The role of mechanical dilation of the cervical canal through the internal os during a cesarean section in preventing the formation of an isthmocele

Cesarean scar defect or isthmocele represents significant problem in obstetrics that may lead to subsequent complications and high healthcare burden. The aim of the current study was to investigate the effect of mechanical cervical dilation during selective cesarean section on occurrence of isthmocele. Patients and Methods: This was a prospective randomized controlled trial included 100 pregnant women at full term meeting inclusion criteria, who were admitted at the department of obstetrics, Lattakia University Hospital, during two-years period(2023-2025). Women were divided equally into two groups according to performance of mechanical cervical dilation, in which demographic characteristics, occurrence of isthmocele and related parameters were compared between two groups. The mean age was 27.43±4.3 with range of 19 to 36 years, without significant differences between two groups regarding of age, gestational age and body mass index(BMI) (p>0.05). Isthmocele was detected in 10% of dilation group versus 30% in controls,p:0.01. Width and depth were significantly reduced in dilation group;(2.76±0.2 vs. 3.13±0.8,p:0.003) and (2.26±0.2 vs. 2.57±0.4,p:0.0001) respectively, while residual  myometrium thickness(RMT) and RMT to AMT ratio were significantly increased in dilation group;(6.08±2.1 vs. 5.11±1.8,p:0.01) and (0.72±0.2 vs. 0.62±0.2,p:0.03) respectively. The current study demonstrated that mechanical cervical dilation in patients undergoing selective cesarean section decreased the incidence of isthmocele with promoting healing leading to thicker RMT.