Diagnosis and management of isthmocele: a SWOT analysis
The purpose of this State-of-the-Art Review was to provide a strategic analysis, in terms of strengths, weaknesses, opportunities and threats (SWOT analysis), of the current evidence regarding the management of uterine isthmocele (Cesarean scar defect). Strengths include the fact that isthmocele can...
| Autores: | , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2023 |
| País: | España |
| Institución: | Universidad de Navarra |
| Repositorio: | Dadun. Depósito Académico Digital de la Universidad de Navarra |
| Idioma: | inglés |
| OAI Identifier: | oai:dadun.unav.edu:10171/67241 |
| Acceso en línea: | https://hdl.handle.net/10171/67241 |
| Access Level: | acceso abierto |
| Palabra clave: | Materias Investigacion::Ciencias de la Salud::Obstetricia y ginecología Materias Investigacion::Ciencias de la Salud::Cirugía |
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Diagnosis and management of isthmocele: a SWOT analysisDomínguez, J.A. (J.A.)|||/items/6bf25cfd-89a3-4b68-81cd-d330681062d5Alonso-Pacheco, L. (L.)|||/items/39dc3a8b-c52d-486e-a378-1e24c65ed2dfMoratalla, E. (E.)|||/items/f5f02f5c-bc37-4b76-a6d0-516990f42ac8Carugno, J.A. (J.A)|||/items/e80155c6-3c00-461d-8382-baee4ad714c9Carrera, M. (M.)|||/items/8d5f049c-2b6f-4fa7-8f81-f7ebac73f331Perez-Milan, F. (F.)|||/items/b75cfff9-06b2-4835-9c08-acf630fc27c3Caballero, M. (M.)|||/items/502d1534-7727-4a44-81d4-fee326c3dc45Alcazar, J.L. (Juan Luis)|||/items/60547d4c-c930-4ef2-a41a-55ae849f2e96Materias Investigacion::Ciencias de la Salud::Obstetricia y ginecologíaMaterias Investigacion::Ciencias de la Salud::CirugíaThe purpose of this State-of-the-Art Review was to provide a strategic analysis, in terms of strengths, weaknesses, opportunities and threats (SWOT analysis), of the current evidence regarding the management of uterine isthmocele (Cesarean scar defect). Strengths include the fact that isthmocele can be diagnosed on two-dimensional transvaginal ultrasound, and that surgical repair may restore natural fertility potential and prevent secondary infertility, as well as reduce the risk of miscarriage and other obstetric complications. However, there is a lack of high-quality evidence regarding the best diagnostic method and criteria, as well as the potential benefits of surgical repair with respect to fertility. There is a need for experienced surgeons skilled in the various isthmocele repair techniques. Isthmocele repair does not prevent the need for Cesarean delivery in subsequent pregnancies. There is increasing awareness regarding the accuracy of transvaginal ultrasound in diagnosing isthmocele. This may lead to surgical correction and prevention of obstetric and perinatal complications in subsequent pregnancies, including Cesarean scar pregnancy. Regarding threats, the existence of different surgical techniques means that there is a risk of selecting an inadequate approach if the type of isthmocele and the patient's characteristics are not considered. There is a risk of overtreatment when asymptomatic defects are repaired surgically. Finally, there is an absence of cost-effectiveness analyses to justify routine repair. Thus, while there are many data suggesting that isthmocele has an adverse effect on both natural fertility and the outcome of assisted reproduction techniques, high-quality evidence to support surgical isthmocele repair in all asymptomatic patients desiring future fertility are lacking. There is increasing agreement to recommend hysteroscopic repair of isthmocele as a first-line approach as long as the residual myometrial thickness is at least 2.5-3.0 mm. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.WileyDadun. Depósito Académico Digital Universidad de Navarra20232023-09-1420232023-01-0120232023-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10171/67241reponame:Dadun. Depósito Académico Digital de la Universidad de Navarrainstname:Universidad de NavarraInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:dadun.unav.edu:10171/672412026-06-21T12:47:57Z |
| dc.title.none.fl_str_mv |
Diagnosis and management of isthmocele: a SWOT analysis |
| title |
Diagnosis and management of isthmocele: a SWOT analysis |
| spellingShingle |
Diagnosis and management of isthmocele: a SWOT analysis Domínguez, J.A. (J.A.)|||/items/6bf25cfd-89a3-4b68-81cd-d330681062d5 Materias Investigacion::Ciencias de la Salud::Obstetricia y ginecología Materias Investigacion::Ciencias de la Salud::Cirugía |
| title_short |
Diagnosis and management of isthmocele: a SWOT analysis |
| title_full |
Diagnosis and management of isthmocele: a SWOT analysis |
| title_fullStr |
Diagnosis and management of isthmocele: a SWOT analysis |
| title_full_unstemmed |
Diagnosis and management of isthmocele: a SWOT analysis |
| title_sort |
Diagnosis and management of isthmocele: a SWOT analysis |
| dc.creator.none.fl_str_mv |
Domínguez, J.A. (J.A.)|||/items/6bf25cfd-89a3-4b68-81cd-d330681062d5 Alonso-Pacheco, L. (L.)|||/items/39dc3a8b-c52d-486e-a378-1e24c65ed2df Moratalla, E. (E.)|||/items/f5f02f5c-bc37-4b76-a6d0-516990f42ac8 Carugno, J.A. (J.A)|||/items/e80155c6-3c00-461d-8382-baee4ad714c9 Carrera, M. (M.)|||/items/8d5f049c-2b6f-4fa7-8f81-f7ebac73f331 Perez-Milan, F. (F.)|||/items/b75cfff9-06b2-4835-9c08-acf630fc27c3 Caballero, M. (M.)|||/items/502d1534-7727-4a44-81d4-fee326c3dc45 Alcazar, J.L. (Juan Luis)|||/items/60547d4c-c930-4ef2-a41a-55ae849f2e96 |
