Abstract
BackgroundThe increase in number of cesarean section (CS) operations has resulted in an increase in cases of isthmocele development. The objective of this study is to determine the risk factors for isthmocele development after CS.MethodsIsthmocele measurements were taken for 404 women with a history of at least one low transverse CS. The following potential risk factors were investigated: patient’s age at CS, cause of CS, weeks of gestation at CS, premature rupture of membrane (PROM), phase of labor, type suture (single/double layer), operation time, uterine flexion (anteversion/retroversion), and blood transfusion during operation. A transvaginal ultrasound was carried out to examine the isthmocele in the uterus after CS, including the shape of the isthmocele, residual myometrial thickness, depth and width of isthmocele, cervical thickness, location of the isthmocele, and clinical characteristics.ResultsIn our study population, the isthmocele had a prevalence of 73.8%. Most isthmocele had a triangular (65.4%) or semicircular shape (10.4%). The presence of an isthmocele was significantly associated with repeat CS, premature rupture of membrane (PROM), short operation time, and extent of cervix dilatation at CS. The risk of isthmocele was low in women who had placenta previa totalis (PPT), twin, a long operation time, or a transfusion during the operation.ConclusionsIn our study, isthmocele development was significantly associated with repeat CS, PROM, a short operation time, and the extent of cervix dilatation at CS. Therefore, PROM prevention and a more careful uterine closure are needed to reduce the risk of developing an isthmocele after CS.
Highlights
The increase in number of cesarean section (CS) operations has resulted in an increase in cases of isthmocele development
A case control study was carried out with data collected from January 1, 2009 to November 30, 2016 for women with a history of cesarean section (CS) who were screened with transvaginal ultrasound (TVUS) for various gynecological indications
Height, weight, BMI, ultrasonographic follow up period, and comorbidity were not significantly different between the two groups
Summary
The increase in number of cesarean section (CS) operations has resulted in an increase in cases of isthmocele development. The objective of this study is to determine the risk factors for isthmocele development after CS. The number of cesarean section (CS) per 1000 live births in Korea was 380.3 in 2014, which was 1.4 times higher than the average number of CS (264.7 per per 1000 live births) in the Organization for Economic Cooperation and Development (OECD) member countries. There is no consensus regarding the definition of an isthmocele or a standardized approach for its assessment. The prevalence of an isthmocele in a random population with a history of CS differs between 24 and. An isthmocele is usually asymptomatic, symptoms related to this condition have been described, and it is a relatively new entity that needs further evaluation
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