Antila-Långsjö RM, et al. - In this prospective observational cohort study, researchers examined factors associated with the risk for isthmocele assessed by sonohysterography. According to the sonohysterographic examination, maternal body mass index, gestational diabetes, and previous cesarean deliveries were related to an increased risk for the incomplete healing of the uterine incision.

Methods

• Eligible study participants included 401 non-pregnant women who were recruited within three days of cesarean delivery.
• In order to detect a possible isthmocele, women were assessed with sonohysterography a half-year after cesarean delivery.
• The ultrasonographer was blinded to any clinical data.
• The presence of isthmocele was the main outcome measure.
• In relation to isthmocele, type of surgery (elective vs emergency), maternal background variables, and factors related to pregnancy, labor and post-operative recovery were analyzed.
• Using a logistic regression model, they evaluated independent risk factors from univariate analysis.

Results

• A total of 371 women were examined with sonohysterography, resulting in a follow-up rate of 92.5%.
• Investigators found that the prevalence of isthmocele was 45.6%.
• A history of gestational diabetes (OR: 1.73 [95% CI: 1.02–2.92]; P=0.042), previous cesarean delivery (OR: 3.14 [95% CI: 1.90–5.17]; P < 0.001) and advanced maternal body mass index (BMI; OR: 1.06 [95% CI: 1.01–1.11]; P=0.012) were independent risk factors for isthmocele development.
• It was noted that every additional unit of BMI increased the risk of isthmocele by 6%.
• Longer duration of active labor increased the risk for isthmocele (OR: 1.06 [1.01–1.11]; P=0.032) in the subgroup of emergency cesarean delivery.
• No statistically significant difference was found in prevalence between the groups of elective and emergency cesarean delivery (P=0.898).