Previous Next

ARCHIVE

№1' 2021

OBSTETRICS AND GYNECOLOGY

International Medical Journal, Vol. 27., Iss. 1, 2021, P. 52−55.

DOI (https://doi.org/10.37436/2308-5274-2021-1-9)

ISTHMOCELE: ETIOLOGY, CLINIC, DIAGNOSIS AND TREATMENT (Literature review)

Kharkiv Medical Academy of Postgraduate Education, Ukraine

Modern obstetrics is characterized with a loyal approach to surgical delivery, which has significantly affected the activity of maternity hospitals: the number of complications in childbirth from both the mother and fetus has decreased. The formed scar on the uterus is determined differently when examining the women in the postoperative period. Isthmocele is a hypogenic area in the myometrium within the site of postoperative scar in the form of a "niche", diverticulum or sac after cesarean section. It can lead to the development of diseases: abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, dyspareunia, infertility, adenomyosis, bladder dysfunction, as well as be the cause of ectopic pregnancy, uterine rupture, abnormalities in the placenta attachment of. Risk factors for isthmocele include low uterine incisions, a history of cervical removal, cervical dilatation of more than 5 cm, more than five hours of delivery, etc. For the first time the diagnosis of "isthmocele" is made at ultrasonic research, more often transvaginal one. The diagnosis is confirmed by hysteroscopy or constructive surgery. An important criterion for ismocele is the degree of deficiency, i.e. the ratio between the the biometry thickness on the scar and adjacent to the scar the myometrium area. Depending on the woman's reproductive plans, conservative or surgical treatment of isthmocele is recommended, using autologous stem cells to regenerate muscle tissue. Conservative treatment involves taking oral contraceptives. Surgical treatment includes the imposition of a two−row single−wing suture. The use of stem cells in the postoperative period allows a rise in the frequency of pregnancies in women with a scar on the uterus in the case of the isthmocele formation.

Key words: isthmocele, cesarean section, myometrium, autocells.

REFERENCES

1. Isthmocele: from risk factors to management / Giulia Nencini et al. // Rev. Bras. Ginecol. Obstet. 2019. Vol. 41, № 1.

2. Osser O. V., Jokubkiene L., Valentin L. Cesarean sections car defects: agreement between transvaginal sonographic findings with and without saline contrasten hancement // Ultrasound Obstet. Gynecol. 2010. № 35 (01). R. 75−83. doi: 10.1002/uog.7496

3. Sonographic imaging of cervicals cars after Cesarean section / E. Z. Zimmer, R. Bardin, A. Tamir, M. Bronshtein // Ultrasound Obstet. Gynecol. 2004. № 23 (06). R. 594−598. doi: 10.1002/uog.1033

4. Abacjew−Chmylko A., Wydra D. G., Olszewska H. Hysteroscopy in the treatment of uterine cesarean sections cardiverticulum: A systematic review // Adv. Med. Sci. 2017. № 62 (02). R. 230−239. doi: 10.1016/j.advms.2017.01.004

5. Hysteroscopic treatment of symptomatic cesarean induced isthmocele: a prospective study / G. Raimondo et al. // J. Minim. Invasive Gynecol. 2015. № 22 (02). R. 297−301. doi: 10.1016/j.jmig.2014.09.011

6. Postoperative adhesion development following cesarean and open intraabdominal gynecological operations: a review / A. O. Awonuga, N. M. Fletcher, G. M. Saed, M. P. Diamond // ReprodSci. 2011. № 18 (12). R. 1166−1185. doi: 10.1177/1933719111414206

7. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review / A. J. Bijde Vaate et al. // Ultrasound Obstet. Gynecol. 2014. № 43 (04). R. 372−382. doi: 10.1002/uog.13199

8. Why do niches developin Caes are anuterines cars? Hypotheses on the aetiology of niche development / A. J. Vervoort et al. // Hum. Reprod. 2015. Vol. 30 (12). P. 2695−2702. doi: 10.1093/humrep/dev240

9. Cesarean scar defect: a prospective study on risk factors / R. M. Antila−Långsjö et al. // Am. J. Obstet. Gynecol. 2018. Vol. 219 (5). P. 458.el−458.e8. doi: 10.1016/j.ajog.2018.09.004

10. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review / A. J. Vaate et al. // Ultrasound Obstet. Gynecol. 2014. Vol. 43 (4). P. 372−382. doi: 10.1002/u org.13199

11. Matkovі krovotechі ta yakіst' zhittya zhіnki. Rezolyutsіya Ekspertnoї radi / Yu. G. Antipkіn ta іn. // Reproduktivna endokrinologіya. 2019. № 3 (47). S. 8−12.

12. Morris H. Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms? // Int. J. Gynecol. Pathol. 1995. Vol. 14. P. 16−20. https://doi.org/10.1097/00004347−199501000−00004

13. Gorokh Ya. V. Lіkuvannya і reabіlіtatsіya khvorikh z іstmotsele poza vagіtnostі // Suchasnі teoretichnі ta praktichnі aspekti klіnіchnoї meditsini: materіali nauk.−prakt. konf. z mіzhnar. uchastyu, Odesa: ONMedU, 2018. S. 38−50.

