Conceptual Paper
Volume 9 Issue 9 - 2020
Uterine Isthmocele: Diagnosis and Management
Erasmo Huertas1* and Milagros Manrique2
1Chief of Perinatology at San Felipe Clinic and Associate Professor of Obstetrics and Gynecology at San Marcos National University, Jesus Maria, Lima, Lima, Peru
2General Practitioner at Villa Alejandro Health Centre, Lima, Peru
*Corresponding Author: Erasmo Huertas, Chief of Perinatology at San Felipe Clinic and Associate Professor of Obstetrics and Gynecology at San Marcos National University, Jesus Maria, Lima, Lima, Peru.
Received:March 23, 2020; Published: August 31, 2020




Keywords: Isthmocele; Cesarean Scar Defect; Niche; Uterine Diverticulum; Ultrasound

Definition

It is an anechoic area, generally triangular in shape, with the vertex directed towards the bladder and of different sizes, located at the level of the anterior wall of the isthmus or the uterine cervix and just in the area of the scar from a previous caesarean section [1,2] (Figure 1). Some authors consider that the depth of the defect must be at least 1 mm and indentation of the myometrium of at least 2 mm [24], but there are no clear criteria for diagnosing it.

References

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  2. Fabres C., et al. “The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy”. Journal of Ultrasound in Medicine 22 (2003): 695-700. 
  3. Gubbini G., et al. “Resectoscopic correction of the isthmocele in women with postmenstrual abnormal uterine bleeding and secondary infertility”. Journal of Minimally Invasive Gynecology 15 (2008): 172-175.
  4. Morris H. “Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms?” Journal of Minimally Invasive Gynecology 14.1 (1995): 16-20.
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  10. Monteagudo A., et al. “Saline infusión sonohysterography in nonpregnant women with previous cesarean delivery: the ‘‘niche’’ in the scar”. Journal of Ultrasound in Medicine 20 (2001): 1105-1115.
  11. Sasaki K. “Diagnosis and treatment of uterine isthmocele”. Obstetrics and Gynaecology News 50 (2015): 8-9.
  12. Osser OV., et al. “Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement”. Ultrasound in Obstetrics and Gynecology 35 (2010): 75-83.
  13. Tahara M., et al. “Preliminary report of treatment with oral contraceptive pills for intermenstrual vaginal bleeding secondary to a cesarean section scar”. Fertility and Sterility 86.2 (2): 477-479.
  14. Allornuvor GFN., et al. “The definition, aetiology, presentation, diagnosis and management of previous caesarean scar defects”. Journal of Obstetrics and Gynaecology 33.8 (2013): 759-763.
  15. Voet LF., et al. “Minimally invasive therapy for gynaecological symptoms related to a niche in the caesarean scar: a systematic review”. BJOG: An International Journal of Obstetrics and Gynaecology 121.2 (2014): 145-156.
  16. Fernandez E., et al. “Hysteroscopic correction of cesarean section scars in women with abnormal uterine bleeding”. Journal of the American Association Gynecologic Laparoscopists 3 (1996): S13.
  17. Wang CJ., et al. “Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect”. European Journal of Obstetrics, Gynecology, and Reproductive Biology 154 (2011): 218-222.
  18. Donnez O., et al. “Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section”. Fertility and Sterility 89 (2008): 974-980.
  19. Luo L., et al. “Vaginal repair of cesarean section scar diverticula”. Journal of Minimally Invasive Gynecology 19 (2012): 454-458.
  20. Lin YH., et al. “Endometrial ablation as a treatment for postmenstrual bleeding due to cesarean scar defect”. International Journal of Gynaecology and Obstetrics 111 (2010): 88-89.
  21. Erickson SS and Van Voorhis BJ. “Intermenstrual bleeding secondary to cesarean scar diverticuli: report of three cases”. Obstetrics and Gynecology 93 (1999): 802-805.
  22. Regnard C., et al. “Cesarean section scar evaluation by saline contrast sonohysterography”. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 23.3 (2004): 289-292.
  23. Gubbini G., et al. “Surgical Hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study”. Journal of Minimally Invasive Gynecology 18 (2011): 234-237.
  24. Tulandi Togas and Aviad Cohen. "Emerging manifestations of cesarean scar defect in reproductive-aged women”. Journal of Minimally Invasive Gynecology 23.6 (2016): 893-902.
Citation: Erasmo Huertas and Milagros Manrique. “Uterine Isthmocele: Diagnosis and Management”. EC Gynaecology 9.9 (2020): 69-75.

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