Leonardo-Pinto João Paulo, Brito Luiz Gustavo Oliveira, Belluomini Renata Teles Piva, Benetti-Pinto Cristina Laguna, Yela Daniela Angerame
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Rua Alexander Fleming 101 Cidade Universitária, Campinas, SP, CEP 13083-881, Brazil.
Reprod Sci. 2024 Dec;31(12):3908-3912. doi: 10.1007/s43032-024-01711-8. Epub 2024 Sep 27.
We aimed to analyze the prevalence of isthmocele and factors associated with its onset within a cohort of women with previous history of cesarean section. A cross-sectional study with 90 women assessed from 2020 to 2022. Isthmocele was a composite variable diagnosed by transvaginal ultrasound (TVUS), magnetic resonance imaging (MRI) and/or diagnostic hysteroscopy (DxHys) and were asked about clinical symptoms, sociodemographic and obstetrical history and quality of life by the WHO-QOL questionnaire. Univariate and multivariate analysis (odds ratio (OR) plus 95% confidence intervals-CI) were performed to seek factors associated with the presence of isthmocele (5% significance level).The prevalence of isthmocele after combining MRI, TVUS and DxHys was 63.3% (n = 57). Women with isthmocele presented a higher body mass index (BMI) measured during delivery (32.70 ± 6.07 vs. 28.28 ± 9.86 kg/m;p < 0.05) than women without isthmocele. Other sociodemographic variables, obstetrical history and WHO-QOL subdomains did not differ between groups. Within women with isthmocele, the residual myometrial mantle had an average of 4.97 ± 1.57 cm. Uterine volume was higher in the isthmocele group (103.95 vs. 81.34 cm; p = 0.08), but with no statistical difference. Multivariate analysis (logistic regression) has reported that the factors associated with isthmocele were: higher BMI during delivery (aOR = 1.26[1.07-1.49];p < 0.05); longer interpartum interval (aOR = 1.22[1.03-1.46];p = 0.02) and presence of more than two cesarean sections (aOR = 2.16[1.16-4.01];p = 0.02). We concluded that a high prevalence of isthmocele was found. Women with previous cesarean section, with higher BMI during delivery and longer interdelivery interval were risk factors for the presence of isthmocele.
我们旨在分析既往有剖宫产史的女性队列中峡部缺损的患病率及其发病相关因素。这是一项横断面研究，对2020年至2022年期间的90名女性进行了评估。峡部缺损是通过经阴道超声（TVUS）、磁共振成像（MRI）和/或诊断性宫腔镜检查（DxHys）诊断的复合变量，并通过世界卫生组织生活质量问卷（WHO-QOL）询问了临床症状、社会人口统计学和产科病史以及生活质量。进行单因素和多因素分析（比值比（OR）加95%置信区间-CI）以寻找与峡部缺损存在相关的因素（显著性水平为5%）。结合MRI、TVUS和DxHys后峡部缺损的患病率为63.3%（n = 57）。有峡部缺损的女性在分娩时测量的体重指数（BMI）（32.70±6.07 vs. 28.28±9.86 kg/m；p < 0.05）高于无峡部缺损的女性。其他社会人口统计学变量、产科病史和WHO-QOL子领域在两组之间没有差异。在有峡部缺损的女性中，剩余肌层厚度平均为4.97±1.57 cm。峡部缺损组的子宫体积较高（103.95 vs. 81.34 cm；p = 0.08），但无统计学差异。多因素分析（逻辑回归）报告与峡部缺损相关的因素为：分娩时较高的BMI（调整后OR = 1.26[1.07 - 1.49]；p < 0.05）；产间期较长（调整后OR = 1.22[1.03 - 1.46]；p = 0.02）以及剖宫产次数超过两次（调整后OR = 2.16[1.16 - 4.01]；p = 0.02）。我们得出结论，峡部缺损的患病率较高。既往有剖宫产史、分娩时BMI较高和产间期较长的女性是峡部缺损存在的危险因素。
