Takeaway
- Uterine scar defect (isthmocele) is associated with postmenstrual and postcoital bleeding.
Why this matters
- Isthmocele is most often identified on ultrasound and represents inadequate healing at the site of uterine incision after cesarean delivery (CD).
- The symptoms include abnormal uterine bleeding, pain, dysmenorrhoea, and prolonged menstrual cycles.
Key results
- The presence of isthmocele increased the rate of postmenstrual spotting (20.0% vs 8.3%; P=.004) and postcoital spotting (8.3% vs 2.4%; P=.026).
- No differences in length of menstrual cycle, dysmenorrhoea, or dyspareunia between the groups.
Study design
- A prospective observational cohort study.
- Women who underwent CD between 2016 and 2017 were asked to participate (n=401).
- Saline-contrast sonohysterography was performed 6 months postoperatively (n=371).
- Isthmocele was diagnosed as an anechoic defect at least 2.0 mm deep at the site of the CD scar.
- Bleeding questionnaires were emailed at 12, 13, and 14 months after CD.
- Primary outcome measure was the prevalence of postmenstrual spotting (≥2 days of brownish discharge at the end of a menstrual period).
- Funding: Competitive Research Funding of Pirkanmaa Hospital District and the School of University of Tampere.
Limitations
- Symptom of postmenstrual bleeding assessed without validation measures.
- Follow-up was limited to 1 year.
References
References
