Association of caesarean scar defects in abnormal uterine bleeding: A clinical study

Abstract

Background: The increasing global rate of Caesarean section (CS) deliveries has coincided with a rise in Caesarean Scar Defect (CSD) also known as Isthmocele, which is emerging as a significant cause of Abnormal Uterine Bleeding (AUB). Despite their clinical relevance, Caesarean Scar Defects remain underdiagnosed. Objective: To determine the Association of Caesarean Scar Defects (CSD) among women presenting with Abnormal Uterine Bleeding (AUB) with a prior history of Caesarean Section. Methods: A Prospective Observational study was conducted at GITAM Institute of Medical Sciences and Research, Visakhapatnam, from February 2025 to August 2025 involving 189 women aged 18-45 years presenting with Abnormal Uterine Bleeding (AUB) with ?1 prior Caesarean Section. Clinical evaluation and Transvaginal sonography (TVS) were performed to detect Caesarean Scar Defects. Results: Among 189 women, 8 (4.2%) were diagnosed with Caesarean Scar Defects on Transvaginal sonography (TVS). In the present study women with two or more caesarean deliveries exhibited a substantially higher CSD association (12.2%) compared to those with a single caesarean section (1.4%). Postmenstrual bleeding (PMB) was observed in 20.5% of women without a CSD and in 50% of those with CSD. No association was found with the Age, Parity, Interval since last Caesarean Section (CS). Conclusion: Caesarean Scar Defects association among Abnormal Uterine Bleeding (AUB) cases with prior Caesarean Section (CS) was 4.2%. Integration of routine Transvaginal sonography (TVS) evaluation in women with Abnormal Uterine Bleeding (AUB) and previous Caesarean Section (CS) delivery may support early diagnosis and management.