帝王切開瘢痕症候群の子宮鏡併用腹腔鏡下修復術後に双胎を自然妊娠し、正期産まで管理できた１例

抄録

　The increasing rates of cesarean section are accompanied by a corresponding increase in the complications associated with the operation, including cesarean scar syndrome (CSS). CSS refers to a clinical presentation of abnormal genital bleeding, pelvic pain, and/or infertility in a woman with cesarean-induced isthmocele. CSS is associated with the risk of serious complications such as uterine rupture and preterm delivery; however, CSS is not widely known.

　Case: A 29-year-old woman with a history of cesarean delivery presented with secondary infertility in addition to abnormal uterine bleeding after cesarean section.

　We diagnosed the patient with CSS based on transvaginal ultrasonography and magnetic resonance imaging, which revealed cesarean-induced isthmocele with scar thickness of 2 mm.

　She underwent hysteroscopy assisted laparoscopic repair for CSS and conceived spontaneously during the first cycle of our permission to get pregnant, 6 months postoperatively. The patient was at a high risk of uterine rupture and preterm delivery of a monochorionic diamniotic twin pregnancy.

　Eventually, she underwent elective cesarean section and delivered two healthy female neonates (birth weight 2500 g and 2735 g) at 38 weeks' gestation.