腹腔鏡下子宮瘢痕部修復術後の妊娠予後についての考察

抄録

　We report on the treatment progress and pregnancy outcomes of two cases of infertility due to cesarean scar disorder, treated with laparoscopic uterine scar repair.

Case 1: A 40-year-old woman, after delivering her first child via emergency cesarean section due to arrested labor, repeatedly underwent embryo transfers in her desire for a second child, but failed to conceive. Following imaging examinations, she was diagnosed with infertility caused by cesarean scar disorder. Following laparoscopic uterine scar repair, she was permitted to conceive six months after the surgery. Subsequent embryo transfer led to pregnancy, which unfortunately resulted in premature delivery at 24 weeks.

Case 2: A 35-year-old woman, whose first child was born by emergency cesarean section due to early placental abruption, conceived and delivered her second child via cesarean section. Despite her desire for a third child, she did not conceive for about 30 months. We diagnosed and treated her for infertility caused by cesarean scar disorder, similarly to Case 1. Post-treatment, she spontaneously conceived and gave birth by planned cesarean section at 38 weeks. When compared with Case 2, the uterine scar in Case 1 was located on the caudal side, and the postoperative cervix in Case 1 was shortened.

Conclusion: We hypothesize that in Case 1 the extensive resection of the uterine scar might have induced a condition akin to cervical incompetence. Therefore, we emphasize the crucial importance of ensuring that the resection area during the repair procedure is as minimal as possible.