Late morbidity in cesarean section scar syndrome

To summarize recent knowledge on ethiology, diagnostic management and treatment possibilities of cesarean section scar syndrome (isthmocoele).

Review article.

Department of Gynaecology and Obstetrics, Faculty Hospital and Palacky University, Olomouc; Department of Gynaecology and Obstetrics, Vítkovická nemocnice, Ostrava-Vítkovice.

A literature review of published data on cesarean section scar syndrome (isthmocoele).

Cesarean section scar syndrome may be associated with subsequent complications including postmenstrual spotting or bleeding, dysmenorrhoea, abdominal pain, dyspareunia, infertility, scar pregnancy, a morbidly adherent placenta, scar dehiscence or rupture in later pregnancy. Ethiopathogenesis of isthmocoele remains poorly understood. Magnetic resonance, sonohysterography and transvaginal ultrasound are the gold standard imaging techniques for diagnosis. Surgical treatment is still controversial but should be offered to symptomatic women.

Given the association between an isth-mocoele and gynaecological symptoms, obstetric complications and infertility, it is important to focus on preventive strategies of its development.