Presentación clínica y ultrasonográfica del istmocele en pacientes con cesárea previa - López Torres, Luisa Fernanda; Quirós Sánchez, Juliana; Serna Hoyos, Luis Carlos; López Restrepo, María Fernanda; Echavarría Restrepo, Luis Guillermo; Campo Campo, María Nazareth; Cuesta Castro, Diana Paola (Revista Cubana de Obstetricia y Ginecología, 2023)
<span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*493.56px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(1.02874);" role="presentation">Introducción: <span dir="ltr" style="left: calc(var(–scale-factor)*152.30px); top: calc(var(–scale-factor)*493.56px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.912584);" role="presentation">La atención del parto por vía de la cesárea es un procedimiento frecuente <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*514.26px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.913965);" role="presentation">en cuya cicatriz puede aparecer un defecto conocido como istmocele con consecuencias <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*534.96px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.91684);" role="presentation">clínicas <span dir="ltr" style="left: calc(var(–scale-factor)*122.00px); top: calc(var(–scale-factor)*534.96px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.886134);" role="presentation">frecuentes: <span dir="ltr" style="left: calc(var(–scale-factor)*181.92px); top: calc(var(–scale-factor)*534.96px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.912061);" role="presentation">hemorragi<span dir="ltr" style="left: calc(var(–scale-factor)*231.32px); top: calc(var(–scale-factor)*534.96px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.8328);" role="presentation">a, <span dir="ltr" style="left: calc(var(–scale-factor)*246.97px); top: calc(var(–scale-factor)*534.96px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.889083);" role="presentation">dismenorrea, <span dir="ltr" style="left: calc(var(–scale-factor)*316.47px); top: calc(var(–scale-factor)*534.96px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.891381);" role="presentation">dispareunia y <span dir="ltr" style="left: calc(var(–scale-factor)*392.40px); top: calc(var(–scale-factor)*534.96px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.949411);" role="presentation">dolor <span dir="ltr" style="left: calc(var(–scale-factor)*424.96px); top: calc(var(–scale-factor)*534.96px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.947091);" role="presentation">pélvico <span dir="ltr" style="left: calc(var(–scale-factor)*467.60px); top: calc(var(–scale-factor)*534.96px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.877901);" role="presentation">agudo y <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*555.66px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.928606);" role="presentation">crónico. <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*576.36px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(1.00021);" role="presentation">Objetivos: <span dir="ltr" style="left: calc(var(–scale-factor)*137.54px); top: calc(var(–scale-factor)*576.36px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.98042);" role="presentation">Describir los hallazgos clínicos y ultrasonográficos de las pacientes con <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.907308);" role="presentation">istmocele <span dir="ltr" style="left: calc(var(–scale-factor)*131.36px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.836915);" role="presentation">después <span dir="ltr" style="left: calc(var(–scale-factor)*176.70px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.849118);" role="presentation">de <span dir="ltr" style="left: calc(var(–scale-factor)*195.35px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.927533);" role="presentation">la <span dir="ltr" style="left: calc(var(–scale-factor)*211.36px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.917724);" role="presentation">realización <span dir="ltr" style="left: calc(var(–scale-factor)*271.34px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.849118);" role="presentation">de <span dir="ltr" style="left: calc(var(–scale-factor)*290.05px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.865908);" role="presentation">una <span dir="ltr" style="left: calc(var(–scale-factor)*314.70px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.827706);" role="presentation">cesárea y <span dir="ltr" style="left: calc(var(–scale-factor)*370.76px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.83817);" role="presentation">su <span dir="ltr" style="left: calc(var(–scale-factor)*388.75px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.912402);" role="presentation">posible <span dir="ltr" style="left: calc(var(–scale-factor)*430.79px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.918931);" role="presentation">relación <span dir="ltr" style="left: calc(var(–scale-factor)*476.80px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.895925);" role="presentation">con <span dir="ltr" style="left: calc(var(–scale-factor)*501.44px); top: calc(var(–scale-factor)*597.06px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.927533);" role="presentation">el <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*617.76px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.895576);" role="presentation">grado/tamaño de la lesión. M<span dir="ltr" style="left: calc(var(–scale-factor)*89.36px); top: calc(var(–scale-factor)*638.46px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.932465);" role="presentation">étodos: <span dir="ltr" style="left: calc(var(–scale-factor)*131.90px); top: calc(var(–scale-factor)*638.46px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.953437);" role="presentation">Estudio transversal, analítico en pacientes con istmocele y antecedente de <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*659.16px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.962839);" role="presentation">cesárea evaluados entre mayo de 2016 y mayo 2017, en tres hospitales de Medellín <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*679.86px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.930942);" role="presentation">Colombia. <span dir="ltr" style="left: calc(var(–scale-factor)*132.62px); top: calc(var(–scale-factor)*679.86px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.920784);" role="presentation">Se excluyeron las <span dir="ltr" style="left: calc(var(–scale-factor)*224.18px); top: calc(var(–scale-factor)*679.86px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.86929);" role="presentation">pacientes <span dir="ltr" style="left: calc(var(–scale-factor)*273.16px); top: calc(var(–scale-factor)*679.86px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.923305);" role="presentation">con sospecha de cáncer ginecológico o con otra <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*700.58px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.849484);" role="presentation">causa u<span dir="ltr" style="left: