Prevalence and Clinical Features of Uterine Isthmocele Following Cesarean Sections: An Observational Study at Rabia Balkhi Hospital in Afghanistan

Background Uterine isthmocele, a defect in the uterine wall at the cesarean scar, is increasingly recognized due to the rising rate of cesarean deliveries. Often asymptomatic, it may lead to complications such as abnormal bleeding, chronic pelvic pain, secondary infertility, or uterine rupture during subsequent pregnancies. Objective This study aimed to assess the prevalence, clinical features, and associated risk factors of uterine isthmocele among women with previous cesarean scars over four years (2019-2023) at Rabia Balkhi Hospital, Afghanistan. Methods This observational study analyzed 9,207 women with prior cesarean sections, including 4,540 cases retrospectively (2019-2021) and 4,667 cases prospectively (2021-2023). The diagnosis was based on clinical evaluations and transvaginal ultrasonography. Data were analyzed using MS Excel (Microsoft Corporation, Redmond, USA), with statistical significance assessed for symptom associations and risk factors. Results Uterine isthmocele was identified in 58 women (0.63%). The most common symptom was abnormal uterine bleeding (78%, p < 0.001), followed by dysmenorrhea (48%, p = 0.793), chronic pelvic pain (31%, p = 0.004), secondary infertility (22%, p < 0.001), and hypovolemic shock (8.6%, p < 0.001). Women with three cesarean scars had the highest prevalence of isthmocele (46.5%, p < 0.001). Ultrasonography was effective in detecting isthmocele and evaluating post-surgical outcomes. Conclusion The study highlights the need for improved cesarean techniques, early ultrasonographic diagnosis, and standardized management protocols for uterine isthmocele. These findings provide a foundation for optimizing care in women with multiple cesarean scars and underscore the importance of early intervention to prevent complications.