ISTHMOCELE: ETIOLOGY, CLINIC, DIAGNOSIS AND TREATMENT (Literature review)

Abstract

Modern obstetrics is characterized with a loyal approach to surgical delivery, which has significantly affected the activity of maternity hospitals: the number of complications in childbirth from both the mother and fetus has decreased. The formed scar on the uterus is determined differently when examining the women in the postoperative period. Isthmocele is a hypogenic area in the myometrium within the site of postoperative scar in the form of a "niche", diverticulum or sac after cesarean section. It can lead to the development of diseases: abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, dyspareunia, infertility, adenomyosis, bladder dysfunction, as well as be the cause of ectopic pregnancy, uterine rupture, abnormalities in the placenta attachment of. Risk factors for isthmocele include low uterine incisions, a history of cervical removal, cervical dilatation of more than 5 cm, more than five hours of delivery, etc. For the first time the diagnosis of "isthmocele" is made at ultrasonic research, more often transvaginal one. The diagnosis is confirmed by hysteroscopy or constructive surgery. An important criterion for ismocele is the degree of deficiency, i.e. the ratio between the the biometry thickness on the scar and adjacent to the scar the myometrium area. Depending on the woman's reproductive plans, conservative or surgical treatment of isthmocele is recommended, using autologous stem cells to regenerate muscle tissue. Conservative treatment involves taking oral contraceptives. Surgical treatment includes the imposition of a two−row single−wing suture. The use of stem cells in the postoperative period allows a rise in the frequency of pregnancies in women with a scar on the uterus in the case of the isthmocele formation. Key words: isthmocele, cesarean section, myometrium, autocells.