title: Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study.
abstract: The reproductive outcome in 41 consecutive patients with cesarean-induced isthmocele and secondary infertility was evaluated prospectively. Patients included menopausal women (mean [SD; 95% CI] age, 35 [4.1; 29-42] years), with fertility duration of 3 to 8 (4.6 [28]) years with isthmocele, postmenstrual abnormal uterine bleeding, and suprapubic pelvic pain. Transvaginal ultrasound and office hysteroscopy were used to diagnosis isthmocele. Complete fertility tests were performed to exclude other causes of infertility in both female and male participants. Operative hysteroscopy was performed to correct the cesarean scar defect, and histologic findings were evaluated. Correction of isthmocele via operative hysteroscopy was successful in all cases evaluated. Patients became pregnant spontaneously between 12 and 24 months after isthmoplasty. Thirty-seven of the 41 patients (90.2%) delivered via cesarean section, and 4 (9.8%) had a spontaneous abortion in the first trimester. Isthmoplasty resulted in resolution of postmenstrual abnormal uterine bleeding and suprapubic pelvic pain in all patients. Thus, it was concluded that surgical treatment of cesarean-induced isthmocele using a minimally-invasive approach (operative hysteroscopy) restores fertility and resolves symptoms in women with a cesarean section scar and secondary infertility.
authors.affiliation: Division of Gynecology, Madre Fortunata Toniolo Hospital, Bologna, Italy.
authors.forename: Giampietro
authors.initials: G
authors.lastname: Gubbini
authors.forename: Gabriele
authors.initials: G
authors.lastname: Centini
authors.forename: Daniela
authors.initials: D
authors.lastname: Nascetti
authors.forename: Elena
authors.initials: E
authors.lastname: Marra
authors.forename: Irene
authors.initials: I
authors.lastname: Moncini
authors.forename: Luca
authors.initials: L
authors.lastname: Bruni
authors.forename: Felice
authors.initials: F
authors.lastname: Petraglia
authors.forename: Pasquale
authors.initials: P
authors.lastname: Florio
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery*