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Isthmocele
IMAGE OF THE MONTH
Isthmocele Ally Murji, MD,1,2 Karen Glass, MD,1 Nicholas Leyland, MD, MHCM2 1
Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
2
Department of Obstetrics and Gynaecology, McMaster University, Hamilton ON
A
37-year-old woman, gravida 1, para1, presented with intermenstrual bleeding and secondary infertility. Her first pregnancy resulted in a Caesarean section for failure to progress in labour. Transvaginal ultrasound demonstrated a diverticulum in the anterior wall of the uterine isthmus, at the site of her previous Caesarean section scar (Figure 1). A combined hysteroscopic and laparoscopic approach was used to repair the defect because of the close proximity to the bladder. Because of hysteroscope angulation, the anterior uterine wall defect was visualized by turning the hysteroscope around (Figure 2).
debris may also interfere with sperm transport and embryo implantation.1,2 Treatment with menstrual suppression or surgical repair can improve symptoms.
Isthmocele can cause abnormal uterine bleeding and infertility. Functioning endometrium and impaired drainage from poor scar contractility can cause blood to accumulate in the reservoir-like pouch. This can result in intermenstrual bleeding and pelvic pain. Retained blood and
2. Gubbini G, Centini G, Nascetti D, Marra E, Moncini I, Bruni L, et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol 2011;18(2):234–7.
Figure 1.
Figure 2.
Consent to publish these images was obtained from the patient. REFERENCES 1. Fabres C, Aviles G, La Jara De C, Escalona J, Muñoz JF, Mackenna A, et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med 2003;22(7):695–700; quiz701–2.
J Obstet Gynaecol Can 2013;35(9):779
SEPTEMBER JOGC SEPTEMBRE 2013 l 779
Isthmocele Ally Murji, MD,1,2 Karen Glass, MD,1 Nicholas Leyland, MD, MHCM2 1
Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
2
Department of Obstetrics and Gynaecology, McMaster University, Hamilton ON
A
37-year-old woman, gravida 1, para1, presented with intermenstrual bleeding and secondary infertility. Her first pregnancy resulted in a Caesarean section for failure to progress in labour. Transvaginal ultrasound demonstrated a diverticulum in the anterior wall of the uterine isthmus, at the site of her previous Caesarean section scar (Figure 1). A combined hysteroscopic and laparoscopic approach was used to repair the defect because of the close proximity to the bladder. Because of hysteroscope angulation, the anterior uterine wall defect was visualized by turning the hysteroscope around (Figure 2).
debris may also interfere with sperm transport and embryo implantation.1,2 Treatment with menstrual suppression or surgical repair can improve symptoms.
Isthmocele can cause abnormal uterine bleeding and infertility. Functioning endometrium and impaired drainage from poor scar contractility can cause blood to accumulate in the reservoir-like pouch. This can result in intermenstrual bleeding and pelvic pain. Retained blood and
2. Gubbini G, Centini G, Nascetti D, Marra E, Moncini I, Bruni L, et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol 2011;18(2):234–7.
Figure 1.
Figure 2.
Consent to publish these images was obtained from the patient. REFERENCES 1. Fabres C, Aviles G, La Jara De C, Escalona J, Muñoz JF, Mackenna A, et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med 2003;22(7):695–700; quiz701–2.
J Obstet Gynaecol Can 2013;35(9):779
SEPTEMBER JOGC SEPTEMBRE 2013 l 779