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Ultrasound/Imaging

Poster Session 1

(240) Isthmocele in Patients with History of Cesarean Delivery followed by Pregnancy Complicated with Placenta Accreta

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Isthmocele, a complication of Cesarean Delivery (CD), is associated with postmenstrual spotting, secondary infertility, cesarean scar pregnancies, and abnormal placentation. The extent isthmocele is associated with development of placenta accreta spectrum (PAS) is unknown and existing data is mostly retrospective. This study aims to determine the relationship between isthmocele and development of PAS.

Study Design: A retrospective study was conducted at a National Accreta Center from January 1, 2012 through September 30, 2022. All patients with a history of CD and confirmed PAS were identified and compared to patients who did not develop PAS and underwent repeat CD. Ultrasounds were reviewed for presence, size, and appearance of isthmocele, as well as associated prenatal and demographic information. Statistical analysis included T test and Chi square with P< 0.05 considered significant when comparing the two study groups.

Results:

We identified 137 patients with a history of CD who went on to develop PAS. Among those who had early ultrasound images for review, there were 23 patients who developed PAS after CD compared to 70 patients who had normal placentation. There were no differences in age and number of prior CDs across study groups.  Patients who developed PAS were nearly 6 times as likely to have an isthmocele on early US (p=0.002). Notably, every patient with early implantation in the lower half of the uterus ultimately developed PAS whereas those patients with implantation in the upper half of the uterus did not irrespective of isthmocele diagnosis.


Conclusion: Isthmoceles diagnosed on early US are associated with a significantly increased risk of PAS. Our study highlights the importance that accurate identification of early implantation in the lower uterine segment has in prediction of development of PAS in patients with history of CD. Prospective studies are critically necessary in order to evaluate isthmocele as an independent risk factor for development of PAS.