Ultrasound Study of Risk Factors for Isthmocele After Cesarean Section

This study aimed to assess the prevalence and risk factors associated with the development of isthmocele in women following lower segment cesarean sections (LSCS), as well as to compare the effectiveness of Transvaginal Ultrasound (TVS) and Saline Infusion Sonohysterography (SIS) for diagnosing isthmocele. Conducted in the Department of Obstetrics and Gynecology, the study evaluated women post-LSCS for any indentation of at least 2 mm at the scar site, identifying this as an isthmocele, within 6 weeks to 6 months after delivery. Evaluations adhered to the 2019 modified Delphi consensus, taking into account several variables, including maternal comorbidities, closure techniques, and labor-related factors. Results showed that 30% of participants developed isthmocele. Notably, certain risk factors significantly correlated with isthmocele formation, including higher maternal body mass index (BMI), the number of previous cesarean deliveries, longer surgical duration, and characteristics of previous cesarean scars. Furthermore, diagnostic agreement between TVS and SIS was generally consistent for clinically significant parameters of isthmocele. However, slight variations in isthmocele length and its distance from the internal os were observed through Bland-Altman plots. Findings underscore the importance of managing maternal obesity early in pregnancy, advocating for vaginal birth after cesarean whenever possible, and providing thorough surgical training to lower the risk of isthmocele formation. TVS proved effective as a diagnostic tool and could be reliably used in place of SIS. Overall, these results contribute valuable insights into preventing and detecting isthmocele, improving maternal post-cesarean outcomes through proactive measures and diagnostic efficiency.