Presentation of isthmocoele and its management options: a review

ABSTRACT
Objective. Rapidly increasing trend of caesarean sections in day-to-day obstetric practice has increased the incidence of isthmocele. The present study aims to perform a literature review to give a comprehensive knowledge of isthmocele – a defect in the uterine wall due to previous caesarean section.
Isthmocele is defined as an iatrogenic myometrial defect of the isthmocervical anterior uterine wall at the site of previous caesarean scar due to defective tissue healing.
Materials and Methods. A non-systematic review of various articles on isthmocele and its management techniques was undertaken by searching in the databases like PubMed, Scopus, EMBASE, web of science, science direct, etc. The studies describing about isthmocele and its different management techniques were included in present study.
Results. Isthmocele has been studied in various aspects such as: risk factors, clinical symptoms, classification, diagnosis and different management options have been reported according to the actual literature data.
Conclusions. Cost effective diagnostic tool for isthmocele are transvaginal ultrasound and saline infusion sonography which are highly specific as well as sensitive. Treatment plan should be individualized depending upon the presenting symptoms like secondary infertility, size of the defect, and future conception plans. The small defects can be repaired minimal invasively with sparing techniques by hysteroscopy, and larger defects are managed by laparoscopy, vaginal approach and combined hysteroscopy and laparoscopy.