<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0300-9041</journal-id>
<journal-title><![CDATA[Ginecología y obstetricia de México]]></journal-title>
<abbrev-journal-title><![CDATA[Ginecol. obstet. Méx.]]></abbrev-journal-title>
<issn>0300-9041</issn>
<publisher>
<publisher-name><![CDATA[Federación Mexicana de Colegios de Obstetricia y Ginecología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0300-90412019001200007</article-id>
<article-id pub-id-type="doi">10.24245/gom.v87i12.2748</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Istmocele: una revisión sistemática de la literatura]]></article-title>
<article-title xml:lang="en"><![CDATA[Istmocele: a systematic review of literature]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alkon-Meadows]]></surname>
<given-names><![CDATA[Tamar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Luna-Rojas]]></surname>
<given-names><![CDATA[Martha]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hernández-Nieto]]></surname>
<given-names><![CDATA[Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sandler]]></surname>
<given-names><![CDATA[Benjamin]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Reproductive Medicine Associates on New York  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>USA</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,The Jones Institute for Reproductive Medicine  ]]></institution>
<addr-line><![CDATA[Norfolk Virginia]]></addr-line>
<country>USA</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Icahn School of Medicine at Mount Sinai  ]]></institution>
<addr-line><![CDATA[New York ]]></addr-line>
<country>USA</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<volume>87</volume>
<numero>12</numero>
<fpage>820</fpage>
<lpage>831</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0300-90412019001200007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0300-90412019001200007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0300-90412019001200007&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  OBJETIVO:  Revisar la bibliografía de la prevalencia, factores de riesgo, síntomas, diagnósticos y tratamiento de las pacientes con istmocele.  MÉTODO:  Búsqueda electrónica en las bases de datos: PubMed, EMBASE y Google Scholar. Se utilizaron los siguientes términos, palabras y sus combinaciones: &#8220;Cesarean section defect, uterine niche, isthmocele, uterine sacculation, uterine diverticulum, uterine pouch, isthmocele diagnosis, segmentocele y isthmocele treatment&#8221;. La variable primaria estudiada fueron los síntomas asociados con el istmocele. Las variables secundarias: prevalencia, factores de riesgo, diagnóstico y tratamiento.  RESULTADOS:  Se reunieron 549 artículos de los que se eliminaron 288 por duplicidad y 228 no cumplieron los criterios de inclusión; al final solo se analizaron 33 artículos. El istmocele tiene una prevalencia de 15 a 84% en mujeres con antecedente de cesárea. Su incidencia se correlaciona directamente con la cantidad de cesáreas previas. Su aparición puede ser sintomática o asintomática. La manifestación clínica más común es el sangrado uterino anormal, que sucede en 28.9 a 82% de los casos. Incluso 88% se diagnostican en el ultrasonido transvaginal. La histeroscopia quirúrgica se asoció con disminución de los síntomas en 56.9 a 100%.  CONCLUSIONES:  El istmocele suele identificarse de manera fortuita en el ultrasonido transvaginal y casi siempre es asintomático. Puede ocasionar sangrado uterino anormal e infertilidad secundaria. Su prevalencia depende del método diagnóstico utilizado. La histeroscopia es el método de tratamiento más efectivo.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  OBJECTIVE:  Review the literature on the prevalence, risk factors, symptoms, diagnoses and treatment of patients with isthmocele.  METHOD:  An electronic search was performed using the following databases: PubMed, EMBASE and Google Scholar. The following terms, words and their combinations were used: "Cesarean section defect, uterine niche, isthmocele, uterine sacculation, uterine diverticulum, uterine pouch, isthmocele diagnosis, segmentocele y isthmocele treatment&#8221;. The primary outcome was the symptoms associated with a cesarean scar defect. The secondary outcomes were prevalence, risk factors, diagnosis and treatment of istomocele.  RESULTS:  549 articles were collected, of which 288 were eliminated due to duplication and 228 did not meet the inclusion criteria; In the end, only 33 articles were analyzed. A prevalence of 15 to 84% was found in women with a previous caesarean section. The prevalence of this alteration is correlated with the number of cesarean sections; the greater the number of caesarean sections, the greater the risk of developing an isthmocele. Its presence can be symptomatic or asymptomatic. The most common symptom is abnormal uterine bleeding, occurring in a 28.9% to 82% of the patients. Up to 88% of cases are diagnosed by a transvaginal ultrasound. A surgical hysteroscopy was associated with a 56.9% to a 100% improvement of symptoms.  CONCLUSIONS:  Isthmocele is commonly identified incidentally through a transvaginal ultrasound and is usually asymptomatic. It can cause abnormal uterine bleeding and secondary infertility. Its prevalence depends on the diagnostic method used. A surgical hysteroscopy is the most effective treatment method.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Istmocele]]></kwd>
<kwd lng="es"><![CDATA[prevalencia de factores de riesgo]]></kwd>
<kwd lng="es"><![CDATA[cesárea]]></kwd>
<kwd lng="es"><![CDATA[enfermedades uterinas]]></kwd>
<kwd lng="es"><![CDATA[infertilidad]]></kwd>
<kwd lng="es"><![CDATA[hemorragia uterina]]></kwd>
<kwd lng="en"><![CDATA[Isthmocele]]></kwd>
<kwd lng="en"><![CDATA[Prevalence risk factors]]></kwd>
<kwd lng="en"><![CDATA[Cesarean section]]></kwd>
<kwd lng="en"><![CDATA[Uterine diseases]]></kwd>
