Resectoscopic correction of the "isthmocele" in women with postmenstrual abnormal uterine bleeding and secondary infertility
Bibliographic record
Abstract
STUDY OBJECTIVE: \n \nThe obstetric complications that a cesarean delivery may produce have been known and studied for a long time. In the last few years, new correlations with some gynecologic disturbances also emerged, such as postmenstrual abnormal uterine bleeding (PAUB), and with some cases of secondary infertility. This is due to the presence of a diverticulum on the anterior wall of the uterine isthmus or of the cervical canal at the site of a previous cesarean delivery scar. The aim of our study was to assess the effectiveness of a hysteroscopic surgical technique to correct this anatomic defect and therefore eliminate the symptoms. \nDESIGN: \n \nA prospective study (Canadian Task Force classification III). \nSETTING: \n \nPrivate clinic and university hospital. \nPATIENTS: \n \nTwenty-six patients who previously had 1 or more cesarean deliveries, were evaluated from 2001 to 2005 for postmenstrual uterine bleeding and secondary infertility in 9 patients. All patients had a "niche" (which we defined as "isthmocele") principally on the isthmus-superior third of cervical canal (18/26), but on the lower cervical tract too (8/26). All of them underwent resectoscopic correction of the "isthmocele." \nINTERVENTIONS: \n \nHysteroscopic resection of the edges and the bottom of the defect until the complete removal of the fibrotic scar tissue showing the muscular tissue below, using a cutting loop and pure cutting current. Aimed electrocoagulation of the bottom of the pouch with a roller-ball to avoid the in situ production of blood. \nMEASUREMENTS AND MAIN RESULTS: \n \nThe anatomic defect in 100% of patients treated (26/26) was repaired, thus solving the symptom. Seven of 9 patients with secondary infertility became pregnant. \nCONCLUSIONS: \n \nThe "isthmocele" represents a possible consequence of one or more cesarean deliveries and may be symptomatic in some women. It is a defect that can be easily diagnosed by hysteroscopy and successfully treated by resectoscopic technique.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".