Isthmocele: From Risk Factors to Management

Abstract

Objective The aim of the present study was to perform a comprehensive review of the literature to provide a complete and clear picture of isthmocele-a hypoechoic area within the myometrium at the site of the uterine scar of a previous cesarean section-by exploring in depth every aspect of this condition. Methods A comprehensive review of the literature was performed to identify the most relevant studies about this topic. Results Every aspect of isthmocele has been studied and described: pathophysiology, clinical symptoms, classification, and diagnosis. Its treatment, both medical and surgical, has also been reported according to the actual literature data. Conclusion Cesarean section is the most common surgical procedure performed worldwide, and one of the consequences of this technique is isthmocele. A single and systematic classification of isthmocele is needed to improve its diagnosis and management. Further studies should be performed to better understand its pathogenesis. Palavras-chave ResumoObjetivo O objetivo do presente estudo foi realizar uma revisão abrangente da literatura a fim de fornecer um quadro completo e claro da istmocele-uma área hipoecoica dentro do miométrio no local da cicatriz uterina de uma cesariana anterioraprofundando todos os aspectos desta condição Métodos Uma revisão abrangente da literatura foi realizada para identificar os estudos mais relevantes sobre este tema. Resultados Todos os aspectos da istmocele foram estudados e descritos: fisiopatologia, sintomas clínicos, classificação e diagnóstico. Os tratamentos médico e cirúrgico também foram relatados de acordo com os dados reais da literatura. Conclusão A cesárea é o procedimento cirúrgico mais comum realizado em todo o mundo, e uma das consequências desta técnica é a istmocele. Uma classificação única e sistemática da istmocele é necessária para melhorar seu diagnóstico e manejo. Novos estudos devem ser realizados para melhor entender sua patogênese.ORCID ID is https://orcid.org/0000-0001-9485-0126.

Is Hysteroscopy a Good Option to Manage Severe Cesarean Scar Defect?

“…The main strength of this study is the reporting of the results of hysteroscopic management of severe cesarean scar defect. The threshold to define a severe defect has, however, been arrived at arbitrarily and varies among authors, even if most of them used a threshold of more than 3-mm [1,7,9,10,22,27].…”

“…A cesarean scar defect can lead to abnormal uterine bleeding, pelvic pain, and secondary infertility [1].…”

Outcomes after hysteroscopic repair of symptomatic isthmocele: a single center experience in Ukraine

“…The cause of pain and AUB in case of IC is seen in the limited ability of the uterus to contract in the scar area, as well as to the presence of a pocket-like defect in the myometrium where menstrual blood and thick mucus are accumulated. Abnormal scar tissue vascularization, dilatation and fragility of capillaries, lymphocytic infiltration of the scar, peritoneal tissue and endometrium, as a manifestation of chronic endometritis are also considered by different authors [15,16]. The role of endometrial polyps and adenomyosis as well as other uterine and endometrial pathology in the development of IC, its symptoms severity effectiveness of its surgical treatment is not studied.…”

Retained Products of Conception Sequestered in an Isthmocele

“…2 The defect can be asymptomatic or present with abnormal bleeding, pelvic pain, and secondary infertility. 3 Consent to publish these images was obtained from the patient.…”