calc(var(–scale-factor)*113.72px); top: calc(var(–scale-factor)*700.58px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.895915);" role="presentation">terina que explicara los síntomas. <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*721.28px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.947464);" role="presentation">Resultados: <span dir="ltr" style="left: calc(var(–scale-factor)*143.72px); top: calc(var(–scale-factor)*721.28px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.939231);" role="presentation">Se analizaron 26 pacientes con manifestaciones clínicas asociadas, tales <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*741.98px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.965727);" role="presentation">como dolor pélvico crónico (80,8 %), hemorragia uterina anormal (73,1 %), infección <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*73.82px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.972113);" role="presentation">pélvica (46,2 %), e infertilidad secundaria (15,4 %<span dir="ltr" style="left: calc(var(–scale-factor)*334.90px); top: calc(var(–scale-factor)*73.82px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.980989);" role="presentation">). Un 34,6 % se clasificaron como <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.891342);" role="presentation">grado I y <span dir="ltr" style="left: calc(var(–scale-factor)*138.61px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(1.20016);" role="presentation">II y <span dir="ltr" style="left: calc(var(–scale-factor)*168.16px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.869049);" role="presentation">las <span dir="ltr" style="left: calc(var(–scale-factor)*189.25px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.850977);" role="presentation">restantes <span dir="ltr" style="left: calc(var(–scale-factor)*239.04px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.887822);" role="presentation">grado <span dir="ltr" style="left: calc(var(–scale-factor)*274.07px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(1.12808);" role="presentation">III. <span dir="ltr" style="left: calc(var(–scale-factor)*296.84px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.909117);" role="presentation">Otros <span dir="ltr" style="left: calc(var(–scale-factor)*331.27px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.893375);" role="presentation">hallazgos <span dir="ltr" style="left: calc(var(–scale-factor)*384.36px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.911785);" role="presentation">ultrasonográficos <span dir="ltr" style="left: calc(var(–scale-factor)*475.46px); top: calc(var(–scale-factor)*94.52px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.926169);" role="presentation">fueron: <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*115.22px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.975163);" role="presentation">miomatosis uterina categoría 4-<span dir="ltr" style="left: calc(var(–scale-factor)*242.00px); top: calc(var(–scale-factor)*115.22px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(1.01335);" role="presentation">5 de la Federación Internacional de Ginecología y <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*135.94px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.939543);" role="presentation">Obstetricia (42,3 %), útero retroverso (19,2 %), pólipos en<span dir="ltr" style="left: calc(var(–scale-factor)*367.00px); top: calc(var(–scale-factor)*135.94px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.92767);" role="presentation">dometriales (11,5 %), quistes <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*156.64px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.957221);" role="presentation">simples del ovario (15,4 %) y endometriosis (7,7 %). No se encontró asociación de la <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*177.34px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.890435);" role="presentation">severidad del istmocele con número previo de cesáreas y <span dir="ltr" style="left: calc(var(–scale-factor)*353.68px); top: calc(var(–scale-factor)*177.34px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.90081);" role="presentation">síntomas clínicos. <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*197.98px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.94661);" role="presentation">Conclusiones: <span dir="ltr" style="left: calc(var(–scale-factor)*153.38px); top: calc(var(–scale-factor)*197.98px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.924923);" role="presentation">El istmocele es una secuela directa del parto por c<span dir="ltr" style="left: calc(var(–scale-factor)*401.50px); top: calc(var(–scale-factor)*197.98px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.877581);" role="presentation">esárea. Son frecuentes <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.869049);" role="presentation">las <span dir="ltr" style="left: calc(var(–scale-factor)*98.62px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.890866);" role="presentation">manifestaciones <span dir="ltr" style="left: calc(var(–scale-factor)*183.12px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.91564);" role="presentation">clínicas <span dir="ltr" style="left: calc(var(–scale-factor)*227.02px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.868004);" role="presentation">tales <span dir="ltr" style="left: calc(var(–scale-factor)*256.22px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.905902);" role="presentation">como <span dir="ltr" style="left: calc(var(–scale-factor)*290.10px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.901189);" role="presentation">hemorragia <span dir="ltr" style="left: calc(var(–scale-factor)*352.03px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.90748);" role="presentation">uterina <span dir="ltr" style="left: calc(var(–scale-factor)*392.58px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.905106);" role="presentation">anormal, <span dir="ltr" style="left: calc(var(–scale-factor)*442.12px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.949411);" role="presentation">dolor <span dir="ltr" style="left: calc(var(–scale-factor)*474.73px); top: calc(var(–scale-factor)*218.68px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.945806);" role="presentation">pélvico <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*239.38px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.933413);" role="presentation">crónico, infertilidad secundaria e infección pélvica<span dir="ltr" style="left: calc(var(–scale-factor)*324.04px); top: calc(var(–scale-factor)*239.38px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.91831);" role="presentation">. Existe relación entre la severidad del <span dir="ltr" style="left: calc(var(–scale-factor)*78.00px); top: calc(var(–scale-factor)*260.08px); font-size: calc(var(–scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.896458);" role="presentation">istmocele y las manifestaciones clínicas de la enfermedad.