SEQUELA OF CESAREAN SECTION DELIVERY; ISTMOCELE

Yıl 2022, Cilt: 23 Sayı: 1, 119 - 124, 17.01.2022

Gülşah Selvi Demirtaş

https://doi.org/10.18229/kocatepetip.744836

Cited By: 1

Öz

This study aims to reveal the current literature about the methods in the diagnosis and treatment of isthmocele. A total of 72 case reports and clinical studies using the key words “isthmocele”, “niche” and “uterine scar defect” which were published in English language between the years 2008 and 2020, were searched from the Pubmed database. Amongst these publications, 32 clinical studies and case reports that were only related to the diagnosis and treatment of isthmocele and whose full texts are available, were included in the study. Forty publications were excluded from the study due to not being a related to isthmocele, unavailability of full text, and publication in other languages. Symptoms, complication, treatment methods and their success were evaluated. A total of 1021 cases described in 32 clinical trials and case reports were evaluated of the cases. Hysteroscopy was perfomed in 385 cases, laparoscopy was performed in 151 cases, hysteroscopy combined with laparoscopy was performed in 36 cases, vaginal repair was performed in 287 cases, vaginal repair combined with laparoscopy was performed in 37 cases, and laparotomy was performed in five cases. Medical treatment was applied in 120 cases. All patients who had surgery were symptomatic and complications were reported only in 4 patients who underwent surgery. Isthmocele can be easily diagnosed with ultrasonography and sonohysterography, which are frequently used in daily practice. Isthmocele should be kept in mind especially in patients with retroflexed uterus and old cesarean history who have abnormal uterine bleeding, secondary infertility, and pelvic pain. Surgical treatment yields successful results especially in symptomatic patients as it.

Anahtar Kelimeler

Istmocele, Laparoscopy, Hysteroscopy, Cesarean scar defect

SEZARYEN DOĞUM SEKELİ; İSTMOSEL

Öz

Bu çalışma, istmoselin tanı ve tedavisinde kullanılan yöntemler hakkında güncel literatürü ortaya çıkarmayı amaçlamaktadır. Pubmed veri tabanından 2008 - 2020 yılları arasında istmosel, niş, uterus skar defekti tanılı, İngilizce yayın dili olan, toplam 72 olgu sunumu ve klinik çalışma incelendi. Bu yayınlardan tam metnine ulaşılabilinir ve sadece isthmosel tanı ve tedavisi ile ilgili olan 32 klinik çalışma ve olgu raporu çalışmaya alındı. Kırk çalışma ise istmosel ile ilişkili yayın olmama, tam makale metnine ulaşılamaması, başka bir dilde yayımlanması nedeni ile çalışma dışı bırakıldı. Tedavi yöntemleri, başarıları, hasta semptomları ve komplikasyonlar değerlendirildi. Literatürdeki 32 klinik çalışma ve olgu raporunda tanımlanan 1021 olgu incelendi. Bu olguların 385’ine histeroskopi, 151’ine laparoskopi, 36’sına histeroskopi eşliğinde laparoskopi, 287’sine vaginal tamir, 37’sine laparoskopi eşliğinde vaginal tamir, 5’ ine laparotomi, 120’sine ise medikal tedavi uygulandığı belirlendi. Cerrahi uygulananların tamamı semptomatik hastalar olup sadece 4 hastada komplikasyon bildirilmiştir. İstmosel tanısı, özellikle klinikte çok sık kullanılan ultrasonografi ve sonohisterografi ile rahatlıkla konulabilir. Özellikle retroflex uteruslu, eski sezaryen öyküsü olan hastalarda, anormal uterin kanama, sekonder infertilite ve pelvik ağrı şikayetleri varlığında istmosel akılda tutulmalıdır. Cerrahi tedavi, özellikle semptomatik hastalarda oldukça iyi sonuçlar vermektedir

