Several cases of isthmocele due to C-section births not reported: Experts

NEW DELHI: As the number of Caesarean section (C-section) births increases across the country, cases of isthmocele – a defect caused by C-section scars – are reported to be up by 15-20 per cent. However, the number could be even higher as many cases remain undiagnosed.

Isthmocele appears as a fluid-filled, pouch-like abnormality in the anterior uterine wall at the site of a prior cesarean section, say medical experts.

Its symptoms include postmenstrual bleeding, pelvic pain, secondary infertility, and ectopic scar pregnancy. However, lack of enough awareness regarding the same is adding to the complications further.

Gynaecologist Dr Nikita Trehan said that she has been treating as many as two-three cases of isthmocele every month. Women with multiple C-section births are at a higher risk of having Isthmocele, compared to those who only had one C-section, she said.

“We have treated around 30 cases in the last year. Most cases are from north India and the prevalence is reported up to 15-20 per cent, but could be even higher since all cases are not reported or remain undiagnosed,” she said.

Dr Trehan added that isthmoceleis caused due to the position of the fluid-filled, pouch-like abnormality at the uterine isthmus.

It is also called ‘caesarean scar defect’ as the problem can occur at the endocervical canal or in the area in the lower uterine section.

She added that laparoscopic repair of uterine isthmocele is definitely a successful way of improving symptoms and thereby will be improving the fertility. The thickness of isthmocele also determines the surgical approach towards it.

“There are some cases where isthmocele is not diagnosed properly. And this, in turn, leads to symptoms being uncorrected for a prolonged period of time. No one deserves open surgeries when it can be done laparoscopically. In safe hands, even extremely difficult cases can be managed by laparoscopy today,” said Dr Shuchita Singh.