Instruments and TechniquesHysteroscopic Treatment of Symptomatic Cesarean-induced Isthmocele: A Prospective Study
Section snippets
Materials and Methods
This prospective study (Canadian Task Force classification III) was performed from December 2007 through October 2013 on 120 consecutive patients with isthmoceles at Clinica Mediterranea (Naples), St Orsola Hospital (Bologna), and Agostino Gemelli Hospital (Rome). Only symptomatic patients were included in the study. Clinical characteristics of the study population are described in Table 1. One hundred eighteen patients had postmenstrual abnormal uterine bleeding for 2 to 13 days after
Results
An isthmocele appears as a triangular or oval-shaped shadow in the anterior uterine wall, with transonic content of variable size (Fig. 1). Fig. 2, Fig. 3 show a pocket in the middle or upper cervical channel, respectively, where blood is retained and then slowly released. Figure 2 highlights the anterior border trapping the blood, whereas Figure 3 shows the edge of the isthmocele where the blood is collected and the second posterior border, which usually (but not always) corresponds to the
Discussion
The gynecologic sequelae caused by deficient uterine scar healing after cesarean section are only recently being identified and described 5, 6, 7. These include conditions such as postmenstrual abnormal uterine bleeding (PAUB), chronic pelvic pain, infertility, and cesarean scar ectopic pregnancy as well as a potentially higher risk of complications during gynecologic procedures, such as uterine evacuation, hysterectomy, endometrial ablation, and insertion of an intrauterine device. In
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Reproductive outcomes after vaginal repair of isthmocele: A preliminary study and systematic review of the literature
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2022, Journal of Gynecology Obstetrics and Human ReproductionCitation Excerpt :According to Wang et al. [27] and Xie et al. [28], the mean surgical time which was defined as the whole procedure, including preoperative preparations, were 30.2 min (range 18–52 min) and 25 min (range 20–35 min), respectively. Raimondo et al. [12] recorded only the time required for N of the lesions, and it took 8 ± 2.1 min (range 7–8.6 min). Using Raimondo's definition, our average surgical duration was 17.4 ± 3.5 min (range 10–25 min).
The authors declare no conflict of interest.