Hysteroscopic transcervical resection
A straightforward method corrects bleeding
related to cesarean section scar defects
Chao Lan Shih, MD; Yin Yi Chang, MD; Ming Ho, MD; Wu Chou Lin, MD; Anne Mei-Hung Wang, MD; Wu Chou Lin, MD
Problem: protracted bleeding
Some women find that after undergoing
a cesarean section delivery, menstrua-
tion is prolonged so much that quality of
life is diminished. Recent studies indi-
cate that one possible cause of extended
periods after cesarean delivery is a scar
defect. Certain distinct clinical scenarios
have been noted. Usually, the patient re-
ports that, after a second cesarean deliv-
ery, she menstruates for twice as long as
she had been before giving birth. Her pe-
riods occur regularly, and the normal
amount of blood is discharged, but spot-
ting occurs for up to 2 weeks.
Our solution
The cause of prolonged bleeding can be
identified easily with sonography or
hysteroscopy. Sonograms display a tri-
angular anechoic filling defect; hyster-
oscopy shows the uterine anterior wall
defect at the isthmus, just below the in-
ternal 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 us-
ing 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 diver-
ticulum, (3) small hollows or depres-
sions in the diverticulum of the scar de-
fect, and (4) other regions of the defect.
Blood can adhere to these sites and form
From the Department of Obstetrics and
Gynecology, China Medical University
Hospital, Taichung (Drs Shih, Chang, Ho,
Wang, and Lin), China Medical University
School of Medicine, Taichung (Drs Shih,
Chang, and Ho), China Medical University
School of Chinese Medicine, Taichung (Dr
Lin) and Kaohsiung Medical University,
Kaohsiung (Dr Wang), Taiwan.
0002-9378/$36.00
© 2011 Mosby, Inc. All rights reserved.
doi: 10.1016/j.ajog.2010.11.031
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FIGURE
Before and after Lin’s transcervical resection. Upper left, before correction; upper right, after
correction; bottom sections, a, Cave in scar defect; b, excision line; c, internal orifice of cervix; d,
external orifice of cervix; e, before excision; f, after excision.
Shih. Hysteroscopic transcervical resection. Am J Obstet Gynecol 2011.
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 ce-
sarean section defect. With this simple procedure, the patients had greatly improved their
quality of life, as well as discomfort.
Key words: cesarean section defect, hysteroscopy-metroplasty, prolonged bleeding,
TCR-metroplasty
Cite this article as: Shih CL, Chang YY, Ho M, et al. Hysteroscopic transcervical resection: straight-
forward method corrects bleeding related to cesarean section scar defects. Am J Obstet Gynecol
2011;204:278.e1-2.
Surgeon’s Corner
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278.e1
American Journal of Obstetrics & Gynecology MARCH 2011