The uterine scar after caesarean section in the literature is called isthmocele. It is even found with the term “niche” which means recess, nest.

In case of cesarean delivery, the incision site inside the uterus is a weak point, which requires special attention for the next pregnancy.

The manner of cesarean site healing at the uterine site is multifactorial and includes the conditions under which the cesarean was performed, the manner in which the uterus was sutured (i.e., the sutures used and the type of suture) and the local healing conditions which they are unpredictable and vary from woman to woman. In addition, a posterior curvature of the uterus (a uterus tilted backwards) is a risk factor.

Consequently, only a small percentage of women will develop an isthmocele after caesarean section, and of these an even smaller percentage will be symptomatic.

A possible rupture of the uterus during labor contractions, in a subsequent pregnancy, due to this weak point, can endanger the life of the child as well as the mother herself.

Natural childbirth is possible after caesarean section, but the treating gynecologist is the one who will decide if it can be carried out, as long as all the necessary conditions are met.

Also, the implantation of the pregnancy in this weak point is problematic and with a great risk of bleeding, so in these cases termination of pregnancy is recommended.

Beyond the pregnancy period, the caesarean scar can create problems in a woman’s cycle, such as vaginal bleeding and/or foul-smelling vaginal discharge. In those cases where the healing has not been done properly, all the secretions of the uterus pool at the incision site.

This can also be a cause of secondary chronic infertility, as all these excretions can have a toxic effect on the implantation of the embryo in the endometrial cavity and even affect the results of an in vitro fertilization.

The thickness of the cesarean scar on the uterus can be measured by ultrasound before the next pregnancy to assess the risk of uterine rupture.
If the thickness of the scar is very thin, or the deficit is very large and there is a desire for pregnancy, then surgical correction of the scar is necessary, which can now be done safely by the laparoscopy method, with only one day of hospitalization. With this technique, the weak point of the uterus is removed and then sutured so that healing takes place under the best conditions.

In cases where there is no desire for pregnancy from the woman and the problem is limited only to foul-smelling vaginal secretions or vaginal bleeding, then it is possible to do the correction with the hysteroscopic method, through the natural route, with hospitalization of only a few hours. With this technique, we align the scar cavity so that blood does not pool in this area and drains into the sinus.