Formation of isthmocele after caesarean section

The article presents the modern data on the cause-and-effect relations of surgical peculiarities of caesarean section with isthmocele. The main factors associated with the formation of isthmocele are the method of uterine wall closure, repeated caesarean section, cervical dilatation. The key cause of isthmocele formation is the violation of uterine wall anatomy during its suturing due to inaccurate juxtaposition of muscle layers of the wound edges and suturing the uterine wall with a single-layer suture without prisonization, fibrosis in the lower segment during repeated caesarean sections. Double-layer suture reduces the incidence of isthmocele formation or reduces the proportion of large-sized niches by increasing the thickness of the muscular layer. An additional pathophysiological factor of isthmocele formation may be endometritis, conditions for the development of which arise with a closed cervical canal with an obstacle to the outflow of the contents from the uterine cavity.