ParentsAugust 13, 2018

Caesarean scar defects and fertility: what you need to know


Experts have told the Spinoff that there is sufficient evidence about cases in which c-section can lead to infertility that women should be given more information. Catherine Woulfe addresses the key questions.

Read Catherine Woulfe’s investigation into the connection between c-section scar defects and fertility here.

I’ve had a c-section (or I’m about to) and now I’m freaking out. 

Remember not all scars develop defects, and most defects don’t cause any problems.

Unless you are:

  •  spotting or bleeding between periods, or
  •  experiencing chronic pelvic pain, pain during sex or really painful periods, or
  •  you have infertility that is not explained by other factors …  try not to worry about it.

OK but I’m pregnant and in the story you talk about defects rupturing during pregnancy?

This is a tricky one. Some experts think women who are pregnant after a c-section should routinely have an ultrasound to check the scar. A very thin uterine wall could mean you’re not a good candidate for vaginal birth. On the other hand, scanning every pregnant woman who’s had a c-section would cause a lot of anxiety (and cost a bomb). The best we can advise is to talk it over with your lead maternity carer.

I do have weird bleeding, pain or unexplained infertility!

You need to see a specialist who is familiar with caesarean scar defect. (Don’t expect your GP to know about the condition. It’s really not on the radar, even for some obstetricians, gynaecologists, or fertility specialists). They should try to rule out the many other conditions that could cause these symptoms.

How will they diagnose me?

If your specialist suspects a defect they should do a transvaginal ultrasound in the week after your period. Sometimes fluid (saline) is injected through the cervix to better demarcate and diagnose the defect (this technique is called SIS, or saline-infusion sonogram). Defects are much easier to spot when they’re filled with fluid. An MRI is also used on occasion.

And then?

If you want it, surgery! Defects are usually fixed laporoscopically, meaning a few tiny cuts on the tum and a very quick recovery. I was out of hospital after one night and off painkillers in three or four days.  It can also be repaired hysteroscopically (through the cervix). More research is likely to come out in the coming years unpicking which option is best.

For most women, surgery will resolve the bleeding and pain, and restore fertility. (You will likely be cleared to try naturally or continue with fertility treatment a few months after surgery).

Who pays?

That’s a bit unclear. We paid about $11,500 to have my operation done privately because time is a real pressure for us: our doctors said we could likely have it done through the public system but we were all really twitchy about the wait. We have made an ACC claim for treatment injury.

I have unexplained infertility, and the usual ultrasounds haven’t discovered a defect, but I really think I might have one.

You might. Specialists have to know what they’re looking for, ultrasounds have to be done at the right time – and even then defects can be devilishly hard to spot. They don’t always cause bleeding or pain, either. So do ask to get your scar specifically checked. And good luck.

How did I not know this was a thing?

Hardly anyone knows it’s a thing. There’s no grand conspiracy. It’s just really hard to get gold-standard evidence on this condition, and for surgery – unlike medicines or medical devices – there’s no mandated reporting mechanism or database to keep track of problems. Basically it’s only come to light because doctors all over the world are writing about the women they’re treating. The last three years has seen a boom in the medical literature so hopefully we’re close to formal guidelines for diagnosis and treatment.

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Mad Chapman, Editor
Aotearoa continues to adapt to a new reality and The Spinoff is right there, sorting fact from fiction to bring you the latest updates and biggest stories. Help us continue this coverage, and so much more, by supporting The Spinoff Members.Madeleine Chapman, EditorJoin Members

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