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Strengths include the fact that isthmocele can be diagnosed on two\u2010dimensional transvaginal ultrasound, and that surgical repair may restore natural fertility potential and prevent secondary infertility, as well as reduce the risk of miscarriage and other obstetric complications. However, there is a lack of high\u2010quality evidence regarding the best diagnostic method and criteria, as well as the potential benefits of surgical repair with respect to fertility. There is a need for experienced surgeons skilled in the various isthmocele repair techniques. Isthmocele repair does not prevent the need for Cesarean delivery in subsequent pregnancies. There is increasing awareness regarding the accuracy of transvaginal ultrasound in diagnosing isthmocele. This may lead to surgical correction and prevention of obstetric and perinatal complications in subsequent pregnancies, including Cesarean scar pregnancy. Regarding threats, the existence of different surgical techniques means that there is a risk of selecting an inadequate approach if the type of isthmocele and the patient's characteristics are not considered. There is a risk of overtreatment when asymptomatic defects are repaired surgically. Finally, there is an absence of cost\u2010effectiveness analyses to justify routine repair. Thus, while there are many data suggesting that isthmocele has an adverse effect on both natural fertility and the outcome of assisted reproduction techniques, high\u2010quality evidence to support surgical isthmocele repair in all asymptomatic patients desiring future fertility are lacking. There is increasing agreement to recommend hysteroscopic repair of isthmocele as a first\u2010line approach as long as the residual myometrial thickness is at least 2.5\u20133.0\u2009mm. \u00a9 2023 The Authors. Ultrasound in Obstetrics &amp; Gynecology published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>","DOI":"10.1002\/uog.26171","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T18:22:51Z","timestamp":1675362171000},"page":"336-344","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":67,"title":["Diagnosis and management of isthmocele (Cesarean scar defect): a <scp>SWOT<\/scp> analysis"],"prefix":"10.1002","volume":"62","author":[{"given":"J. A.","family":"Dominguez","sequence":"first","affiliation":[{"name":"IERA (Instituto Extreme\u00f1o de Reproducci\u00f3n Asistida)  Badajoz Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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