Clinical Value of Saline Infusion Sonohysterography in the Assessment of Cesarean Scar Defects

Background and Rationale:

The precise assessment of the structure of the cesarean section incision is the core of achieving "individualized surgery". Through multi-dimensional analysis of anatomical structure, functional status, and patient needs, one can precisely select hysteroscopy, laparoscopy, or combined surgical methods, significantly improving symptom relief rate, diverticulum closure rate, and reducing the risks of recurrence and pregnancy complications. However, preoperative precise diagnosis is the prerequisite for treatment. The SIS technology can obtain a good acoustic window through a simple uterine cavity water injection method, clearly displaying the structure of the cesarean section incision, enhancing the diagnostic confidence of ultrasound doctors, providing more detailed diagnoses for patients and clinicians, and is expected to replace diagnostic hysteroscopy operations. In the future, it is necessary to promote the standardization of assessment and technology transformation, ultimately achieving the leap from "treatment based on symptoms" to "precise repair" of CSD, improving the long-term prognosis of patients.

Study Design and Methodology:

This is a single-center, prospective, observational cohort study. The objective is to To explore the diagnostic value of the acoustic contrast imaging technique using normal saline for the uterine cavity in the assessment of the incision structure after cesarean section.

This study included patients who were scheduled for cesarean section for secondary infertility from January 2023 to July 2025 as the research subjects. General clinical data of the patients were collected, including age, history of cesarean section, gynecological history, time of secondary infertility, whether there was excessive menstrual bleeding or dysmenorrhea, etc.

Data Collection and Assessments:

This study included patients who were scheduled for cesarean section for secondary infertility from January 2023 to July 2025 as the research subjects. General clinical data of the patients were collected, including age, history of cesarean section, gynecological history, time of secondary infertility, whether there was excessive menstrual bleeding or dysmenorrhea, etc.The primary ultrasonographic parameters to be recorded include:

During TVUS, assess whether a diverticulum is present at the cesarean section incision site. If identified, measure its longitudinal diameter, transverse diameter, depth, residual myometrial thickness, and the distance from the lower margin of the diverticulum to the external cervical os, in accordance with international consensus guidelines. During SIS, evaluate the presence of a diverticulum. In cases where a diverticulum is detected, apply the conventional TVUS measurement protocol to quantify all relevant dimensions and assess for associated complications-including cysts or polyps-as well as overall uterine cavity morphology. Concurrently, collect MRI and hysteroscopy findings.

Follow-up and Endpoints:

Following surgical intervention, participants will undergo longitudinal follow-up, including documentation of the surgical approach, clinical symptom status at 6 months postoperatively, and pregnancy outcomes at 12 months postoperatively. Analyze the aggregated data to determine the clinical decision-making utility of SIS.