<kwd lng="en"><![CDATA[Infertility]]></kwd>
<kwd lng="en"><![CDATA[Uterine hemorrhage]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Di Spiezio Sardo]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Saccone]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[McCurdy]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Bujold]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Bifulco]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Berghella]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Risk of Cesarean scar defect following single- vs double-layer uterine closure systematic review and meta-analysis of randomized controlled trials]]></article-title>
<source><![CDATA[Ultrasound Obstet Gynecol]]></source>
<year>2017</year>
<volume>50</volume>
<page-range>578-83</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Morris]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms?]]></article-title>
<source><![CDATA[Int J Gynecol Pathol]]></source>
<year>1995</year>
<volume>14</volume>
<page-range>16-20</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bij de Vaate]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Brolmann]]></surname>
<given-names><![CDATA[HA]]></given-names>
</name>
<name>
<surname><![CDATA[van der Voet]]></surname>
<given-names><![CDATA[LF]]></given-names>
</name>
<name>
<surname><![CDATA[van der Slikke]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Veersema]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Huirne]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ultrasound evaluation of the Cesarean scar relation between a niche and postmenstrual spotting]]></article-title>
<source><![CDATA[Ultrasound Obstet Gynecol]]></source>
<year>2011</year>
<volume>37</volume>
<page-range>93-9</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gubbini]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Casadio]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Marra]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Resectoscopic correction of the "isthmocele" in women with postmenstrual abnormal uterine bleeding and secondary infertility]]></article-title>
<source><![CDATA[J Minim Invasive Gynecol]]></source>
<year>2008</year>
<volume>15</volume>
<page-range>172-5</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gubbini]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Centini]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Nascetti]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility prospective study]]></article-title>
<source><![CDATA[J Minim Invasive Gynecol]]></source>
<year>2011</year>
<volume>18</volume>
<page-range>234-7</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Borges]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Scapinelli]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Depes]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Lippi]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Lopes]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Findings in patients with postmenstrual spotting with prior cesarean section]]></article-title>
<source><![CDATA[J Minim Invasive Gynecol]]></source>
<year>2010</year>
<volume>17</volume>
<page-range>361-4</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Thurmond]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Harvey]]></surname>
<given-names><![CDATA[WJ]]></given-names>
</name>
<name>
<surname><![CDATA[Smith]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cesarean section scar as a cause of abnormal vaginal bleeding diagnosis by sonohysterography]]></article-title>
<source><![CDATA[J Ultrasound Med]]></source>
<year>1999</year>
<volume>18</volume>
<page-range>13-6</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fabres]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Aviles]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[De La Jara]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The cesarean delivery scar pouch clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy]]></article-title>
<source><![CDATA[J Ultrasound Med]]></source>
<year>2003</year>
<volume>22</volume>
<page-range>695-700</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Osser]]></surname>
<given-names><![CDATA[OV]]></given-names>
</name>
<name>
<surname><![CDATA[Jokubkiene]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Valentin]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[High prevalence of defects in cesarean section scars at transvaginal ultrasound examination]]></article-title>
<source><![CDATA[Ultrasound Obstet Gynecol]]></source>
<year>2009</year>
<volume>34</volume>
<page-range>90-7</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ofili-Yebovi]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Ben-Nagi]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Sawyer]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Deficient lower-segment cesarean section scars prevalence and risk factors]]></article-title>
<source><![CDATA[Ultrasound Obstet Gynecol]]></source>
<year>2008</year>
<volume>31</volume>
<page-range>72-7</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Armstrong]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Hansen]]></surname>
<given-names><![CDATA[WF]]></given-names>
</name>
<name>
<surname><![CDATA[Van Voorhis]]></surname>
<given-names><![CDATA[BJ]]></given-names>
</name>
<name>
<surname><![CDATA[Syrop]]></surname>
<given-names><![CDATA[CH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Detection of cesarean scars by transvaginal ultrasound]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2003</year>
<volume>101</volume>
<page-range>61-5</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[CB]]></given-names>
</name>
<name>
<surname><![CDATA[Chiu]]></surname>
