Factors associated with the isthmocele: an analytical case series from five hospitals in Kinshasa, Democratic Republic of Congo

Abstract

Context and objective. Isthmocele is an isthmic dehiscence of the uterine wall due to impaired healing after caesarean section. Its prevalence varies in parallel with the increasing caesarean section rate worldwide. The objective of the present study was to describe the sociodemographic and clinical characteristics of caesarean patients and to identify factors associated with isthmocele. Methods. This research was a case series conducted on medical records of patients who have been seen between 1 September 2022 and 31 December 2023 in five hospitals in Kinshasa. The recruited patients had undergone hysteroscopy three months after caesarean section. A multivariate logistic regression analysis was performed to identify the determinants of isthmocele. Results. Fifty-one caesarean sections were included in the study. The mean age of caesarean section patients was 32.2 ± 5 years. The incidence of isthmocele was 35.3%. The absence of dysmenorrhea and water breakage, as well as non-closure of the peritoneum, were associated with isthmocele in bivariate analysis. After adjustment, only undergoing at least three caesarean sections emerged as an independent determinant (aOR: 4.48, 95% CI: 1.02-19.79). Conclusion. The incidence of isthmocele is a concern in the present setting. Having undergone at least three caesarean sections is the main factor associated with isthmocele. Efforts to reduce the caesarean section rate are necessary to decrease the incidence of isthmocele. Received: April 10th, 2025 Accepted: July 26th, 2025 https://dx.doi.org/10.4314/aamed.v18i4.9