GynecologyGynecologyГинекология2079-56962079-5831Consilium Medicum62715310.26442/20795696.2024.2.202716REVIEWОБЗОРReview ArticleIsthmocele: controversial issues of terminology, diagnosis and treatment. A reviewИстмоцеле: дискуссионные вопросы терминологии, диагностики и леченияhttps://orcid.org/0000-0001-9183-7030PodzolkovaNatalia M.ПодзолковаНаталия Михайловна
Russian Federation

D. Sci. (Med.), Prof., Russian Medical Academy of Continuous Professional Education, Botkin City Clinical Hospital

д-р мед. наук, проф., зав. каф. акушерства и гинекологии ФГБОУ ДПО РМАНПО, вед. науч. сотр. ГБУЗ «ГКБ им. С.П. Боткина»

podzolkova@gmail.comDemidovAnton V.ДемидовАнтон Владимирович
Russian Federation

Chief doctor, Pletnev City Clinical Hospital

глав. врач ГБУЗ «ГКБ им. Д.Д. Плетнева»

yuliya.sheveleva.97@mail.ruhttps://orcid.org/0000-0001-5351-0854OsadchevVasilii B.ОсадчевВасилий Борисович
Russian Federation

Cand. Sci. (Med.), Assoc. Prof., Russian Medical Academy of Continuous Professional Education, Pletnev City Clinical Hospital

канд. мед. наук, доц., доц. каф. акушерства и гинекологии ФГБОУ ДПО РМАНПО, зав. гинекологическим отд-нием ГБУЗ «ГКБ им. Д.Д. Плетнева»

yuliya.sheveleva.97@mail.ruhttps://orcid.org/0000-0001-6260-2734BabkovKirill V.БабковКирилл Владимирович
Russian Federation

Cand. Sci. (Med.), Assoc. Prof., Russian Medical Academy of Continuous Professional Education, Pletnev City Clinical Hospital

канд. мед. наук, доц., доц. каф. акушерства и гинекологии ФГБОУ ДПО РМАНПО, врач – акушер-гинеколог гинекологического отд-ния ГБУЗ «ГКБ им. Д.Д. Плетнева»

kirill.babkov@mail.ruhttps://orcid.org/0000-0003-1753-0537DenisovaYulia V.ДенисоваЮлия Вадимовна
Russian Federation

Assistant, Russian Medical Academy of Continuous Professional Education, Pletnev City Clinical Hospital

ассистент каф. акушерства и гинекологии ФГБОУ ДПО РМАНПО, врач – акушер-гинеколог гинекологического отд-ния ГБУЗ «ГКБ им. Д.Д. Плетнева»

yuliya.sheveleva.97@mail.ruRussian Medical Academy of Continuous Professional EducationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России2Botkin City Clinical HospitalГБУЗ «Городская клиническая больница им С.П. Боткина» Департамента здравоохранения г. МосквыPletnev City Clinical HospitalГБУЗ «Городская клиническая больница им. Д.Д. Плетнева» Департамента здравоохранения г. Москвы100620242621191271802202406062024Copyright ©; 2024, Consilium MedicumCopyright ©; 2024, ООО "Консилиум Медикум"2024Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://gynecology.orscience.ru/2079-5831/article/view/627153

The frequency of abdominal delivery in the world is steadily rising. Since the latter is associated with a lot of complications compared with vaginal delivery, the increase in the proportion of deliveries in women with a uterine scar through the natural birth canal is an important strategic goal of the obstetrics and gynecology community. In addition, it is established that every second patient after a cesarean section develops a defect in the scar area, which is often accompanied by various disorders of the menstrual cycle (in 25,5% of cases – abnormal uterine bleeding) and can cause secondary infertility. Both assessment of the risk of scar failure at the stage of preconceptional preparation and timely detection and treatment of isthmocele symptoms are still serious challenges facing obstetricians and gynecologists. Clinical guidelines devoted to the cesarean scar defect problem have not yet been developed. This review presents the quintessence of modern data on possible risk factors, clinical manifestations with a detailed consideration of pathophysiological mechanisms, diagnostic tools and correction methods of symptomatic isthmocele and uterine scar defect with a detailed description of indications and a comparative assessment of their effectiveness in order to standardize approaches to the diagnosis and treatment of these pathological conditions.

Частота абдоминального родоразрешения в мире неуклонно растет. Поскольку последнее сопряжено с большим, в сравнении с вагинальными родами, количеством осложнений, увеличение доли родов у женщин с рубцом на матке через естественные родовые пути служит важной стратегической задачей акушерско-гинекологического сообщества. Помимо этого установлено, что у каждой второй пациентки после кесарева сечения формируется дефект области рубца, который часто сопровождается различными нарушениями менструального цикла (в 25,5% случаев – аномальными маточными кровотечениями) и может служить причиной вторичного бесплодия. Как оценка риска развития несостоятельности рубца на этапе прегравидарной подготовки, так и своевременное выявление и лечение симптомов истмоцеле являются серьезными задачами специалистов акушерско-гинекологического профиля. Клинические рекомендации, посвященные проблеме дефекта рубца на матке после кесарева сечения, на данный момент не разработаны. С целью стандартизации подходов к диагностике и лечению данного патологического состояния в обзоре собрана квинтэссенция современных данных о возможных факторах риска, клинических проявлениях с подробным рассмотрением патофизиологических механизмов их развития, диагностических инструментах и методах коррекции с подробным описанием показаний и сравнительной оценкой эффективности существующих методик.

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