Optimal Timing and Recommended Route of Delivery after Hysteroscopic Management of Isthmocele? a Consensus Statement From the Global Congress on Hysteroscopy Scientific Committee

Current data suggest the development of isthmocele in approximately 60% after a primary caesarean section (CS) and 100% after three CSs. In cases where myometrial thickness is greater than 3 mm, hysteroscopic treatment of cesarean-induced isthmocele represents a feasible and safe approach; conversely, when myometrial thickness is less than 3 mm, the laparoscopic approach should be favored due to risk of uterine perforation and bladder injury. Considering the lack of available evidence, and the need of a clear indication to counsel our patients, the members of this committee concur in recommending to strongly encourage patients to wait at least 3 months after the procedure to conceive. In addition, we suggest the use of contraception during this period and to perform a hysteroscopic follow-up study at 3 months in order to visualize surgical outcomes. Finally, as precautionary measure we recommend delivery by scheduled CS not later than 38 weeks gestation, due to hypothetical increased risk of uterine rupture.