Fakhr Masoud Saadat, Mozafari Mahya, Rezvanfar Kiana, Amini Zahra, Amiri Koosha, Hosseini Reza Shah, Sarnaz Hengame, Gholami Poorya, Lavasani Zohreh
Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran (Drs Fakhr, Mozafari, Rezvanfar, Amini, Amiri, Sarnaz, and Gholami).
Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey (Mr Hosseini).
AJOG Glob Rep. 2023 Dec 13;4(2):100299. doi: 10.1016/j.xagr.2023.100299. eCollection 2024 May.
Cesarean delivery rates are increasing globally, raising concerns about associated complications such as isthmocele. Isthmoceles are pouch-like defects in the anterior uterine wall at the site of a prior cesarean delivery scar.
This study aimed to determine isthmocele prevalence, associated symptoms, and risk factors among women with a history of cesarean delivery.
This cross-sectional study evaluated 297 women with prior cesarean delivery using transvaginal ultrasound to screen for isthmocele. Data on demographics, pregnancy details, comorbidities, and indications for cesarean delivery were collected. Isthmocele was defined sonographically as any niche or defect at the hysterotomy site. Descriptive and comparative analyses identified factors associated with isthmocele.
Isthmocele prevalence was 65.3% (n=194). Abnormal vaginal bleeding was reported in 21.1% of participants, pelvic pain by 4.1% of participants, and both by 4.1% of participants. Compared to women without isthmocele, those with isthmocele were older (35.9 vs 31.6 years), had higher body mass index (26.8 vs 25.5 kg/m), gravidity (1.8 vs 1.3), and parity (1.7 vs 1.2). Repeat cesarean delivery was more common (30.4% vs 12.6%) and elective cesarean delivery less common (33.5% vs 67.9%) among those with isthmocele.
Over half of the women with history of cesarean delivery had an isthmocele. Abnormal bleeding was common. Advanced maternal age, obesity, repeat procedures, and certain comorbidities appear to increase risk. Further research on prevention and treatment is warranted given the high prevalence.
全球剖宫产率正在上升，引发了对诸如子宫峡部憩室等相关并发症的担忧。子宫峡部憩室是既往剖宫产瘢痕部位子宫前壁的袋状缺损。
本研究旨在确定有剖宫产史女性的子宫峡部憩室患病率、相关症状及危险因素。
这项横断面研究对297例有剖宫产史的女性进行经阴道超声检查以筛查子宫峡部憩室。收集了人口统计学、妊娠细节、合并症及剖宫产指征等数据。子宫峡部憩室在超声检查中被定义为子宫切口部位的任何壁龛或缺损。描述性和对比分析确定了与子宫峡部憩室相关的因素。
子宫峡部憩室患病率为65.3%（n = 194）。21.1%的参与者报告有异常阴道出血，4.1%的参与者有盆腔疼痛，4.1%的参与者两者都有。与无子宫峡部憩室的女性相比，有子宫峡部憩室的女性年龄更大（35.9岁对31.6岁），体重指数更高（26.8对25.5kg/m²），妊娠次数更多（1.8次对1.3次），产次更多（1.7次对1.2次）。有子宫峡部憩室的女性中再次剖宫产更常见（30.4%对12.6%），择期剖宫产则较少见（33.5%对67.9%）。
超过一半有剖宫产史的女性有子宫峡部憩室。异常出血很常见。高龄产妇、肥胖、再次手术及某些合并症似乎会增加风险。鉴于高患病率，有必要对预防和治疗进行进一步研究。
