产手术。她在妊娠 10 周零 3 天时就诊，在之前剖宫产疤痕处出现子宫完全裂开，经超声诊断。在获得同意后，已从该患者的图表中提取手术视频和医学图像。

干预措施

妊娠 11 周零 3 天超声引导腹腔镜修复剖宫产瘢痕缺损。

主要观察指标）

视频显示，经超声和磁共振成像证实，早孕期有一个 2.6 厘米的大子宫疤痕缺损。该诊断通过手术时的直接可视化得到证实。该视频演示了我们的手术方法如下：通过腹腔镜检查和同步经阴道超声仔细操作子宫并识别缺陷；使用超声引导方法反射膀胱以确认缺损的边界；并在经阴道超声引导下进行连续 2 层闭合修复。

结果）

通过超声引导腹腔镜修复，我们能够在产前随访中证明横跨剖宫产疤痕缺损的子宫肌层厚度恢复了大约 8 毫米。患者通过剖腹产足月活产。

结论

随着剖宫产手术数量的增加和超声成像质量的提高，观察到剖宫产疤痕缺陷的偶然发现有所增加。自发性产前子宫破裂的风险仍然未知。关于适当的护理标准，该领域存在文献空白。该视频表明，超声引导的腹腔镜修复术对我们的患者是可行、安全且有效的。然而，需要进一步的研究来确定这种方法的安全性和有效性。