Resumo

MERCADO HERRERA, María Isabel; ROSAS HURTADO, Enrique Edgar  e  CASTILLO, Richard Florian. Pregnancy in a cesarean scar: Presentation of three clinical cases and review of the literatura. Vive Rev. Salud [online]. 2025, vol.8, n.23, pp.849-860.  Epub 01-Maio-2025. ISSN 2664-3243.  https://doi.org/10.33996/revistavive.v8i23.416.

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.

Palavras-chave : Cesarean section; Ectopic; Embarrassment; Scar pregnancy; Isthmocele, Niche.

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