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Am J Obstet Gynecol. 2018 Nov;219(5):458.e1-458.e8. doi: 10.1016/j.ajog.2018.09.004. Epub 2018 Sep 18.

Cesarean scar defect: a prospective study on risk factors.

Author information

1
Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland. Electronic address: riitta.antila-langsjo@pshp.fi.
2
Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
3
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
4
Tampere University Hospital, Tampere, Finland.
5
Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; BioMediTech, University of Tampere, Tampere, Finland.

Abstract

BACKGROUND:

Cesarean scar defect (isthmocele) is a known complication after cesarean delivery. It has become more common due to a rising cesarean delivery rate. Isthmocele has been associated with various gynecological and obstetric problems such as uterine rupture, cesarean scar pregnancy, and bleeding disorders.

OBJECTIVE:

We sought to prospectively investigate factors associated with the risk for isthmocele assessed by sonohysterography.

STUDY DESIGN:

A prospective observational cohort study was conducted in 401 nonpregnant women who were recruited within 3 days of cesarean delivery. Women were evaluated with sonohysterography 6 months after cesarean delivery to detect a possible isthmocele. The ultrasonographer was blinded to any clinical information. The main outcome measure was the presence of isthmocele. Type of surgery (elective vs emergency), maternal background variables, and factors related to pregnancy, labor, and postoperative recovery were analyzed in relation to isthmocele. A logistic regression model was used to assess independent risk factors from univariate analysis.

RESULTS:

In all, 371 women were examined with sonohysterography resulting in a follow-up rate of 92.5%. The prevalence of isthmocele was 45.6%. Independent risk factors for isthmocele development were a history of gestational diabetes (odds ratio, 1.73; 95% confidence interval, 1.02-2.92; P = .042), previous cesarean delivery (odds ratio, 3.14; 95% confidence interval, 1.90-5.17; P < .001), and advanced maternal body mass index (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P = .012). Every additional unit of body mass index increased the risk of isthmocele by 6%. In the subgroup of emergency cesarean delivery, longer duration of active labor increased the risk for isthmocele (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P = .032). There was no statistically significant difference in prevalence between the groups of elective and emergency cesarean delivery (P = .898).

CONCLUSION:

Based on sonohysterographic examination, maternal body mass index, gestational diabetes, and previous cesarean deliveries are associated with an increased risk for incomplete healing of the uterine incision.

KEYWORDS:

cesarean delivery; cesarean scar defect; isthmocele; sonohysterography; ultrasonography

PMID:
30240650
DOI:
10.1016/j.ajog.2018.09.004
[Indexed for MEDLINE]

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