Embarazo en cicatriz de cesárea: Presentación de tres casos clínicos y revisión de la literatura
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Vive Rev. Salud
Abstract
El embarazo por cicatriz de cesárea (ECC) es una afección poco común, pero de alto riesgo, cuya incidencia ha aumentado junto con las tasas globales de cesáreas. El istmocele, un defecto de la cicatriz uterina, se asocia a riesgos obstétricos como rotura uterina, infertilidad secundaria y sangrado anormal. El objetivo del estudio es revisar las características clínicas, las opciones de tratamiento y los resultados reproductivos en tres pacientes con ECC e istmocele. Se realizó una revisión de tres pacientes con ECC e istmocele. Se realizó una revisión narrativa basada en casos clínicos y literatura reciente, evaluando el diagnóstico por ecografía transvaginal, el tratamiento según el grosor del miometrio y la evolución clínica. Resultados: El diagnóstico precoz por ecografía es esencial, ya que hasta el 50 % de los casos son asintomáticos. El tratamiento histeroscópico fue eficaz en pacientes con miometrio ≥2,5 mm, mientras que la laparoscopia o laparotomía se indicó para miometrios más delgados (<3 mm) con resultados favorables. Una revisión sistemática demostró que el istmocele reduce significativamente las tasas de nacidos vivos en la FIV, especialmente con líquido intracavitario. La resección quirúrgica permitió el embarazo en más del 60 % de las mujeres con infertilidad secundaria. Se concluye que el manejo del CSP debe individualizarse según la clínica y la ecografía.
Embarrassment due to cesarean scars (CSE) is a relatively common but high-risk condition, the incidence of which has increased along with the global incidence of cesarean sections. Istmocele, a defect of the uterine scar, is associated with obstetric risks such as uterine rupture, secondary infertility and abnormal bleeding. The objective of the study is to review clinical characteristics, treatment options and reproductive results among three patients with ECC and isthmocele. A review of three patients with ECC and isthmocele was carried out. A narrative review was carried out based on clinical cases and recent literature, evaluating the diagnosis by transvaginal ultrasound, the treatment according to the size of the myometrium and the clinical evolution. Results: Early diagnosis by ultrasound is essential, as 50% of cases are asymptomatic. Hysteroscopic treatment was effective in patients with myometrium ≥2.5 mm, although laparoscopy or laparotomy is indicated for thinner myometriums (<3 mm) with favorable results. A systematic review demonstrated that isthmocele significantly reduces live birth rates in IVF, especially with intracavitary fluid. Surgical resection allowed the loss of more than 60% of women with secondary infertility. It is concluded that the management of CSP must be individualized according to the clinic and the ultrasound.
Embarrassment due to cesarean scars (CSE) is a relatively common but high-risk condition, the incidence of which has increased along with the global incidence of cesarean sections. Istmocele, a defect of the uterine scar, is associated with obstetric risks such as uterine rupture, secondary infertility and abnormal bleeding. The objective of the study is to review clinical characteristics, treatment options and reproductive results among three patients with ECC and isthmocele. A review of three patients with ECC and isthmocele was carried out. A narrative review was carried out based on clinical cases and recent literature, evaluating the diagnosis by transvaginal ultrasound, the treatment according to the size of the myometrium and the clinical evolution. Results: Early diagnosis by ultrasound is essential, as 50% of cases are asymptomatic. Hysteroscopic treatment was effective in patients with myometrium ≥2.5 mm, although laparoscopy or laparotomy is indicated for thinner myometriums (<3 mm) with favorable results. A systematic review demonstrated that isthmocele significantly reduces live birth rates in IVF, especially with intracavitary fluid. Surgical resection allowed the loss of more than 60% of women with secondary infertility. It is concluded that the management of CSP must be individualized according to the clinic and the ultrasound.
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Vol. 8, No. 23