Isthmocele‑an iatrogenic pathology: A prospective study in a tertiary unit.

Area of Science:

• Gynecology
• Obstetrics
• Surgical Innovation

Background:

• Isthmocele, or uterine niche, is a myometrial defect at C-section scars, increasing with caesarean delivery rates.
• Surgical technique, particularly suture choice, is implicated as a risk factor for isthmocele formation.

Purpose of the Study:

• To investigate the association between different uterine closure suture types and the incidence of isthmocele after caesarean section.
• To determine if specific suture techniques correlate with the development and severity of uterine niches.

Main Methods:

• Retrospective analysis of 52 patients 6 weeks post-caesarean section.
• Evaluation of patient age, prior C-section history, uterine anatomy, and type of suture used for uterine closure.
• Correlation of suture types (continuous locking, continuous non-locking, interrupted) with isthmocele presence and severity.

Main Results:

• 42.3% of patients developed an isthmocele.
• A statistically significant association was found between continuous locking sutures and isthmocele development.
• Continuous locking sutures were linked to a higher incidence of severe niches, whereas non-locking sutures were associated with fewer niches.

Conclusions:

• The choice of suture for the first layer of uterine closure in caesarean sections significantly influences isthmocele formation.
• Continuous locking sutures appear to increase the risk of developing uterine niches, including severe cases.
• Further research is needed to identify optimal suturing techniques to minimize isthmocele risk in the context of rising C-section rates.