| author |
Domínguez, J.A. (J.A.)|||/items/6bf25cfd-89a3-4b68-81cd-d330681062d5 |
| author_facet |
Domínguez, J.A. (J.A.)|||/items/6bf25cfd-89a3-4b68-81cd-d330681062d5 Alonso-Pacheco, L. (L.)|||/items/39dc3a8b-c52d-486e-a378-1e24c65ed2df Moratalla, E. (E.)|||/items/f5f02f5c-bc37-4b76-a6d0-516990f42ac8 Carugno, J.A. (J.A)|||/items/e80155c6-3c00-461d-8382-baee4ad714c9 Carrera, M. (M.)|||/items/8d5f049c-2b6f-4fa7-8f81-f7ebac73f331 Perez-Milan, F. (F.)|||/items/b75cfff9-06b2-4835-9c08-acf630fc27c3 Caballero, M. (M.)|||/items/502d1534-7727-4a44-81d4-fee326c3dc45 Alcazar, J.L. (Juan Luis)|||/items/60547d4c-c930-4ef2-a41a-55ae849f2e96 |
| author_role |
author |
| author2 |
Alonso-Pacheco, L. (L.)|||/items/39dc3a8b-c52d-486e-a378-1e24c65ed2df Moratalla, E. (E.)|||/items/f5f02f5c-bc37-4b76-a6d0-516990f42ac8 Carugno, J.A. (J.A)|||/items/e80155c6-3c00-461d-8382-baee4ad714c9 Carrera, M. (M.)|||/items/8d5f049c-2b6f-4fa7-8f81-f7ebac73f331 Perez-Milan, F. (F.)|||/items/b75cfff9-06b2-4835-9c08-acf630fc27c3 Caballero, M. (M.)|||/items/502d1534-7727-4a44-81d4-fee326c3dc45 Alcazar, J.L. (Juan Luis)|||/items/60547d4c-c930-4ef2-a41a-55ae849f2e96 |
| author2_role |
author author author author author author author |
| dc.contributor.none.fl_str_mv |
Dadun. Depósito Académico Digital Universidad de Navarra |
| dc.subject.none.fl_str_mv |
Materias Investigacion::Ciencias de la Salud::Obstetricia y ginecología Materias Investigacion::Ciencias de la Salud::Cirugía |
| topic |
Materias Investigacion::Ciencias de la Salud::Obstetricia y ginecología Materias Investigacion::Ciencias de la Salud::Cirugía |
| description |
The purpose of this State-of-the-Art Review was to provide a strategic analysis, in terms of strengths, weaknesses, opportunities and threats (SWOT analysis), of the current evidence regarding the management of uterine isthmocele (Cesarean scar defect). Strengths include the fact that isthmocele can be diagnosed on two-dimensional transvaginal ultrasound, and that surgical repair may restore natural fertility potential and prevent secondary infertility, as well as reduce the risk of miscarriage and other obstetric complications. However, there is a lack of high-quality evidence regarding the best diagnostic method and criteria, as well as the potential benefits of surgical repair with respect to fertility. There is a need for experienced surgeons skilled in the various isthmocele repair techniques. Isthmocele repair does not prevent the need for Cesarean delivery in subsequent pregnancies. There is increasing awareness regarding the accuracy of transvaginal ultrasound in diagnosing isthmocele. This may lead to surgical correction and prevention of obstetric and perinatal complications in subsequent pregnancies, including Cesarean scar pregnancy. Regarding threats, the existence of different surgical techniques means that there is a risk of selecting an inadequate approach if the type of isthmocele and the patient's characteristics are not considered. There is a risk of overtreatment when asymptomatic defects are repaired surgically. Finally, there is an absence of cost-effectiveness analyses to justify routine repair. Thus, while there are many data suggesting that isthmocele has an adverse effect on both natural fertility and the outcome of assisted reproduction techniques, high-quality evidence to support surgical isthmocele repair in all asymptomatic patients desiring future fertility are lacking. There is increasing agreement to recommend hysteroscopic repair of isthmocele as a first-line approach as long as the residual myometrial thickness is at least 2.5-3.0 mm. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
| publishDate |
2023 |
| dc.date.none.fl_str_mv |
2023 2023-09-14 2023 2023-01-01 2023 2023-01-01 |
| dc.type.none.fl_str_mv |
journal article http://purl.org/coar/resource_type/c_6501 |
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info:eu-repo/semantics/article |
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article |
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https://hdl.handle.net/10171/67241 |
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https://hdl.handle.net/10171/67241 |
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Inglés eng |
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Inglés |
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eng |
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open access http://purl.org/coar/access_right/c_abf2 |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 |
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openAccess |
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application/pdf |
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Wiley |
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Wiley |
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reponame:Dadun. Depósito Académico Digital de la Universidad de Navarra instname:Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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