Appearance of Uterine Scar Due to Previous

Cesarean Section on Hysterosalpingography :

Various Shapes, Location and Size
Firoozeh Ahmadi , Leila Torbati, Farnaz Akhbari , Gholam Shahrzad
Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute
for Reproductive Biomedicine, ACECR, Tehran, Iran

Iran J Radiol. 2013;10(2):103-10

Dibacakan oleh:
dr. Mirana Dian Krisanti

Pembimbing:
dr. Tri Wulanhandarini, Sp.Rad (K)
 ABSTRACT
Cesarean
HSG This Study
section

assessment of demonstrate the

The most commonly
infertility and appearance of
performed surgical
evaluation of anatomic defects of
procedure involving
abnormalities of the the uterine cavity on
the uterus in fertile
uterus and fallopian HSG after cesarian
women
tubes section

Different shapes
Various changes Different locations
to differentiate them from
Differential diagnoses
normal variations and other
pathologies mimicking it
 1. INTRODUCTION
HSG Procedure :

• Must be performed under strict sterile conditions

• During the proliferative phase, after cessation of menstruation and before
ovulation, between days 7 and 11,
• The patient is placed on a radiographic table in a lithotomy position
• Insertion of the speculum
• The cervix is grasped with a tenaculum at 12 o’clock and brought forward
to straighten the uterus
• A Jarco cannula is used to instill the contrast media (Visipaque 320mg/ml)
into the cervix
• All air bubbles should be removed from the cannula before injection
• Under fluoroscopic monitoring, at least four images are obtained
routinely, each time by instillation of 2-3 ml of contrast media
HSG Procedure Hysterosalpingogram
 HSG IN CESAREAN SECTION

- not routinely used for

evaluation of a scar
- should be postponed to
three months after

Evaluation of the cesarean scar is performed

to choose the technique of future delivery
and prevention of uterine rupture and in
cases of abnormal bleeding after delivery
 2. Locations of uterine scar in patients with
cesarean section history
1. Uterine body 3. Uterine isthmus
(scar in this section is rare)
2. Lower uterine cavity 4. Upper endocervical canal
1. Uterine body 2. Lower uterine cavity
3. Uterine isthmus 4. Upper endocervical canal
3. Shapes of uterine scar in patients with cesarean
section history
1. Thin linear defect
2. Wedge-shaped defect (triangular)
3. Focal saccular outpouching
4. Pseudodiverticula [unilateral or bilateral (dog-ear like)
5. Overhanging defect
6. Hanging or anchoring defect showing a narrowed region above
the scar recess
7. Irregularity and narrowing
8. Atypical insertion in scar recess
9. Fistula to other organs such as the urinary bladder or free soft
tissue fistula
10. Multiple cesarean scar defects
 2. Wedge-shaped defect
1. Thin linear defect
(triangular)
3. Focal saccular outpouching
4. Pseudodiverticula [unilateral or bilateral
(dog-ear like)]
 5. Overhanging defect

shows a congested endometrium above the scar recess and

results from prominence of the superior aspect of the defect and
narrowing of its lower border
6. Hanging or anchoring defect 7. Irregularity and narrowing
showing a narrowed region
above the scar recess
8. Atypical insertion in scar recess 9. Multiple cesarean scar defects
10. Fistula to other organs such as the urinary
bladder or free soft tissue fistula
4. Differential Diagnoses of Cesarean Scar Defect

1. Prominent cervical glands

2. Nabothian cyst
3. Post myomectomy diverticulum
4. Post curettage diverticulum
5. Congenital cervical diverticula
6. Focal adenomyosis
7. Tuberculosis
1. Prominent cervical glands 2. Nabothian cyst
4. Post curettage 5. Congenital cervical
diverticulum diverticula
6. Focal adenomyosis 7. Tuberculosis
 CONCLUSSION

- The reader will be capable of explaining the

method and indication of HSG
- HSG in cesarian section is not routinely used for
evaluation of a scar
- Awareness of the appearance and locations of
uterine defects due to previous cesarean section
is necessary  differentiate them from normal
variations and other pathologies mimicking it
THANK YOU