Isthmocele and Infertility (original) (raw)
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Journal of Minimally Invasive Gynecology, 2011
The reproductive outcome in 41 consecutive patients with cesarean-induced isthmocele and secondary infertility was evaluated prospectively. Patients included menopausal women (mean [SD; 95% CI] age, 35 [4.1; 29-42] years), with fertility duration of 3 to 8 (4.6 [28]) years with isthmocele, postmenstrual abnormal uterine bleeding, and suprapubic pelvic pain. Transvaginal ultrasound and office hysteroscopy were used to diagnosis isthmocele. Complete fertility tests were performed to exclude other causes of infertility in both female and male participants. Operative hysteroscopy was performed to correct the cesarean scar defect, and histologic findings were evaluated. Correction of isthmocele via operative hysteroscopy was successful in all cases evaluated. Patients became pregnant spontaneously between 12 and 24 months after isthmoplasty. Thirtyseven of the 41 patients (90.2%) delivered via cesarean section, and 4 (9.8%) had a spontaneous abortion in the first trimester. Isthmoplasty resulted in resolution of postmenstrual abnormal uterine bleeding and suprapubic pelvic pain in all patients. Thus, it was concluded that surgical treatment of cesarean-induced isthmocele using a minimally-invasive approach (operative hysteroscopy) restores fertility and resolves symptoms in women with a cesarean section scar and secondary infertility.
Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility
Current Opinion in Obstetrics & Gynecology, 2012
Purpose of review To review the treatments of the cesarean-induced isthmocele in restoring infertility, associated techniques, and the risks of complications associated with their use. Recent findings Isthmocele is a reservoir-like pouch defect on the anterior wall of the uterine isthmus located at the site of a previous cesarean delivery scar. The flow of menstrual blood through the cervix may be slowed by the presence of isthmocele, as the blood may accumulate in the niche because of the presence of fibrotic tissue, causing pelvic pain in the suprapubic area. Moreover, persistence of the menstrual blood after menstruation in the cervix may negatively influence the mucus quality and sperm quality, obstruct sperm transport through the cervical canal, interfere with embryo implantation, leading to secondary infertility. The removal of the local inflamed tissue may be performed by laparoscopic, combined laparoscopicvaginal, or vaginal surgery, and operative hysteroscopy, a minimally invasive approach to improve symptoms and restore fertility.
One of the known complications after caesarean delivery is uterine caesarean scar defect or isthmocele. Isthmocele is usually asymptomatic or may cause gynecological problems, such as menometrorrhagia, infertility, chronic abdominal/pelvic pain. Isthmocele may cause obstetrical sequalae like preterm delivery, uterine rupture, caesarean scar pregnancy or abnormal placental implantation. In the present case report, asymptomatic patient underwent laparoscopic surgery for isthmocele repair after shared decision-making and medical treatment have been evaluated. We suggested that isthmoplasty should be offered to women with symptoms or if it is causing infertility.
Hysteroscopy Versus Laparoscopy in the Management of Isthmocele: A Review of the Literature
Women's Health – Open Journal, 2019
Isthmocele is a pouch defect of the anterior uterine wall, detected at the site of the previous cesarean scar. It can be asymptomatic or cause abnormal uterine bleeding, pelvic discomfort and difficulty conceiving. The main objective of this review is to highlight the hysteroscopic and laparoscopic approaches in the management of this disorder. Main Findings During the hysteroscopic approach, the superior and inferior edges or just the superior edge of the defect are resected, removing the fibrotic tissue and allowing renewal of the continuous canal between the cervix and the uterine cavity. Whereas, the laparoscopic approach consists of direct visualization and removal of the defect followed by re-approximation of the myometrium. Both methods lead to significant improvement in symptoms and fertility. Conclusion While hysteroscopy is a quick non-morbid procedure that allows concurrent removal of other uterine pathology, laparoscopy is characterized by improved visualization and decreased risk of complications with defects less than 3 mm as well as the possible correction of uterine retroversion. Definitely, randomized controlled trials are required in this field for better guidance of the diagnosis and management.
2017
Background: The aim of our study was to assess the prevalence and the benefits of endoscopic surgical procedures to patients with secondary infertility. Design: This is a retrospective hospital based study, in a private hospital with a major profile in assisted reproductive techniques and endoscopic surgery in Budapest, Hungary. During the study period of between 1st January 2013 31st December 2016, patients presenting with secondary infertility after one or more caesarean section were evaluated, using the HyCoSy and diagnostic hysteroscopy. Within a group of 15 patients diagnosed with isthmocele who had surgical treatment, 80% (n=12/15) became pregnant within 24months and delivered before 36 months of treatment. All the patients had hysteroscopy guided laparoscopic isthmoplasty, except one who had hysteroscopy procedure alone. Conclusion: We therefore conclude, that the combined use of laparoscopy and hysteroscopy is an effective method for the accurate diagnosis and treatment of p...
Treatment for Uterine Isthmocele, a Pouch-Like Defect at the Site of Cesarean Section Scar
Journal of minimally invasive gynecology, 2017
Isthmocele appears as a fluid pouch-like defect in the anterior uterine wall at the site of a prior Cesarean section and ranges in prevalence from 19% to 84%, a direct relation to the increase in Cesarean sections performed worldwide. Many definitions have been suggested for the dehiscence resulting from Cesarean section, and we propose standardization with a single term for all cases: isthmocele. Patients are not always symptomatic, but symptoms typically include intermittent abnormal bleeding, pain, and infertility. Pregnancy complications that result from isthmocele include ectopic pregnancy, low implantation, and uterine rupture. Magnetic resonance imaging and transvaginal ultrasound are the gold standard imaging techniques for diagnosis. Surgical treatment of isthmocele is still a controversial issue but should be offered to symptomatic women or the asymptomatic patient who desires future pregnancy. When surgery is the treatment choice, laparoscopy guided by hysteroscopy, hyste...
Surgical Management of Cesarean Scar Defect in Restoring Fertility
2018
Cesarean scar defect, niche, or isthmocele is commonly detected as an incidental finding on transvaginal ultrasound as a wedge-shaped anechoic area. The presence of a uterine scar defect is usually asymptomatic or relates to postmenstrual spotting and dark red or brown discharge, pelvic pain or infertility. Surgical repair or isthmoplasty is associated with an improvement in uterine bleeding in 59% to 100% of cases and a pregnancy rate of 77.8% to 100%. Therefore, treatment of isthmocele should be offered to women with symptoms or if it is causing infertility. Hysteroscopic isthmoplasty appears to be the most popular and less invasive treatment. However, in the absence of randomized trials, the efficacy of different surgical approaches remains to be evaluated.
Case Report: Laparoscopic Isthmocele Repair on an 8 Weeks Pregnant Uterus
Frontiers in Medicine, 2022
An isthmocele, also known as a caesarean scar defect, is a long-term complication of caesarean sections with an increasing incidence. Although is often asymptomatic, it is a novel recognised cause of abnormal uterine bleeding, and it is a major risk factor for caesarean scar pregnancies or uterine ruptures in subsequent pregnancies. Currently there are no guidelines for the diagnosis and management of this condition. Several surgical techniques for the correction of isthmocele are proposed, including laparoscopic excision, vaginal repair, a combined laparoscopic-vaginal approach or more recently hysteroscopic resection. We present the case of a GII PI, 29 years old patient with a previous c-section who presented in our clinic with a positive pregnancy test for pregnancy confirmation. The ultrasound examination revealed an intrauterine evolutive 8 weeks pregnancy and a caesarean scar defect. After counselling the patient opted for pregnancy continuation and laparoscopic correction of...