Isthmocele: prevalence and clinical impact on menstrual bleeding patterns
Montas Laporte1, Ana C Marcelino1, Paula da Cunha Pereira1
1Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil.
Summary
Istmocele, a uterine scar defect, affects over 40% of women with prior C-sections, often causing heavy menstrual bleeding and pelvic pain. Larger defects correlate with more severe symptoms.
Area of Science:
- Gynecology
- Reproductive Medicine
- Surgical Outcomes
Background:
- Isthmoceles are uterine diverticula or niches that can form at the site of a previous cesarean scar.
- These defects may be associated with abnormal uterine bleeding and other gynecological symptoms.
Purpose of the Study:
- To determine the prevalence of isthmocele in women with a history of cesarean delivery.
- To investigate the clinical impact of isthmocele on menstrual bleeding patterns and associated symptoms.
Main Methods:
- A cross-sectional study involving 301 non-pregnant women aged 18-43 years with at least one prior cesarean delivery.
- Data collection included sociodemographic questionnaires, a 90-day bleeding diary, and transvaginal ultrasound for isthmocele assessment.
- Bivariate and multivariate logistic regression analyses were used to identify factors associated with isthmocele.
Main Results:
- The prevalence of isthmocele was 41.9% (126/301), with 82.5% of these cases being symptomatic.
- Isthmoceles were associated with older maternal age, higher number of pregnancies, previous cesarean deliveries, prolonged menstrual bleeding (≥8 days), and chronic pelvic pain.
- Symptomatic isthmoceles were linked to larger defect dimensions and thinner residual myometrium compared to asymptomatic cases.
Conclusions:
- Isthmoceles are common in women with cesarean delivery history and are frequently symptomatic.
- Factors such as advanced maternal age, multiple cesarean deliveries, chronic pelvic pain, and prolonged menstrual bleeding are associated with isthmocele presence.
- Defect size and myometrial thickness are key indicators of symptom severity in isthmocele patients.
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