A cesarean scar defect or isthmocoele or uterine diverticulum, is a pouchlike defect of the anterior uterine isthmus at the site of a prior cesarean section. The worldwide prevalence of this condition varies from 19-84%. This occurs due to inadequate healing of myometrium at the cesarean scar site. Such patients present with postmenstrual bleeding. There occurs a collection of blood and debris in the isthmocoele diverticulum during the menstrual bleeding which later on leads to postmenopausal bleeding varying from 2-12 days. Other symptoms are dysmenorrhoea, secondary infertility, abnormal vaginal discharge, pelvic inflammatory disease etc.
A subsequent pregnancy can implant in this site leading to cesarean scar pregnancy. Such pregnancies can further lead to morbidly adherent placentas or can lead to massive bleeding which can be life threatening.
Treatment consists of excising the cesarean scar defect and reinforcing the scar site. In case of cesarean scar pregnancy , the pregnancy is excised and the scar is reinforced. This is done laproscopically in our centre.