Cesarean scar defect: a prospective study on risk factors

Area of Science:

• Reproductive Medicine
• Obstetrics & Gynecology
• Medical Imaging

Background:

• Cesarean scar defect, known as isthmocele, is an increasingly common complication following cesarean delivery.
• Isthmoceles are associated with significant obstetric and gynecological issues, including uterine rupture and abnormal bleeding.

Purpose of the Study:

• To prospectively identify risk factors for developing isthmocele.
• To assess the association between various maternal and surgical factors and the presence of isthmocele.

Main Methods:

• A prospective observational cohort study involving 401 nonpregnant women within 3 days of cesarean delivery.
• Sonohysterography was performed 6 months post-cesarean delivery to diagnose isthmocele, with ultrasonographers blinded to clinical data.
• Logistic regression analysis was used to determine independent risk factors.

Main Results:

• The prevalence of isthmocele was 45.6% among 371 evaluated women.
• Independent risk factors identified included a history of gestational diabetes (OR 1.73), previous cesarean delivery (OR 3.14), and elevated maternal body mass index (OR 1.06 per unit increase).
• In emergency cesarean deliveries, a longer active labor duration also increased isthmocele risk (OR 1.06).

Conclusions:

• Maternal body mass index, gestational diabetes, and prior cesarean deliveries are significantly associated with an increased risk of isthmocele.
• These findings highlight key risk factors for incomplete uterine scar healing after cesarean delivery.