14. Ogorodnik A. O., Davidova Yu. V., Butenko L. P. Kesarіv roztin: vіddalenі naslіdki − "nіshі" pіslyaoperatsіinogo rubtsya // Perinatologіya ta pedіatrіya. 2018. № 1 (73). S. 54−56. https://doi.org/10.15574/pp.2018.73.54

15. Impact of Cesarean section on subsequent fertility: a systematic review and metaanalysis / I. Gurol Urganci et al. // HumReprod. 2013. Vol. 28. P. 1943−1952.

16. Gordenchuk Z. Defekt rubtsya na mattsі pіslya kesars'kogo roztinu. Yakі faktori riziku naivazhlivіshі? // Z turbotoyu pro zhіnku. 2018. № 9 (93). S. 40−42.

17. Vdovіchenko Yu. P., Goida N. G., Yuz'ko O. M. Vagіtnіst' ta pologi u zhіnok z rubtsem na mattsі pіslya kesars'kogo roztinu: navch. posіb. za zag. red. chl.−kor. NAMN Ukraїni Yu. P. Vdovіchenko. K., 2011. Ch. 2. S. 251−328.

18. Goncharuk N. P., Kovida N. R. Dіagnostika nespromozhnostі rubtsya na mattsі pіslya kesareva roztinu // Zdorov'ya zhіnki. 2016. № 7 (113). S. 171−173.

19. Poluyanova O. M. Optimіzatsіya pregravіdarnoї pіdgotovki u zhіnok z rubtsem na mattsі pіslya kesarevogo roztinu: avtoref. dis. ... kand. med. nauk: 14.01.01. K., 2015. 32 s.

20. Resectoscopi ctreatment combined with sonohysterographice valuation of women with postmenstrual bleeding as a result of previous cesarean deliverys car defects / Y. Chang et al. // Am. J. Obstet. Gynecol. 2009. Vol. 200 (04). P. 370.e1−370.e4. doi: 10.1016/j.ajog.2008.11.038

21. Hysteroscopic treatment of postcesareans car defect / Y. L. Feng, M. X. Li, X. Q. Liang, X. M. Li // J. Minim. Invasive Gynecol. 2012. Vol. 19 (04). P. 498−502. doi: 10.1016/j.jmig.2012.03.010

22. Hysteroscopic and laparoscopic managemen to futerine defects on previous cesarean deliverys cars / C. Li et al. // J. Perinat. Med. 2014. Vol. 42 (03). P. 363−370. doi: 10.1515/jpm−2013−0081

23. The effect of laparoscopic resection of large niches in the uterine caes are anscaron symptoms, ultrasound findings and quality of life: a prospective cohort study / A. Vervoort et al. // BJOG. 2018. Vol. 125 (03). P. 317−325. doi: 10.1111/1471−0528.14822

24. Ultrasounde valuation of the Cesareans car: relation between a niche and postmenstruals potting / A. J. Bijde Vaate et al. // Ultrasound Obstet. Gynecol. 2011. Vol. 37 (01). P. 93−99. doi: 10.1002/uog.8864

25. Treatment for uterine isthmocele, a pouch−like defectat the site of cesarean sections car / A. Setubal et al. // J. Minim. Invasive Gynecol. 2018. Vol. 25 (01). P. 38−46. doi: 10.1016/j.jmig.2017.09.022

26. Tower A. M., Frishman G. N. Cesareans car defects: an under recognized cause of abnormal uterine bleeding and other gynecologic complications // J. Minim. Invasive Gynecol. 2013. Vol. 20 (05). P. 562−572. doi: 10.1016/j. jmig. 2013.03.008

27. Deficient lower segment Cesarean sections cars: prevalence and risk factors / D. Ofili−Yebovi et al. // Ultrasound Obstet. Gynecol. 2008. Vol. 31 (01). P. 72−77. doi: 10.1002/ uog.5200

28. Hysteroscopi cisthmoplasty: step by step technique / A. Di Spiezio Sardo et al. // J. Minim. Invasive Gynecol. 2018. Vol. 25 (02). P. 338−339. doi: 10.1016/j. jmig.2017.09.002

29. A retrospective case−control study comparing hysteroscopic resection versus hormonal modulation in treating menstrual disorders due to isthmocele / P. Florio et al. // Gynecol. Endocrinol. 2011. Vol. 27 (06). P. 434−438. doi: 10.3109/ 09513590.2010.495431

30. Tahara M., Shimizu T., Shimoura H. Preliminary report of treatment with oral contraceptive pills for intermenstrual vaginal bleeding secondary to a cesarean sections car // Fertil. Steril. 2006. Vol. 86 (02). P. 477−479. doi: 10.1016/j.fertnstert.2006.01.020