<given-names><![CDATA[WW]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[CY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cesarean scar defect correlation between cesarean section number, defect size, clinical symptoms and uterine position]]></article-title>
<source><![CDATA[Ultrasound Obstet Gynecol]]></source>
<year>2009</year>
<volume>34</volume>
<page-range>85-9</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[CJ]]></given-names>
</name>
<name>
<surname><![CDATA[Huang]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
<name>
<surname><![CDATA[Chao]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect]]></article-title>
<source><![CDATA[Eur J Obstet Gynecol Reprod Biol]]></source>
<year>2011</year>
<volume>154</volume>
<page-range>218-22</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Osser]]></surname>
<given-names><![CDATA[OV]]></given-names>
</name>
<name>
<surname><![CDATA[Jokubkiene]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Valentin]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cesarean section scar defects agreement between transvaginal sonographic findings with and without saline contrast enhancement]]></article-title>
<source><![CDATA[Ultrasound Obstet Gynecol]]></source>
<year>2010</year>
<volume>35</volume>
<page-range>75-83</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fabres]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Arriagada]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Fernandez]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect]]></article-title>
<source><![CDATA[J Minim Invasive Gynecol]]></source>
<year>2005</year>
<volume>12</volume>
<page-range>25-8</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Feng]]></surname>
<given-names><![CDATA[YL]]></given-names>
</name>
<name>
<surname><![CDATA[Li]]></surname>
<given-names><![CDATA[MX]]></given-names>
</name>
<name>
<surname><![CDATA[Liang]]></surname>
<given-names><![CDATA[XQ]]></given-names>
</name>
<name>
<surname><![CDATA[Li]]></surname>
<given-names><![CDATA[XM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hysteroscopic treatment of postcesarean scar defect]]></article-title>
<source><![CDATA[J Minim Invasive Gynecol]]></source>
<year>2012</year>
<volume>19</volume>
<page-range>498-502</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Liberati]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Altman]]></surname>
<given-names><![CDATA[DG]]></given-names>
</name>
<name>
<surname><![CDATA[Tetzlaff]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Mulrow]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Gøtzsche]]></surname>
<given-names><![CDATA[PC]]></given-names>
</name>
<name>
<surname><![CDATA[Ioannidis]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Clarke]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Devereaux]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
<name>
<surname><![CDATA[Kleijnen]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Moher]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health-care interventions explanation and elaboration]]></article-title>
<source><![CDATA[BMJ]]></source>
<year>2009</year>
<volume>339</volume>
<page-range>b2700</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vandenbroucke]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[von Elm]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Altman]]></surname>
<given-names><![CDATA[DG]]></given-names>
</name>
<name>
<surname><![CDATA[Gøtzsche]]></surname>
<given-names><![CDATA[PC]]></given-names>
</name>
<name>
<surname><![CDATA[Mulrow]]></surname>
<given-names><![CDATA[CD]]></given-names>
</name>
<name>
<surname><![CDATA[Pocock]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Poole]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Schlesselman]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Egger]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<collab>STROBE Initiative</collab>
<article-title xml:lang=""><![CDATA[Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) explanation and elaboration]]></article-title>
<source><![CDATA[PLoS Med]]></source>
<year>2007</year>
<volume>4</volume>
</nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pomorski]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Fuchs]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Zimmer]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the nonpregnant uterus a prospective observational study]]></article-title>
<source><![CDATA[BMC Pregnancy and Childbirth]]></source>
<year>2014</year>
<volume>14</volume>
<page-range>365</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Monteagudo]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Carreno]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Timor-Tritsch]]></surname>
<given-names><![CDATA[IE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery the ''niche'' in the scar]]></article-title>
<source><![CDATA[J Ultrasound Med]]></source>
<year>2001</year>
<volume>20</volume>
<page-range>1105-15</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chang]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Tsai]]></surname>
<given-names><![CDATA[EM]]></given-names>
</name>
<name>
<surname><![CDATA[Long]]></surname>
<given-names><![CDATA[CY]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[CL]]></given-names>
</name>
<name>
<surname><![CDATA[Kay]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Resectoscopic treatment combined with sonohysterographic evaluation of women with postmenstrual bleeding as a result of previous cesarean delivery scar defects]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>2009</year>
<volume>200</volume>
<page-range>370</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hayakawa]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Itakura]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Mitsui]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography]]></article-title>
<source><![CDATA[Acta Obstet Gynecol Scand]]></source>
