Prevalencia de istmocele en el Hospital de San José de Bogotá, Colombia / Prevalence of isthmocele at the San José Hospital in Bogotá, Colombia

Objetivo: Describir la prevalencia de istmocele como hallazgo incidental en pacientes con antecedente de cesárea y síntomas clínicos asociados. Métodos: Estudio descriptivo de corte transversal, mediante muestreo no probabilístico por conveniencia, en pacientes con antecedente de cesárea, programadas para histeroscopia entre noviembre de 2014 y marzo de 2015, en el servicio de cirugía endoscópica ginecológica del Hospital San José de Bogotá, Colombia. Resultados: 42 pacientes fueron elegibles para el estudio por su antecedente de cesárea y todas fueron incluidas. La frecuencia de istmocele fue 83,3% en la histeroscopia, con similar localización en istmo y cérvix. La principal característica clínica presentada por las pacientes fue hemorragia uterina anormal (85,7%), mientras que la menos frecuente fue infertilidad (7,1%). En las pacientes con presencia de istmocele se observó una mayor prevalencia de dismenorrea (65,7% vs. 42,9%), antecedente de 2 o más cesáreas (60% vs. 42,9%) y cesárea de urgencia (54,3% vs. 28,6%) comparadas con el grupo de pacientes sin istmocele, en este último grupo se advirtió que el 100% de las pacientes no tenían antecedente de trabajo de parto previo. En mujeres con antecedente de cesárea y presencia de síntomas como sangrado uterino anormal, dismenorrea, dolor pélvico, infertilidad y dispareunia, la frecuencia de istmocele diagnosticado por histeroscopia fue mayor del 80%. Conclusión: El istmocele se debe a la cicatrización anómala uterina posterior a una cesárea, se requieren otros estudios para determinar no solo la prevalencia sino los factores protectores que reduzcan su incidencia para tener un impacto positivo en este tipo de pacientes.

Objective: To describe the prevalence of isthmocele as an incidental finding in patients with a history of cesarean section and associated clinical symptoms. Methods: Descriptive cross-sectional study using nonprobabilistic sampling for convenience in patients with a history of cesarean section, scheduled for hysteroscopy between November 2014 and March 2015, in the gynecological endoscopic surgery service of the Hospital San José de Bogotá, Colombia. Results: 42 patients were eligible for the study because of their previous cesarean section and all were included. The frequency of isthmocele was 83.3% in hysteroscopy, with similar localization in the isthmus and cervix. The main clinical characteristic presented by the patients was abnormal uterine bleeding (85.7%), while the less common was infertility (7.1%). A higher prevalence of dysmenorrhea (65.7% vs. 42.9%) was observed in patients with isthmocele, a history of 2 or more cesareans (60% vs. 42.9%) and an emergency cesarean section (54, 3% vs. 28.6%) compared to the group of patients without isthmocele, in the latter group it was noted that 100% of the patients had no previous history of labor. In women with a history of cesarean section and presence of symptoms such as abnormal uterine bleeding, dysmenorrhea, pelvic pain, infertility and dyspareunia, the frequency of isthmocele diagnosed by hysteroscopy was greater than 80%. Conclusion: Isthmocele is due to abnormal uterine cicatrization after cesarean section, other studies are required to determine not only the prevalence but also the protective factors that reduce its incidence to have a positive impact on this kind of patients.

Histological and radiological study of the lower segment cesarean section scar and its impact on maternal health

Histological examination of the lower segment caesarean section scars taken from 100 women during repetition of caesarean section and using different types of staining showed that caesarean section scar healed by fibrous tissue formation. The amount of fibrous tissue varied from minimal amount in some cases to dense fibrous scars in other cases. Hysterographic study of the uterus 3 months after caesarean section for 20 cases was done compared to a control group of 10 cases. Post caesarean section cases showed some degree of deformity in only 2 cases, an incidence of 10% while other cases showed the usual smooth outline