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Whether or not you planned to give birth by cesarean section, you definitely didn’t plan for your incision to heal all wrong. Now what?

The aftermath of giving birth via cesarean section (C-section) can be exhausting, especially when you’re trying to take care of a newborn and recovering yourself. And if your C-section incision doesn’t heal quite right, it can cause a pouch (niche) to form in the lower part of your uterine lining. Known as isthmocele, or cesarean scar defect, this pouch can then fill with blood and fluid, which can lead to painful or irregular periods.

Cesarean scar defects are rare, but they can cause problems with future pregnancies, like ectopic pregnancy and even infertility. But at Cleveland Clinic, our gynecological experts are here to help relieve your pain, stop your uterine bleeding and preserve your fertility — for your family and for your future.

Why Choose Cleveland Clinic for Cesarean Scar Defect Care?

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Specialized knowledge:

Our board-certified, fellowship-trained providers focus solely on gynecological health and treat issues that require both surgical and nonsurgical interventions. Meet our team.

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Collaborative care:

We believe in a team approach. In addition to your gynecologist, your care team may include endocrinologists, gynecologic surgeons, interventional radiologists, maternal fetal medicine specialists and nutritionists. We also work closely with reproductive endocrinology and infertility (REI) specialists, when needed.

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Minimally invasive options:

We use hysteroscopic, laparoscopic, vaginal and robot-assisted gynecological surgery techniques to help you recover quickly and lessen your risk of complications.

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High-volume specialty:

We’ve performed thousands of hysteroscopy procedures — so many that our experts often provide clinician training on the latest treatment options in gynecological care.

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National recognition:

Cleveland Clinic is a trusted healthcare leader. We're recognized in the U.S. and throughout the world for our expertise and care.

Cesarean Scar Defect (Isthmocele) Diagnosis at Cleveland Clinic

To diagnose your cesarean scar defect, our skilled specialists need to be able to see the inside your uterus. Depending on your symptoms, your provider may use one or more leading-edge techniques to identify isthmocele. These may include:

  • 3D transvaginal ultrasound: By inserting a thin probe (transducer) into your vagina, our specialists can see uterine pictures, created by soundwaves, that they then use to locate the isthmocele and develop a treatment plan.
  • Hysteroscopy: We insert a hysteroscope (thin tube with a lighted camera) into the vagina and uterus. This instrument sends detailed images of your uterus to a monitor, which allows us to see and diagnose your isthmocele.
  • Saline infusion sonography: In this special transvaginal pelvic ultrasound, specialists use a thin, plastic tube to expand your uterus with saline (salt water) and then place a thin probe into the vagina. This lets them see a detailed image of the inside of your uterus.
  • Pelvic MRI: This painless imaging test uses magnets and radio waves to form pictures of your uterus, which can show us more about your cesarean scar defect.


We offer treatment for cesarean scar defect (isthmocele) at many locations throughout Northeast Ohio, Akron, and Florida.

Cesarean Scar Treatment at Cleveland Clinic

You’ve just had a C-section. Are you really going to have to undergo another procedure to repair your cesarean scar defect? Good news: Our surgeons have extensive experience in treating isthmocele, and in many cases, we can use minimally invasive surgery to repair your cesarean scar defect and strengthen your uterus for future pregnancies. If you’ve had an ectopic pregnancy, our surgeons can typically remove and repair the scar defect all in one surgery, saving you physically and emotionally from having to go through multiple procedures during this difficult time.

To figure out which treatment is best for you, your provider will talk to you about your future plans and whether you want to have more children. Depending on your answers, they may recommend:

Hysteroscopic and vaginal isthmocele repair

We can insert a hysteroscope to see the inside of your uterus and then use surgical instruments to repair your cesarean scar defect. This method doesn’t require any incisions (cuts), and it offers a shorter recovery time and less risk of complications than open surgery.


During laparoscopic surgery, your provider will insert a laparoscope (a very small instrument with an attached camera) through a tiny incision in your abdomen. Then, they’ll insert small surgical instruments as needed through other small incisions. This minimally invasive option allows them to repair the isthmocele with less pain, faster recovery and shorter hospital stays than open abdominal surgery.

Preserving Your Fertility

We know how important your fertility is, and we want to make sure that you have the best possible chance at having the family of your dreams. In designing your personalized cesarean scar defect treatment, our team gets to know you as a person — including your goals for future pregnancies. When needed, we can refer you to our fertility treatment center to give you the best shot at the future you’ve been counting on.

Taking the Next Step

There are many things you may have been prepared for after a C-section delivery. But a cesarean scar defect probably wasn’t one of them. Though rare, care is available. If you’ve experienced the symptoms of a cesarean scar defect (also called isthmocele), we’re here to help you. Together, we’ll craft a treatment plan that fits your life and works for you.

Getting an appointment with Cesarean scar defect experts at Cleveland Clinic is easy. Let us ease your pain and preserve your fertility.


Getting an appointment with Cesarean scar defect experts at Cleveland Clinic is easy. Let us ease your pain and preserve your fertility.

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