Beyond the caesarean scar: A narrative review on isthmocele and its prevalence, etiology, pathology, clinical consequences, histopathology, management, and management outcomes

With the increase in rates of caesarean section worldwide, development of isthmocele, also referred to as cesarean scar defect or niche, is increasingly recognized as one of the late complications giving rise to clinical consequences. It is associated with obstetric and gynecological problems including placenta previa, placenta accreta, pregnancy implantation at the level of the scar and uterine rupture in subsequent pregnancies, abnormal uterine bleeding, pelvic pain, subfertility, and adverse obstetric outcomes1,2. Various treatment strategies have developed for the management of isthmocele due to its clinical relevance and complications. This narrative review focuses on summarizing evidence published between 2015 and 2025 regarding clinical symptomatology, etiology, pathology, management and management outcomes of isthmocele, along with current gaps in evidence.