Anahtar Kelimeler

İstmosel, Laparoskopi, Histeroskopi, Sezaryen skar defekti

Kaynakça

• 1. World Health Organization Human Reproduction Programme, 10 April 2015. WHO statement on cesarean section rates. Reprod Health Matters. 2015;23(45):149-50.
• 2. Poidevin LO. The value of hysterography in the prediction of cesarean section wound defects. Am J Obstet Gynecol. 1961; 81: 67–71.
• 3. Diaz SD, Jones JE, Seryakov M, Mann WJ. Uterine rupture and dehiscence: ten year review and case control study. South Med J. 2002; 95: 431-5.
• 4. Fabres C, Aviles G, De La Jara C, et al. Thecesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med. 2003; 22: 695-700.
• 5. Van der Voet LLF, Limperg T, Veersema S,et al. Niches after cesarean section in a population seeking hysteroscopic sterilization. Eur J Obstet Gynecol Reprod Biol. 2017; 214: 104–8.
• 6. 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; 14(1): 16-20.
• 7. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, Brölmann HA, Mol BW, Huirne JA. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development.Hum Reprod. 2015; 30(12): 2695-702.
• 8. Bij de Vaate AJ, Brölmann HA, van der Voet LF, van der Slikke JW, Veersema S, Huirne JA. Ultrasound evaluation of the Cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 2011; 37(01): 93–9.
• 9. Tower AM, Frishman GN. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol. 2013; 20(5): 562–72.
• 10. Van der Voet L, Vervoort A, Veersman S, BijdeVaate A, Brolmann H, Huirne J. Minimally invasive therapy for gynaecological symptoms related to a niche in the cesarean scar: a systematic review. BJOG. 2014; (121): 145–56.
• 11. Van der Voet LF, Bij de Vaate AM, Veersema S, Brölmann HA, Huirne JA. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG. 2014; 121(2): 236-44.
• 12. Ofili-Yebovi D, Ben-Nagi J, Sawyer E, Yazbek J, Lee C, Gonzalez J, et al. Deficient lower-segment cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol. 2008; 31(1): 72-7.
• 13. Tulandi T, Cohen A. Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol. 2016; 23(6): 893-902.
• 14. Surapaneni K, Silberzweig JE. Cesarean section scar diverticulum: Appearance on hysterosalpingography. AJR Am J Roentgenol. 2008; 190: 870-4.
• 15. Chen HY, Chen SJ, Hsieh FJ. Observation of cesarean section scar by transvaginal ultrasonography. Ultrasound Med Biol. 1990; 16: 443–7.
• 16. Armstrong V, Hansen WF, Van Voorhis BJ, Syrop CH. Detection of cesarean scars by transvaginal ultrasound. Obstet Gynecol. 2003; 101: 61-5.
• 17. Setubal A, Alves J, Osório F, et al. Treatment for uterine isthmocele, a pouch-like defect at the site of cesarean section scar. J Minim Invasive Gynecol. 2018; 25(01): 38–46.
• 18. Wong WSF, Fung WT. Magnetic Resonance Imaging in the Evaluation of Cesarean Scar Defect. Gynecol Minim Invasive Ther. 2018; 7(3): 104-7.
• 19. Sipahi S, Sasaki K, Miller CE. The minimally invasive approach to the symptomatic isthmocele – what does the literature say? A step-by-step primer on laparoscopic isthmocele – excision and repair. Curr Opin Obstet Gynecol. 2017; 29(4): 257-65.
• 20. Florio P, Filippeschi M, Moncini I, Marra E, Franchini M, Gubbini G. Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility. Curr Opin Obstet Gynecol. 2012; 24(3): 180-6.
• 21. Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol. 2009; 34: 90- 7.
• 22. Roberge S, Boutin A, Chaillet N, et al. Systematic review of cesarean scar assessment in the nonpregnant state: Imaging techniques and uterine scar defect. Am J Perinatol. 2012; 29: 465-71.
• 23. Bij de Vaate AJ, Brölmann HA, van der Voet LF, van der Slikke JW, Veersema S, Huirne JA. Ultrasound evaluation of the Cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 2011; 37(1): 93-9.
• 24. Osser OV, Valentin L. Risk factors for incomplete healing of the uterine incision after caesarean section. BJOG. 2010; 117: 1119–26.
• 25. Bujold E, Goyet M, Marcoux S, et al. The role of uterine closure in the risk of uterine rupture. Obstet Gynecol. 2010; 116: 43–50.
• 26. Roberge S, Chaillet N, Boutin A, et al. Single-versus doublelayer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture. Int J Gynaecol Obstet. 2011; 115: 5–10.
