Isthmocele‑an iatrogenic pathology: A prospective study in a tertiary unit

Zampieri,Giorgia; Nitescu,Bianca; Pacu,Irina; Neacsu,Adrian; Ionescu,Cringu Antoniu

doi:10.3892/br.2024.1881

January-2025 Volume 22 Issue 1

Full Size Image

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

An International Open Access Journal Devoted to General Medicine.

January-2025 Volume 22 Issue 1

Full Size Image

Article Open Access

Isthmocele‑an iatrogenic pathology: A prospective study in a tertiary unit

Authors:
- Giorgia Zampieri
- Bianca Nitescu
- Irina Pacu
- Adrian Neacsu
- Cringu Antoniu Ionescu
View Affiliations / Copyright

Affiliations: Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania, Department of Obstetrics and Gynecology, Saint Pantelimon Emergency Clinical Hospital, 021659 Bucharest, Romania

Copyright: © Zampieri et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Article Number: 2
|
Published online on: October 15, 2024

https://doi.org/10.3892/br.2024.1881
Expand metrics +

Abstract

Isthmocele, also known as uterine niche, refers to a myometrial defect of the anterior wall of the uterine isthmus, specifically at the site of the previous C‑section scar. The prevalence of isthmocele has increased in tandem with the rise in deliveries by caesarean section. Risk factors include aspects related to the surgical procedure. The present study aimed to assess the relationship between various suture types and the development of a niche. The analysis of the present study is based on data collected from the evaluation of 52 patients, 6 weeks post C‑section performed in ‘Saint Pantelimon’ Hospital in Bucharest, Romania. The parameters examined included patient age, the number of previous births by C‑section, the type of suture used and uterine anatomy. Out of all the 52 patients, 42.3% developed an isthmocele. The results confirm a significant association between the presence of the niche and the type of suture of the first layer, proving that when non‑locking continuous suture was used, the absence of niche was observed in most cases, while using the locking continuous suture was associated with more niches. Using the continuous locking suture for the first layer was associated with severe niches, while no severe niches were observed in patients with the other two types of sutures. There is a statistically significant association between the use of continuous locking sutures for uterine closure in the first layer and the development of a uterine niche. Furthermore, all instances of severe niches were linked to this type of suture, compared with continuous non‑locking suture or interrupted suture. Given the escalating rate of C‑sections, further research is crucial to identify the suture type that minimizes the risk of isthmocele formation. The present study's limitations revolve around its exclusive focus on a single institution and the relatively small sample size.

View Figures

View References

1	Rupa R, Kushvaha S and Venkatesh K: Uterine isthmocele-a frequently overlooked complication of cesarean sections. Indian J Radiol Imaging. 31:601–604. 2021.PubMed/NCBI View Article : Google Scholar
2	C-Section Rates by Country 2024. https://worldpopulationreview.com/country-rankings/c-section-rates-by-country.
3	Nguyen AD, Duong GTT, Do DT, Nguyen DT, Tran DA, Phan TTH, Nguyen TK and Nguyen HTT: Primary cesarean section rate among full-term pregnant women with non-previous uterine scar in a hospital of Vietnam. Heliyon. 8(e12222)2022.PubMed/NCBI View Article : Google Scholar
4	Kulshrestha V, Agarwal N and Kachhawa G: Post-caesarean niche (isthmocele) in uterine scar: An update. J Obstet Gynecol India. 70:440–446. 2020.PubMed/NCBI View Article : Google Scholar
5	Iannone P, Nencini G, Bonaccorsi G, Martinello R, Pontrelli G, Scioscia M, Nappi L, Greco P and Scutiero G: Isthmocele: From risk factors to management. Rev Bras Ginecol Obstet. 41:044–052. 2019.PubMed/NCBI View Article : Google Scholar
6	Al-Ghotani B, Martini N, Alabdallah E, Alawad I and Hussien K: A large post-caesarean Niche (Isthmocele) with amenorrhea, a symptom that was not reported in the medical literature: A rare case report. Int J Surg Case Rep. 109(108528)2023.PubMed/NCBI View Article : Google Scholar
7	Di Spiezio Sardo A, Saccone G, McCurdy R, Bujold E, Bifulco G and Berghella V: Risk of cesarean scar defect following single- vs double-layer uterine closure: Systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol. 50:578–583. 2017.PubMed/NCBI View Article : Google Scholar
8	Yıldız E and Timur B: Comparison of classic single-layer uterin suture and double-layer purse-string suture techniques for uterus closure in terms of postoperative short-term uterine isthmocele: A prospective randomized controlled trial. Turk J Obstet Gynecol. 20:206–213. 2023.PubMed/NCBI View Article : Google Scholar
9	Turan GA, Gur EB, Tatar S, Gokduman A and Guclu S: Uterine closure with unlocked suture in cesarean section: Safety and quality. Pak J Med Sci. 30:530–534. 2014.PubMed/NCBI View Article : Google Scholar
10	Vervoort AJMW, Uittenbogaard LB, Hehenkamp WJK, Brölmann HAM, Mol BWJ and Huirne JAF: Why do niches develop in caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod. 30:2695–702. 2015.PubMed/NCBI View Article : Google Scholar
11	Setubal A, Alves J, Osório F, Guerra A, Fernandes R, Albornoz J and Sidiroupoulou Z: Treatment for uterine isthmocele, a pouchlike defect at the site of a cesarean section scar. J Minim Invasive Gynecol. 25:38–46. 2018.PubMed/NCBI View Article : Google Scholar
12	Hosseini E, Aghajanpour S, Zameni N and Hafezi M: Isthmocele-a neglected cause of secondary infertility and implantation failure: A case report. Clin Case Rep. 10(e05853)2022.PubMed/NCBI View Article : Google Scholar
13	Scutiero G, Iannone P, Bernardi G, Bonaccorsi G, Spadaro S, Volta CA, Greco P and Nappi L: Oxidative stress and endometriosis: A systematic review of the literature. Oxid Med Cell Longev. 2017(7265238)2017.PubMed/NCBI View Article : Google Scholar
14	Bij de Vaate AJM, Brölmann HAM, van der Voet LF, van der Slikke JW, Veersema S and Huirne JAF: Ultrasound evaluation of the cesarean scar: Relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 37:93–99. 2011.PubMed/NCBI View Article : Google Scholar
15	Setúbal A, Alves J, Osório F and Sidiropoulou Z: Demonstration of isthmocele surgical repair. J Minim Invasive Gynecol. 28:389–390. 2021.PubMed/NCBI View Article : Google Scholar

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Isthmocele‑an iatrogenic pathology: A prospective study in a tertiary unit

This article is mentioned in:

Abstract

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Figure 8

Figure 9

Figure 10

Related Articles