Risk Factors and Clinical Findings of Isthmocele in Women Undergoing Cesarean Section in Sari Imam Khomeini Hospital, 2017-2018

Cesarean section (C-section) is associated with high rate of complications, one of the most important of which is bleeding. Isthmocele is one of the causes of bleeding after a C-section. This study was performed to evaluate the risk factors and clinical findings of isthmocele in women undergoing C-section.

In this cross-sectional study, 200 women with a history of cesarean delivery in Sari Imam Khomeini Hospital (2017-2018) were studied. Demographic information, risk factors, and clinical and ultrasound findings were recorded. Independent t-test and Chi-square were applied for data analysis. Relationship between isthmocele risk factors and its incidence was investigated by multiple logistic regression.

In this study, 57 patients (28.5%) had isthmocele and 143 (71.5%) did not have the problem (P=0.03). According to findings, 100% of patients with isthmocele had dilatation less than 5 cm and 89.7% underwent cesarean in less than five hours since the onset of labor, indicating a significant difference compared to those without isthmocele (P=0.04 and P=0.08, respectively). Number of C-sections was higher in patients with isthmocele (1.9±0.8) than in those without isthmocele (P=0.03). Among the symptoms, there was a significant difference in abnormal uterine bleeding (P=0.02), menometrorrhagia (P=0.01), spotting (P<0.001), and dysmenorrhea (P=0.04) between the groups with and without isthmocele.

Abnormal uterine bleeding was found as the most common symptom and recurrent cesarean was identified as the most important risk factor for isthmocele, which needs to be reduced by health care providers.