Approach and treatment of old cesarean section wound seroma

Seroma of old cesarean section is a common condition nowadays, causing mothers to face many health problems such as menorrhagia, metrorrhagia, infection... even leading to the risk of secondary infertility. In order to update professional knowledge on this issue and at the same time provide valuable discussions from the perspective of experts, the professional activity program of MEDLATEC Healthcare System week 40 with the topic "Approach and treatment of seroma of old cesarean section" was successfully organized.

MEDLATEC Healthcare System's professional activities program week 40 was chaired by Associate Professor, Dr. Nguyen Quoc Dung - Vice Chairman of the Science, Technology and Training Council; Professional Director of MEDLATEC Imaging Diagnostic Center. In addition, the program also had the presence of Associate Professor, Dr. Dang Thi Minh Nguyet - Obstetrics and Gynecology Expert, MEDLATEC Healthcare System, Deputy Head of Obstetrics and Gynecology Department - Hanoi Medical University; Deputy Head of Endocrinology Department - Central Obstetrics and Gynecology Hospital, along with a team of experienced reporters and a large number of doctors and nurses from the entire system attending.

Suggestive signs and examination process of old cesarean section wound seroma

Opening the program, BSCKI. Nguyen Thi Thuy Linh - Obstetrics and Gynecology, MEDLATEC General Hospital presented an overview report on a real clinical case that was successfully treated at the unit.

In the past year, after her menstrual cycle ended, Ms. TTQ (31 years old, Ha Tinh ) often had brown discharge lasting about a week. After giving birth to her first child in 2018, she and her husband also wanted a child for a year.

For those reasons, Ms. Q. went to MEDLATEC General Hospital for examination. After taking the patient's and family's medical history, the doctor found no abnormalities. Ms. Q. was assigned to perform the necessary paraclinical techniques for diagnosis.

The ultrasound image shows that the old cesarean section wound has fluid measuring 7.4 x 6.8mm. The transvaginal ultrasound detects a fluid cavity measuring 17 x 6mm in the waist area, with a remaining muscle layer of 2.5mm. Based on that, the doctor concluded that the patient had a previous cesarean section wound and was advised to treat it with a hysteroscopy to repair the scar.

Ultrasound image shows old cesarean section scar with fluid measuring 7.4 x 6.8mm

Based on the presentation of information about the clinical case, BSCKI. Nguyen Thuy Linh emphasized the information that needs to be noted in the process of diagnosing and treating this condition to all attending physicians.

From A to Z information about cesarean section scar

Next, MSc. Dr. Ha Ngoc Manh - Deputy Director - Head of Andrology Department, Vietnam - Belgium Andrology and Infertility Hospital presented the second report with the topic "Open cesarean section scar - diagnosis and treatment".

MSc. Dr. Ha Ngoc Manh presented a report on the topic "Open cesarean section scar - diagnosis and treatment"

Within the framework of the report, valuable general knowledge on this issue has been clarified by experts, including:

1/ Definition:

Cesarean scar insufficiency is defined as:

• Secondary cavities appear after cesarean section, located in the anterior wall of the uterine isthmus;
• The fluid may be menstrual fluid, or chronic inflammatory exudate;
• Formed by abnormal scar healing process;
• The structure is a cavity, the inner surface of the cavity is covered by mucosa.

2/ Classification:

Based on the volume of the scar cavity, cesarean scar dehiscence is classified as follows:

• Grade 1: Less than 15mm cubic;
• Grade 2: 16 – 25mm cubic;
• Grade 3: Over 25mm cubic.

3/ Complications:

• Secondary infertility;
• During pregnancy;
• Pregnancy at the incision;
• Placenta accreta at the surgical site;
• Placenta previa;
• young vegetables
• Uterine rupture;
• Postmenstrual bleeding;
• Menstrual cramps, pelvic pain, pain during sex;
• Uterine bladder fistula.  

4/ Diagnosis:

Clinically, open surgical scars are recognized through the following signs:

• Abnormal uterine bleeding;
• Brown or black bleeding a few days after menstruation;
• Pelvic pain/dysmenorrhea;
• Secondary infertility.

For paraclinical purposes, imaging techniques have important applications in the diagnosis of open surgical scars, including:

• Supersonic;
• Ultrasonic water pump;
• Hysterosalpingography;
• Magnetic resonance imaging (MRI).

Imaging methods have important applications in diagnosing open surgical scars.

In particular, experts emphasize that the indicators that need to be measured on ultrasound/magnetic resonance include:

• Depth of scar cavity;
• Length of scar cavity;
• Remaining myometrium;
• Adjacent myometrium;
• Endometrial thickness and endometrial fluid layer;
• Width of scar cavity.

5/ Treatment:

Treatment is individualized for each patient. Accordingly, the clinician will take a medical history, conduct an examination and prescribe the necessary paraclinical techniques. Based on the diagnostic results, a suitable treatment regimen will be prescribed, bringing high efficiency and in accordance with the patient's wishes.

Common methods include:

– Internal medicine: Oral contraceptives (applicable to patients who do not want to have children).

– Surgical treatment:

• Laparoscopic surgery;
• Vaginal surgery;
• Hysteroscopy

Among the presented methods, Master, Doctor Ha Ngoc Manh emphasized that hysteroscopy is considered the first choice in treatment with the advantages of simplicity and effectiveness.

In the spirit of serious and urgent work, the professional activity program at MEDLATEC Healthcare System with the theme "Approaching and treating old cesarean section wound fluid retention" ended successfully.

The program took place enthusiastically with exchanges and discussions, thereby helping the medical team acquire useful knowledge and effectively apply it in practical medical examination and treatment.

On the journey to fulfill the mission of community health care, MEDLATEC constantly strives to improve professional capacity, pioneering the application of advanced techniques of world medicine to further improve the quality of diagnosis and treatment to serve the people.

With the advantage of gathering a team of experts, leading doctors and a system of advanced and modern equipment, MEDLATEC Healthcare System meets the need for accurate diagnosis of old surgical scar opening, thereby orienting appropriate treatment regimens, bringing maximum effectiveness to patients.

For in-depth consultation or to schedule a medical examination, please contact hotline 1900 56 56 56, available 24/7.

Source: https://medlatec.vn/tin-tuc/tiep-can-va-xu-tri-benh-ly-u-dich-vet-mo-de-cu