title: Risk factors for development of isthmocele following cesarean section.
abstract: OBJECTIVE
  The aim of this paper was to analyze the risk factors contributing to the development of isthmocele following cesarean section (CS).
  
  
  METHODS
  We retrospectively analyzed a cohort of patients presenting to our outpatient clinic for hysteroscopy. Only premenopausal patients with a history of CS were included. The risk factors investigated were: occurrence of previous vaginal delivery antecedent to CS, patient's age at CS, weeks of gestation at CS, phase of labor, type of suture (single/double layer) employed, and uterine flexion (anteversion/retroversion).
  
  
  RESULTS
  The association between the identified risk factors and the occurrence of isthmocele was found statistical significant concerning indication for hysteroscopy (c2), stage of labor (c2), age at CS (Mann-Withney U test), according to the univariate analysis. This association was then confirmed in the multivariate logistic regression model pooling all the variables together.
  
  
  CONCLUSIONS
  The significance of stage of labor to the development of isthmocele confirms previous observations and may be part of the information needed to the clinical decision of the CS time setting decision for the clinicians. Nevertheless, further prospective studies employing larger cohorts are warranted to further clarify the aforementioned risk factors before suggesting any modifications of clinical practice.
authors.affiliation: Department of Gynecology and Obstetrics University of Florence, Florence, Italy - giovanni83@email.it.
authors.forename: G
authors.initials: G
authors.lastname: Sisti
authors.forename: D
authors.initials: D
authors.lastname: Nasioudis
authors.forename: T
authors.initials: T
authors.lastname: Kanninen
authors.forename: F
authors.initials: F
authors.lastname: Sorbi
authors.forename: M
authors.initials: M
authors.lastname: Fambrini
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D002921:Cicatrix / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D016015:Logistic Models; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors