Investigating the risk factors for isthmocele development after cesarean delivery

Abstract

ObjectiveCesarean section (CS) rates are increasing globally, raising concerns about associated complications like isthmocele. Isthmoceles are pouch-like defects in the anterior uterine wall at the site of a prior CS scar. This study aimed to determine isthmocele prevalence, associated symptoms, and risk factors among women with a CS history. MethodsThis cross-sectional study evaluated 297 women with prior CS using transvaginal ultrasound to screen for isthmocele. Data on demographics, pregnancy details, comorbidities, and indications for CS were collected. Isthmocele was defined sonographically as any niche or defect at the hysterotomy site. Descriptive and comparative analyses identified factors associated with isthmocele. ResultsIsthmocele prevalence was 65.3% (n=194). Abnormal vaginal bleeding was reported by 21.1%, pelvic pain by 4.1%, and both by 4.1%. Compared to women without isthmocele, those with isthmocele were older (35.9 vs. 31.6 years), had higher BMI (26.8 vs. 25.5 kg/m2), gravidity (1.8 vs. 1.3), and parity (1.7 vs. 1.2). Repeat CS was more common (30.4% vs. 12.6%) and elective CS less common (33.5% vs. 67.9%) among those with isthmocele. ConclusionOver half of the women with CS history had an isthmocele. Abnormal bleeding was common. Advanced maternal age, obesity, repeat procedures, and certain comorbidities appear to increase risk. Further research on prevention and treatment is warranted given the high prevalence.