Abstract
The incidence of cesarean section is on rise all over the world and so are the complications associated with the procedure. Isthmocele as a complication of cesarean section is becoming a well documented entity all over the world in medical literature. It presents with symptoms like prolonged post menstrual bleeding, chronic pelvic infection and infertility. A pregnancy can get lodged in this area and can have disastrous consequences for the patient. The present article is an attempt to review to various presenting complaints, diagnosis and management of Isthmocele.International Journal of Human and Health Sciences Vol. 03 No. 03 July’19. Page: 127-133
Highlights
Isthmocele is a pouchlike defect of the anterior uterine isthmus at the site of a prior cesarean section.1Poidevin was the first to describe this term in 1961
Endometrium sparing repairs not approaching the myometrium in its entire width,locking sutures, lack of peritonization causing adhesion formation and pull on the scar, and interrupted suturing techniques are other factors associated with the development of isthmocele.9The use of a delayed absorbable suture in combination with ischemic technique of suturing may result in abnormal healing.[10]
Effect of number of cesarean sections: Repeated cesarean sections are purported to be associated with decreased perfusion of scar tissue, altered scar healing and progressive thinning of the area leading to isthmocele formation
Summary
Isthmocele is a pouchlike defect of the anterior uterine isthmus at the site of a prior cesarean section.1Poidevin was the first to describe this term in 1961. Morris in 1995 confirmed the presence of this entity while analysing uterine specimens of hysteroctomised patients.2Alternatively known as a niche, cesarean scar defect,uteroperitoneal fistula or uterine diverticulum, isthmocele has gained increasing importance in the past decade. Due to the rising incidence of Isthmocele and increasing awareness of the wide range of gynaecological symptoms associated with it, we conducted this review to understand the disease pathology and its implications. Search words included ‘niche’, ‘cesarean scar defect’, ‘Isthmocele’, ‘Isthmocele diagnosis and management’ and ‘ uteroperitoneal fistula’. The most widely accepted one attributes development of isthmocele to the inadequate healing of myometrium at cesarean scar site
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