Isthmocele: From Risk Factors to Management

Piergiorgio Iannone; Giulia Nencini; Gloria Bonaccorsi; Ruby Martinello; Giovanni Pontrelli; Marco Scioscia; Luigi Nappi; Pantaleo Greco; Gennaro Scutiero

doi:10.1055/s-0038-1676109

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, Table of Contents

CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(01): 044-052
DOI: 10.1055/s-0038-1676109

Review Article

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Isthmocele: From Risk Factors to Management

Istmocele: de fatores de risco ao manejo

Authors

Piergiorgio Iannone

¹Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
Giulia Nencini

¹Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
Gloria Bonaccorsi

¹Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
Ruby Martinello

¹Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
Giovanni Pontrelli

²Section of Obstetrics and Gynaecology, Policlinico di Abano Terme, Abano Terme, Padova, Italy
Marco Scioscia

²Section of Obstetrics and Gynaecology, Policlinico di Abano Terme, Abano Terme, Padova, Italy
Luigi Nappi

³Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
Pantaleo Greco

¹Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
Gennaro Scutiero

¹Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy

Abstract

Objective The aim of the present study was to perform a comprehensive review of the literature to provide a complete and clear picture of isthmocele—a hypoechoic area within the myometrium at the site of the uterine scar of a previous cesarean section—by exploring in depth every aspect of this condition.

Methods A comprehensive review of the literature was performed to identify the most relevant studies about this topic.

Results Every aspect of isthmocele has been studied and described: pathophysiology, clinical symptoms, classification, and diagnosis. Its treatment, both medical and surgical, has also been reported according to the actual literature data.

Conclusion Cesarean section is the most common surgical procedure performed worldwide, and one of the consequences of this technique is isthmocele. A single and systematic classification of isthmocele is needed to improve its diagnosis and management. Further studies should be performed to better understand its pathogenesis.

Resumo

Objetivo O objetivo do presente estudo foi realizar uma revisão abrangente da literatura a fim de fornecer um quadro completo e claro da istmocele—uma área hipoecoica dentro do miométrio no local da cicatriz uterina de uma cesariana anterior—aprofundando todos os aspectos desta condição

Métodos Uma revisão abrangente da literatura foi realizada para identificar os estudos mais relevantes sobre este tema.

Resultados Todos os aspectos da istmocele foram estudados e descritos: fisiopatologia, sintomas clínicos, classificação e diagnóstico. Os tratamentos médico e cirúrgico também foram relatados de acordo com os dados reais da literatura.

Conclusão A cesárea é o procedimento cirúrgico mais comum realizado em todo o mundo, e uma das consequências desta técnica é a istmocele. Uma classificação única e sistemática da istmocele é necessária para melhorar seu diagnóstico e manejo. Novos estudos devem ser realizados para melhor entender sua patogênese.

Keywords

isthmocele - niche - cesarean section scar defect - hysteroscopy - laparoscopy

Palavras-chave

istmocele - nicho - defeito cicatricial de cesariana - histeroscopia - laparoscopia

Full Text

References

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