• 27. Bij de Vaate AJ, van der Voet LF, Naji O, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. Ultrasound Obstet Gynecol. 2014; 43: 372–82.
• 28. Chen Y, Han P, Wang YJ, Li YX. Risk factors for incomplete healing of the uterine incision after cesarean section. Arch Gynecol Obstet. 2017; 296: 355–61.
• 29. Hayakawa H, Itakura A, Mitsui T, et al. Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography. Acta Obstet Gynecol Scand. 2006; 85: 429–34.
• 30. Thurmond AS, Harvey WJ, Smith SA. Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultrasound Med. 1999; 18(1): 13-6.
• 31. Wang CB, Chiu WW, Lee CY, Sun YL, Lin YH, Tseng CJ. Cesarean scar defect: correlation between cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol. 2009; 34(1): 85-9.
• 32. Bakavičiūtė G, Špiliauskaitė S, Meškauskienė A, Ramašauskaitė D. Laparoscopic repair of the uterine scar defect - successful treatment of secondary infertility: a case report and literature review. Acta Med Litu. 2016; 23(4): 227-31.
• 33. Gubbini G, Casadio P, Marra E. Resectoscopic correction of the isthmocele in women with postmenstrual abnormal uterine bleeding and secondary infertility. J Minim Invasive Gynecol. 2008; 15: 172–5.
• 34. Api M, Boza A, Gorgen H, et al. Should Cesarean scar defect be treated laparoscopically? A case report and review of the literature. J Minim Invasive Gynecol. 2015; 22: 1145–52.
• 35. Marotta ML, Donnez J, Squifflet J, et al. Laparoscopic repair of post-cesarean section uterine scar defects diagnosed in nonpregnant women. J Minim Invasive Gynecol. 2013; 20: 386–91.
• 36. Gubbini G, Centini G, Nascetti D, et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol. 2011; 18(2): 234-7.
• 37. Calzolari S, Sisti G, Pavone D, Ciocia E, Bianchini N, Cozzolino M. Prevalence of Infertility Among Patients With Isthmocele and Fertility Outcome After Isthmocele Surgical Treatment: A Retrospective Study. Ochsner J. 2019; 19(3): 204-9.
• 38.Smith AV, Cabrera R, Zomer MT, Ribeiro R, Talledo R, Kondo W.CombinedLaparoscopic-Hysteroscopic Isthmoplasty Using the Rendez-vous Technique Guided Step by Step.J Minim Invasive Gynecol. 2020;27(7):1469-1470.
• 39. Candiani M, Ferrari SM, Marotta E, Tandoi I, Ottolina J, Salvatore S.Mini-invasive transvaginal repair of isthmocele: a video case report. Fertil Steril. 2019; 111(4): 828-30.
• 40. Chang Y, Tsai EM, Long CY, et al. Resectoscopic treatment combined with sonohysterographic evaluation of women with postmenstrual bleeding as a result of previous cesarean delivery scar defects. Am J Obstet Gynecol. 2009; 200: 370.
• 41. Tanimura S, Funamoto H, Hosono T, et al. New diagnostic criteria and operative strategy for cesarean scar syndrome: endoscopic repair for secondary infertility caused by cesarean scar defect. J Obstet Gynaecol Res. 2015; 41: 1363–9.
• 42. Brown K, Tkacz Z. Hysteroscopic and laparoscopic management of caesarean scar (niche) defects in symptomatic patients.J Obstet Gynaecol. 2018; 38(5): 730.
• 43. Fabres C, Arriagada P, Fernandez C, Mackenna A, Zegers F, Fernandez E. Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect. J Minim Invasive Gynecol. 2005; 12: 25–8.
• 44. Feng YL, Li MX, Liang XQ, Li XM. Hysteroscopic treatment of postcesarean scar defect. J Minim Invasive Gynecol. 2012; 19: 498–502.
• 45. Wang CJ, Huang HJ, Chao A, Lin YP, Pan YJ, Horng SG. Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect. Eur J Obstet Gynecol Reprod Biol. 2011; 154: 218–22.
• 46. Florio P, Gubbini G, Marra E, et al. A retrospective case–control study comparing hysteroscopic resection versus hormonal modulation in treating menstrual disorders due to isthmocele. Gynecol Endocrinol. 2011; 27:434–8.
• 47. Gubbini G , Casadio P, Marra E. Resectoscopic correction of the "isthmocele" in women with postmenstrual abnormal uterine bleeding and secondary infertility. 2008;15(2):172-5.
• 48. Vervoort AJ, Van der Voet LF, Witmer M, et al. The HysNiche trial: hysteroscopic resection of uterine caesarean scar defect (niche) in patients with abnormal bleeding, a randomised controlled trial.BMC Womens Health. 2015; 12(15):103.
• 49. Akdemir A, Sahin C, Ari SA, Ergenoglu M, Ulukus M, Karadadas N. Determination of Isthmocele Using a Foley Catheter During Laparoscopic Repair of Cesarean Scar Defect. J Minim Invasive Gynecol. 2018; 25(1): 21-2.