<year>2006</year>
<volume>85</volume>
<page-range>429-34</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yazicioglu]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Gokdogan]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Kelekci]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Aygun]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Savan]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Incomplete healing of the uterine incision after caesarean section: Is it preventable?]]></article-title>
<source><![CDATA[Eur J Obstet Gynecol Reprod Biol]]></source>
<year>2006</year>
<volume>124</volume>
<page-range>32-6</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vervoort]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[van der Voet]]></surname>
<given-names><![CDATA[LF]]></given-names>
</name>
<name>
<surname><![CDATA[Witmer]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Thurkow]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Radder]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[van Kesteren]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The HysNiche trial hysteroscopic resection of uterine caesarean scar defect (niche) in patients with abnormal bleeding, a randomised controlled trial]]></article-title>
<source><![CDATA[BMC Women's Health]]></source>
<year>2015</year>
<volume>15</volume>
<page-range>103</page-range></nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vervoort]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Vissers]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Hehenkamp]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Brölmann]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Huirne]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life a prospective cohort study]]></article-title>
<source><![CDATA[BJOG]]></source>
<year>2018</year>
<volume>125</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>317-25</page-range></nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A comparative study of transvaginal repair and laparoscopic repair in the management of patients with previous cesarean scar defect]]></article-title>
<source><![CDATA[J Minim Invasive Gynecol]]></source>
<year>2016</year>
<volume>23</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>535-41</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Luo]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Niu]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[Q]]></given-names>
</name>
<name>
<surname><![CDATA[Xie]]></surname>
<given-names><![CDATA[HZ]]></given-names>
</name>
<name>
<surname><![CDATA[Yao]]></surname>
<given-names><![CDATA[SZ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vaginal repair of cesarean section scar diverticula]]></article-title>
<source><![CDATA[J Minim Invasive Gynecol]]></source>
<year>2012</year>
<volume>19</volume>
<page-range>454-8</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Raimondo]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hysteroscopic treatment of symptomatic cesarean induced isthmocele: a prospective study]]></article-title>
<source><![CDATA[J Minim Invasive Gynecol]]></source>
<year>2015</year>
<volume>22</volume>
<page-range>297-301</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Melo-Cerda]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Importancia ginecológica del istmocele ¿cómo y cuándo tratar?]]></article-title>
<source><![CDATA[Ginecol Obstet Mex]]></source>
<year>2017</year>
<volume>85</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>55-63</page-range></nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Menada Valenzano]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vaginal ultrasonographic and hysterosonographic evaluation of the low transverse incision after caesarean section correlation with gynecological symptoms]]></article-title>
<source><![CDATA[Gynecol Obstet Invest]]></source>
<year>2006</year>
<volume>61</volume>
<page-range>216-22</page-range></nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[HY]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Hsieh]]></surname>
<given-names><![CDATA[FJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Observation of cesarean section scar by transvaginal ultrasonography]]></article-title>
<source><![CDATA[Ultrasound Med Biol]]></source>
<year>1990</year>
<volume>16</volume>
<page-range>443-7</page-range></nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Regnard]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cesarean section scar evaluation by saline contrast sonohysterography]]></article-title>
<source><![CDATA[Ultrasoundm Obstet Gynecol]]></source>
<year>2004</year>
<volume>23</volume>
<page-range>289-92</page-range></nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Uppal]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sonographically detected caesarean section scar defects and menstrual irregularity]]></article-title>
<source><![CDATA[J Obstet Gynaecol]]></source>
<year>2011</year>
<volume>31</volume>
<page-range>413-6</page-range></nlm-citation>
</ref>
<ref id="B34">
<label>34</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[El-Mazny]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnostic correlation between sonohysterography and hysteroscopy in the assessment of uterine cavity after cesarean section]]></article-title>
<source><![CDATA[Middle East Fertil Soc J]]></source>
<year>2011</year>
<volume>16</volume>
<page-range>72-6</page-range></nlm-citation>
</ref>
<ref id="B35">
<label>35</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Borges]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Findings in patients with postmenstrual spotting with prior cesarean Section]]></article-title>
<source><![CDATA[J Minim Invasive Gynecol]]></source>
<year>2010</year>
<volume>17</volume>
<page-range>361-4</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
