Rupa, R., Kushvaha, S., & Venkatesh, K. (2021). Uterine Isthmocele-A Frequently Overlooked Complication of Cesarean Sections. The Indian Journal of Radiology & Imaging, 31(3), 601-604. https://doi.org/10.1055/s-0041-1736393
Rupa R, Kushvaha S, Venkatesh K. Uterine Isthmocele-A Frequently Overlooked Complication of Cesarean Sections. Indian J Radiol Imaging. 2021;31(3):601-604. doi:10.1055/s-0041-1736393
Rupa, R., et al. "Uterine Isthmocele-A Frequently Overlooked Complication of Cesarean Sections." The Indian Journal of Radiology & Imaging, vol. 31, no. 3, 2021, pp. 601-604.
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Isthmocele after cesarean can cause pain, spotting and infertility
A cesarean scar defect can cause pelvic pain, spotting and secondary infertility, a case series of three women reports. One woman was sent for MRI with a clinical diagnosis of endometriosis. All three were symptom-free after repair surgery at short-term follow-up.
Study at a glance, case series of three women: Cesarean scar defects can cause pain, spotting and infertility. Source: Rupa R et al., 2021, PMID 34790304.
Key Findings
A 28-year-old woman sent for MRI with a clinical diagnosis of endometriosis had a cesarean scar defect. MRI showed no features of uterine adenomyosis or pelvic endometriosis.
A 30-year-old woman with postmenstrual spotting for 7 months and pelvic pain, 4 years after one cesarean delivery, had a defect measuring 4.5 × 3.0 × 2.0 cm.
A 35-year-old woman evaluated for secondary infertility, with pelvic pain, menorrhagia and mild postmenstrual spotting, had a uterine niche containing blood products on MRI.
All three women had laparoscopic repair and complete relief of symptoms at short-term follow-up. The 30-year-old was asymptomatic at 6 months, and the 35-year-old had not yet conceived.
A follow-up MRI 4 months after surgery in the 28-year-old showed fibrosis at the repair site with no blood products.
Interpretation
This case series followed three women treated at one hospital for pain, spotting or infertility tied to a cesarean scar defect. Surgery relieved symptoms in all three women at short-term follow-up. A follow-up scan in one woman showed the defect had healed. The authors note that earlier studies found most of these defects stay symptom-free, and that watching and waiting or medicine usually does not help once symptoms start. The findings support larger studies of this surgery.
RRM Context
Restorative reproductive medicine looks for the underlying cause of pain, abnormal bleeding and secondary infertility before treatment begins. The first woman in this series was sent for MRI with a clinical diagnosis of endometriosis, and MRI showed a scar defect with no features of endometriosis. The authors propose that blood pooled in the pouch may make cervical mucus hostile to sperm. A scar defect in the uterus may then link to infertility.
Our editorial summary of this paper, not the article's abstract.
Abstract
Uterine isthmocele or uterine niche is a late complication of cesarean deliveries and causes chronic pelvic pain, menorrhagia or postmenstrual spotting, and infertility. As the number of cesarean sections are constantly increasing, it is important to be aware of this entity so as to make an early diagnosis. This would enable the clinicians to manage these patients efficiently. We present three patients of uterine isthmocele who were evaluated and managed at our institution.
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