P-748 Reproductive impact of isthmocele

Abstract Study question Delayed consequences of reproductive health disorders in patients with isthmocele the effectiveness of hysteroscopic correction of the uterine scar defect. Summary answer Hysteroscopic surgery allows to eliminate the defect of the postoperative scar on the uterus, thereby eliminating the symptoms of long-term consequences and improving reproductive health. What is known already Caesarean section rate in Eastern European countries is about 40%. A significant complication is a scar defect on the uterus, isthmocele or niche, which is detected in 24–70% of cases during ultrasonographic examination. There is no unanimous opinion on the mechanism of formation, site of incision, number of previous cesarean sections, suturing technique and maternal comorbidities, such as diabetes may all play a role. Study design, size, duration An analysis of the frequency and prevalence of uterine scar thinning after caesarean section was performed (analysis of medical records of childbirth of 100 women), assessment of reproductive health features, selection of risk factors for the formation of a uterine scar defect. Sonographic, morphological, immunohistochemical, immunoenzymatic, and laboratory markers of the inflammatory response were evaluated, as well as the main predictors of the formation of a fine scar on the uterus. Participants/materials, setting, methods The medical documentation of childbirth of 100 patients was analyzed, where in 60 cases a scar defect on the uterus was found (the main group), which made it possible to analyze the parameters of the comparison group (40 patients). In 28 patients, surgical correction of uterine scar defect was performed using hysteroscopic technique. Statistical processing of the material was carried out with Microsoft Excel application program using the “Statistica - 6.0” package. Main results and the role of chance Analysis of medical documentation allowed us to identify the most frequently diagnosed symptoms in case of verification of a uterine scar defect: abnormal uterine bleeding and spotting (43.3%), chronic pelvic pain (63.3%), usually due to iatrogenic adenomyosis, dyspareunia (36.7%), dysmenorrhea (26.7%), impaired reproductive potential and infertility (56.7%), abnormal placentation in subsequent pregnancies (36.7%). Limitations, reasons for caution It should be noted that hysteroscopic surgery is the technique of choice in patients with myometrial laxity of at least 3 mm at the upper point of the niche, most effective for abnormal uterine bleeding and dysmenorrhea, less effective for the treatment of chronic pelvic pain and infertility. Wider implications of the findings It is planned to offer practical health care a step-by-step method of restoring reproductive function in women of reproductive age with a scar on the uterus after cesarean section, taking into account the established clinical and laboratory features and predictors of the probability of the formation of isthmocele. Trial registration number No