Retrospective evaluation of the frequency of istmoseles by ultrasonographic examination and its relationship with symptoms in women who have given birth by caesarean section at least four times or more

The aim of this study was to retrospectively evaluate the incidence of isthmocele and associated symptoms in women with four or more caesarean sections. Of the 62 women included in the study, 13 (21%) had an isthmus and 49 (79%) did not have an isthmus.All participants were operated on in a single centre and all had their uterus sutured with a single layer of continuous locking 1/0 polyglactin suture.The surface area measurements of the isthmus (Grade) were calculated by the formula (height x base)/2 and the surface areas ranged from 4.46 to 66.61 mm² (mean: 19.35 mm²). The rate of post-coital bleeding (66.7%) and inter-postmenstrual bleeding (100%) was higher in women with Grade 3 isthmus than in women with Grade 1 and Grade 2 isthmus (p<0.05).These findings show that as the degree of isthmus increases, symptoms become more severe and negatively affect women's quality of life, labour force, general life satisfaction and quality of sexual life. In our study, retroverted uterus (53.8%) was significantly associated with isthmus (p<0.05). Considering that the caesarean section scar line-uterine corpus/stmus distance ratio is short in women with isthmocele and the physiopathology of wound healing, it seems that upper segment incisions of the uterus predispose more to the development of isthmocele. In addition, the caesarean section scar line-uterine posterior wall distance was also short and its AUC value (0.280) was significant (p<0.05).We think that these measurements are important in the early diagnosis of isthmocele.Transvaginal ultrasonography (TVUS) has high accuracy rates in the diagnosis of isthmocele and increases patient comfort as a non-invasive method. Menstrual irregularities and gynaecological symptoms were significantly higher in the group with isthmocele (p<0.05) and this was found to be due to isthmocele.Therefore, it is of great importance to optimise factors such as uterine closure methods and surgical approaches to reduce the rates of isthmocele, to develop clinical guidelines for the management of complaints due to the presence of isthmocele, and to investigate and implement effective methods for the treatment of isthmocele. Key words: Isthmocele, Post Menstrual Bleeding, Dysmenorrhoea, Caesarean section