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Isthmocele: evalueted prevalence, factors of risk and achivement of diagnostic for hysteroscopy

Abstract

In the past ten years, in spite of many public health policies, the rates of cesareansection(CS) delivery has continuously increasing, and has been noticed the association ofmultiple CS with occurrence of isthmocele, which is the dehiscence of CS scar. Isthmocelemay cause abnormal uterine bleeding, dyspareunia, dysmenorrhea, pelvic pain and fertilityimpairment. Though, both symptoms and risk factors are not completely clarified as well asits prevalence, which ranges from 19% to 84% depending on the method of diagnosis, such astransvaginal sonography, hysterosonography and nuclear magnetic resonance among others.Such difficulty in make diagnosis is reflected as absence of a well-established classification aswell as there is no surgical treatment fixed as gold-standard, however, is already an agreementthat the minimal invasive surgery, both laparoscopic or hysteroscopic, is the mostappropriated approach for isthmocele.Objective:The aim of this study is to establishhysteroscopy as a method of diagnosis;to determinate the prevalence and risk factorsassociated to isthmocele and connectits characteristics to symptoms presented by affectedwomen and.Methods: A prospective cohort study embracing 292 women with prior CSdeliverythat will be submitted to hysteroscopy by Bettocchi's technique to establish thediagnosis and prevalence of isthmocele. Findings in hysteroscopy will be compared totransvaginalsonography and magnetic nuclear resonance, exams with good precision fordiagnosis. All women will be also inquired about symptoms such as pelvic pain, dyspareunia,dysmenorrhea and abnormal uterine bleeding intending to correlate them with occurrence ofisthmocele and associated risk factors. (AU)

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