Isthmocele

Isthmocele is a defect of the anterior wall of the uterus that occurs at the site of the uterine incision after a caesarean section.

How often does isthmocele occur?

Isthmocele occurs in 20-80% of women, depending on studies and diagnostic techniques.

How is istmocele diagnosed?

Isthmocele is diagnosed by ultrasound examination with a vaginal probe, magnetic resonance imaging and hysterosalpingography (HSG) as a triangular defect of the anterior uterine wall. The thickness of the uterine wall in the region of the isthmocele is less than 5 mm.

What are the risk factors?

Risk factors for isthmocele are:

• retroflexed (retroverted uterus);
• age of the woman;
• a low incision site on the uterus;
• improper surgical technique.

What are the symptoms of isthmocele?

Symptoms of isthmocele can be prolonged menstrual bleeding (can last up to 10 days) and pain during menstruation and sexual intercourse.

Is isthmocele a risk factor for secondary infertility?

Isthmocele is a possible risk factor for secondary infertility, since there is retention of menstrual blood in the uterus and possible inflammatory reactions. Some studies have shown that women who have had a cesarean section have a 10% lower chance of having another pregnancy, and that the second pregnancy is 2-6 months longer than women who have not had a cesarean section.

Is the isthmocele a risk factor for rupture of the uterus in the next pregnancy?

Thinned uterine wall < 2.5-4.5 mm in the area of the cesarean scar is a risk factor for uterine rupture.

When is the surgical correction of isthmocele performed?

Surgical correction of isthmocele-scar from caesarean section is done when there is prolonged bleeding and when it is estimated that the thin wall is a risk for the next pregnancy.

How is the surgical correction of isthmocele performed?

Surgical correction of isthmocele can be performed as follows:

• hysteroscopic;
• vaginal in combination with hysteroscopy;
• laparoscopic;
• through an open incision on the abdomen.

In the MIlenković Clinic , vaginal/hysteroscopic access is most often performed .

Does surgical correction of istmocele give an increased risk in the next pregnancy?

Surgical correction of isthmocele reduces the risk of uterine rupture during pregnancy. There are no studies that show an increased risk in the next pregnancy.

Vaginal birth is possible after isthmocele surgery.