Caesarean section greatly increases risk of scar endometriosis
Abstract
Objective To estimate the incidence of scar endometriosis after different surgical procedures.Study design A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated.Results Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p<0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years.Conclusion Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis.
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The pathophysiology of cesarean scar endometriosis is iatrogenic implantation (implantation theory), where refluxed endometrial tissue from obstetrics and gynecological surgical manipulation is implanted on ectopic sites.
“The pathophysiology for its occurrence is iatrogenic implantation (implantation theory), where the refluxed endometrial tissue on obstetrics and gynecological surgical manipulation is implanted on the ectopic sites [2,4].”
From Scar Endometriosis: A Rare Cause of Abdominal Pain (2022) · cites this paper as [2]
Under proper hormonal influence, the endometrial tissue proliferates and leads to cesarean scar endometriosis.
“Under the proper hormonal influence, the endometrial tissue proliferates and leads to cesarean scar endometriosis [2,4,7,8,9,10,11,12].”
From Scar Endometriosis: A Rare Cause of Abdominal Pain (2022) · cites this paper as [2]
Nominato et al. analyzed 72 cases, and 66.6% had lesions in the abdominal wall, and 63.8% were found in the cesarean section in the surgical procedures.
“Nominato et al. analyzed 72 cases, and 66.6% had lesions in the abdominal wall, and 63.8% were found in the cesarean section in the surgical procedures [2].”
From Scar Endometriosis: A Rare Cause of Abdominal Pain (2022) · cites this paper as [2]
The incidence of abdominal wall endometriosis is rare, occurring in 0.03-3.5% of cases, with some studies reporting up to 12%.
“The incidence of abdominal wall endometriosis (AWE) is rare. The disorder occurs in 0.03–3.5% of cases, and some studies have reported a rate of up to 12%.”
From Evaluation of cases of abdominal wall endometriosis at Universidade Estadual de Campinas in a period of 10 Years (2017) · cites this paper as [12]
Abdominal wall endometriosis is associated with a history of obstetric or gynecologic procedures, although some cases occur spontaneously.
“It is associated with a history of obstetric or gynecologic procedures,2 12 although some cases occur spontaneously.16”
From Evaluation of cases of abdominal wall endometriosis at Universidade Estadual de Campinas in a period of 10 Years (2017) · cites this paper as [12]
Caesarean section greatly increases the risk of developing AWE due to direct implantation of endometrial tissue from the caesarean incision to the scar.
“Nominato et al., said that CS greatly increased the risk of developing AWE due to its pathophysiology where endometrial tissue from caesarean incision directly implanted to the scar.”
From Case report: Caesarean scar endometriosis – A rare entity (2021) · cites this paper as [8]
CSE may cause long-term discomfort involving cyclic lower abdominal pain.
“It is a rare disease, with a reported incidence of 0.03–0.45% CSE may cause long-term discomfort involving cyclic lower abdominal pain [7], [8], [9].”
From Case report: Caesarean scar endometriosis – A rare entity (2021) · cites this paper as [8]
CSE has a reported incidence of 0.03-0.45%.
“It is a rare disease, with a reported incidence of 0.03–0.45% CSE may cause long-term discomfort involving cyclic lower abdominal pain [7], [8], [9].”
From Case report: Caesarean scar endometriosis – A rare entity (2021) · cites this paper as [8]
Scar endometriosis predominantly occurs at the cesarean scar, followed by uterine surgery scar and laparoscopic port site.
“It predominantly occurs at the cesarean scar, followed by uterine surgery scar, and at the laparoscopic port site.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [18]
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References 29 · Cited by 116
- Authors
- Nominato, N. S., Prates, L. F. V. S., Lauar, I., Morais, J., Maia, L., & Geber, S.
- Affiliations
- Universidade Federal de Minas Gerais (BR)
- Corresponding author
- Geber, Selmo
- ORCID
- Geber, Selmo
- Venue
- European Journal of Obstetrics & Gynecology and Reproductive Biology
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 152
- Issue
- 1
- Pages
- 83-85
- ISSN
- 0028-2243 (ISSN-L)
- 0301-2115
- OpenAlex
- W2012693910
- Semantic Scholar
- ee92e868c337ab5927b82387d58e259387e4aeeb
- Cited by
- 116
- References
- 29
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 8 · 2023: 8 · 2022: 10 · 2021: 17 · 2020: 7 · 2019: 7 · 2018: 7 · 2017: 13 · 2016: 6 · 2015: 3 · 2014: 8 · 2013: 4 · 2012: 5
- FWCI
- 3.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Obstetrics & Gynecology and Reproductive Biology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- scar endometriosis, cesarean section, episiotomy, surgical incision, risk factors, hysterectomy, abdominal surgery, pelvic floor surgery, endometriosis recurrence, postoperative pain
- MeSH terms
- Adolescent, Adult, Cesarean Section, Cicatrix, Endometriosis, Episiotomy, Female, Humans, Hysterectomy, Middle Aged, Pregnancy, Retrospective Studies, Incidence, Young Adult
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