Isthmocele: from risk factors to management / Istmocele: de fatores de risco ao manejo

Abstract Objective The aim of the present study was to perform a comprehensive review of the literature to provide a complete and clear picture of isthmocele-a hypoechoic area within themyometriumat the site of the uterine scar of a previous cesarean section-by exploring in depth every aspect of this condition. Methods A comprehensive review of the literature was performed to identify the most relevant studies about this topic. Results Every aspect of isthmocele has been studied and described: pathophysiology, clinical symptoms, classification, and diagnosis. Its treatment, both medical and surgical, has also been reported according to the actual literature data. Conclusion Cesarean section is the most common surgical procedure performed worldwide, and one of the consequences of this technique is isthmocele. A single and systematic classification of isthmocele is needed to improve its diagnosis and management. Further studies should be performed to better understand its pathogenesis.

Resumo Objetivo O objetivo do presente estudo foi realizar uma revisão abrangente da literatura a fim de fornecer um quadro completo e claro da istmocele-uma área hipoecoica dentro domiométrio no local da cicatriz uterina de uma cesariana anterior- aprofundando todos os aspectos desta condição Métodos Uma revisão abrangente da literatura foi realizada para identificar os estudos mais relevantes sobre este tema. Resultados Todos os aspectos da istmocele foram estudados e descritos: fisiopatologia, sintomas clínicos, classificação e diagnóstico. Os tratamentos médico e cirúrgico também foram relatados de acordo com os dados reais da literatura. Conclusão A cesárea é o procedimento cirúrgico mais comum realizado em todo o mundo, e uma das consequências desta técnica é a istmocele. Uma classificação única e sistemática da istmocele é necessária para melhorar seu diagnóstico e manejo. Novos estudos devem ser realizados para melhor entender sua patogênese.

Clinical effect of hysteroscopic scar defect orthopedic surgery on cicatrical scar of uterine incision / 中国综合临床

Objective To explore the clinical effect of hysteroscopic scar defect correction in the treatment of cesarean scar.Methods Eighty-four cases patients with cesarean section uterine incision scars who were treated in Affiliated Hospital of Hubei Polytechnic University from August 2015 to July 2016 were selected and randomly divided into observation group with hysteroscopic surgery and control group with vaginal surgery,42 cases in each group.The operation condition,clinical efficacy and the incidence of complications of the two groups were observed and compared.Results The amomt of blood loss,hospitalization expenses,hospitalization time and operation time in the observation group were (22.45±3.78) ml,(3028.89±218.79) yuan,(3.89 ±0.80) d,(20.13±2.90) min respectively,in the control group were (40.56±5.48) ml,(4189.58±269.78)yuan,(5.46 ± 1.02) d,(30.78 ± 6.99) min respectively,the differences were significant (P ＞ 0.05).The incidence of infection,relapse and incisional wound healing in the observation group were significantly lower than in the control group,the differences were significant (P＜0.05).The total effective rate was 90.48％ in the observation group and 85.71％ in the control group after treatment,the difference was not significant(P ＞0.05).Conclusion Hysteroscopic scar repair has the same effect as that of vaginal surgery,but the rate of blood loss and complication is lower than that of vaginal operation,which is safer and more effective.

Current Status and Progress on Management of Cesarean Section Scar Defect / 中国微创外科杂志

[Summary] Cesarean section scar defect is one of the most common long-term complications after cesarean section .However the indications and efficacy judgment are not definite .The main managements include medical and surgical interventions .The drug generally used in medical management is oral contraceptives , and the surgical management includes vaginal repair of cesarean section scar defect and hysteroscopic or laparoscopic repair of the defect .To minimize the incidence of cesarean section scar defect , the surgical indications should be strictly followed and the operation should be carefully performed , including application of aseptic techniques , complete removal of decidua and placental tissues , effective hemostasis , and proper suturing .