Clinical and Ultrasonographic Presentation of Isthmocele in Patients with Previous Cesarean Section

Abstract

Introduction: Delivery care by cesarean section is a frequent procedure in which a defect known as isthmocele can appear with frequent clinical consequences such as hemorrhage, dysmenorrhea, dyspareunia and acute and chronic pelvic pain.
Objectives: To describe the clinical and ultrasonographic findings in patients with isthmocele after performing a cesarean section and the possible relationship with the grade / size of the lesion.
Methods: Cross-sectional, analytical study was carried out in patients with isthmocele and a history of caesarean section evaluated from May 2016 to May 2017, in three hospitals in Medellín, Colombia. Patients with suspected gynecological cancer or with another uterine cause that explained the symptoms were excluded.
Results: Twenty-six patients were analyzed, whom suffered conditions associated clinical manifestations such as chronic pelvic pain (80.8%), abnormal uterine bleeding (73.1%), pelvic infection (46.2%), and secondary infertility (15.4%). 34.6% were classified as grade I and II and the rest was classified as grade III. Other ultrasonographic findings were uterine myomatosis category 4-5 from the International Federation of Gynecology and Obstetrics (42.3%), retroverted uterus (19.2%), endometrial polyps (11.5%), ovary simple cysts (15, 4%) and endometriosis (7.7%). No association was found between the severity of the isthmocele with a previous number of cesarean sections
and clinical symptoms.
Conclusions: Isthmocele is a direct sequela of cesarean delivery. Clinical manifestations such as abnormal uterine bleeding, chronic pelvic pain, secondary infertility, and pelvic infection are common. There is a relationship between the severity of the isthmocele and
the clinical manifestations of the disease.