Isthmocele is a pouch defect of the anterior uterine wall, detected at the site of the previous cesarean scar. It can be asymptomatic or cause abnormal uterine bleeding, pelvic discomfort and difficulty conceiving. The main objective of this review is to highlight the hysteroscopic and laparoscopic approaches in the management of this disorder.
During the hysteroscopic approach, the superior and inferior edges or just the superior edge of the defect are resected, removing the fibrotic tissue and allowing renewal of the continuous canal between the cervix and the uterine cavity. Whereas, the laparoscopic approach consists of direct visualization and removal of the defect followed by re-approximation of the myometrium. Both methods lead to significant improvement in symptoms and fertility.
While hysteroscopy is a quick non-morbid procedure that allows concurrent removal of other uterine pathology, laparoscopy is characterized by improved visualization and decreased risk of complications with defects less than 3mm as well as the possible correction of uterine retroversion. Definitely, randomized controlled trials are required in this field for better guidance of the diagnosis and management.
Preconception care improves pregnancy outcomes. The aim of preconception care is to identify situation in which the parents particularly mother or the fetus may be in any additional health risk, and to take steps to minimize the risk before pregnancy is possible. But the concept of preconception care is not as popular as in western countries comparing to India where the number of maternal and newborn morbidity and mortality is high.
To assess the level of knowledge among married women on preconception care by structured knowledge questionnaire; determine the effectiveness of informational booklet in terms of gain in knowledge scores; find the association between pre-test knowledge score and selected variables like age, education, occupation, type of family and parity.
Materials and methods
The study was carried out among married women between the age group of 18-35 residing in a selected village of Udupi District, Karnataka, India. An evaluative approach with one group pre-test and post-test design was used. Frequency, percentage, paired t-test and Chi-square test were used to analyze the data.
Majority (55%) of the women had poor knowledge and 45% women had average knowledge in pre-test. In the post-test 57% of women had good knowledge and 43% had average knowledge. Mean difference between the pre-test and post-test knowledge score was 7.92, p<0.001 which showed an improvement in knowledge scores among women. An association was found between educational status and knowledge among women which can be inferred that the level of knowledge is dependent on the level of education.
Majority of the married women had poor knowledge on preconception care and an informational booklet on preconception care is an effective intervention in improving the knowledge.
Preconception care; Married women; Information booklet; Knowledge level.