Isthmocele endometriosis: the relationship between cesarean section and endometriosis

Bar-El, Liron; Chu, Amanda; Goldstein, Karli Provost; Seckin, Serin; Seckin, Tamer

doi:10.1016/j.fertnstert.2022.02.024

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…With an incidence of 1:1800 to 1:2216 caesarean scar ectopic pregnancies are a rare event [23], however, one that carries a high risk of morbidity for the affected woman. A recent case report described the case of a woman with a history of 3 CS afflicted by symptomatic endometriosis that had developed within an isthmocele [24]. And Calzolari et al [25] reported on a subgroup of infertile patients where isthmoceles were identified as primary cause of infertility and additionally showed that isthmoplasty could restore fertility in 56% of cases.…”

Section: Clinical Implications and Relevancementioning

confidence: 99%

Frequency and associated symptoms of isthmoceles in women 6 months after caesarean section: a prospective cohort study

Gozzi

Hees

Berg

et al. 2022

Arch Gynecol Obstet

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Purpose The purpose of this study was to determine the frequency of detection of isthmoceles by ultrasound 6 months after caesarean section (CS) and which symptoms associated with isthmocele formation occur after CS. Subsequently, it was determined how often the ultrasound finding “isthmocele” coincided with the presence of complaints. Methods A prospective multicentre cohort study was conducted with 546 patients from four obstetric centres in Berlin, who gave birth by primary or secondary CS from October 2019 to June 2020. 461 participants were questioned on symptoms 3 months after CS; 329 participants were included in the final follow-up 6 months after CS. The presence of isthmoceles was determined by transvaginal sonography (TVS) 6 months after CS, while symptoms were identified by questionnaire. Results Of the 329 women, 146 (44.4%) displayed an isthmocele in the TVS. There was no statistically significant difference in the manifestation of symptoms between the two groups of women with and without isthmocele; however, when expressed on a scale from 1 to 10 the intensity of both scar pain and lower abdominal pain was significantly higher in the set of women that had shown to have developed an isthmocele (p = 0.014 and p = 0.031, respectively). Conclusion The prevalence of isthmoceles 6 months after CS was 44.4%. Additionally, scar pain and lower abdominal pain were more pronounced when an isthmocele was also observed in the TVS. Trial registration Trial registration number DRKS00024977. Date of registration 17.06.2021, retrospectively registered.

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Section: Clinical Implications and Relevancementioning

confidence: 99%

Frequency and associated symptoms of isthmoceles in women 6 months after caesarean section: a prospective cohort study

Gozzi

Hees

Berg

et al. 2022

Arch Gynecol Obstet

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“…It appears that during a cesarean section, endometrial cells may migrate to the site of the isthmocele. This dissemination of endometrial cells could be facilitated by the surgical trauma and inflammation associated with the cesarean procedure [23]. This weakening may create an environment that can promote the implantation and proliferation of extrauterine endometriotic tissue [24].…”

Section: Endometriosismentioning

confidence: 99%

Isthmocele and Infertility

Baldini,

Lot,

Malvasi

et al. 2024

JCM

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Isthmocele is a gynecological condition characterized by a disruption in the uterine scar, often associated with prior cesarean sections. This anatomical anomaly can be attributed to inadequate or insufficient healing of the uterine wall following a cesarean incision. It appears that isthmocele may impact a woman’s quality of life as well as her reproductive capacity. The incidence of isthmocele can range from 20% to 70% in women who have undergone a cesarean section. This review aims to sum up the current knowledge about the effect of isthmocele on fertility and the possible therapeutic strategies to achieve pregnancy. However, currently, there is not sufficiently robust evidence to indicate the need for surgical correction in all asymptomatic patients seeking fertility. In cases where surgical correction of isthmocele is deemed necessary, it is advisable to evaluate residual myometrial thickness (RMT). For patients with RMT >2.5–3 mm, hysteroscopy appears to be the technique of choice. In cases where the residual tissue is lower, recourse to laparotomic, laparoscopic, or vaginal approaches is warranted.

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