Have a personal or library account? Click to login
Unveiling the Uterine Niche: The Impact of Isthmocele on Subsequent Pregnancy Outcomes Cover

Unveiling the Uterine Niche: The Impact of Isthmocele on Subsequent Pregnancy Outcomes

Open Access
|Dec 2025

References

  1. Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet Lond Engl. 2018;392:1341–8. https://doi.org/10.1016/S0140-6736(18)31928-7.
  2. de Luget CD, Becchis E, Fernandez H, Donnez O, Quarello E. Can uterine niche be prevented? J Gynecol Obstet Hum Reprod. 2022;51:102299. https://doi.org/10.1016/j.jogoh.2021.102299.
  3. Gozzi P, Hees KA, Berg C, David M, Wernecke K-D, Hellmeyer L, et al. Frequency and associated symptoms of isthmoceles in women 6 months after caesarean section: a prospective cohort study. Arch Gynecol Obstet. 2023;307:841–8. https://doi.org/10.1007/s00404-022-06822-8.
  4. Antila-Långsjö R, Mäenpää JU, Huhtala H, Tomás E, Staff S. Comparison of transvaginal ultrasound and saline contrast sonohysterography in evaluation of cesarean scar defect: a prospective cohort study. Acta Obstet Gynecol Scand. 2018;97:1130–6. https://doi.org/10.1111/aogs.13367.
  5. Ludwin A, Martins WP, Ludwin I. Evaluation of uterine niche by three-dimensional sonohysterography and volumetric quantification: techniques and scoring classification system. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2019;53:139–43. https://doi.org/10.1002/uog.19181.
  6. Budny-Winska J, Pomorski M. Uterine niche after cesarean section: a review of diagnostic methods. Ginekol Pol. 2021;92:726–30. https://doi.org/10.5603/GP.a2021.0195.
  7. Budny-Winska J, Zimmer-Stelmach A, Pomorski M. Two- and three-dimensional transvaginal ultrasound in assessment of the impact of selected obstetric risk factors on cesarean scar niche formation: the case-controlled study. Ginekol Pol. 2021;92:378–82. https://doi.org/10.5603/GP.a2021.0024.
  8. Armstrong F, Mulligan K, Dermott RM, Bartels HC, Carroll S, Robson M, et al. Cesarean scar niche: An evolving concern in clinical practice. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2023;161:356–66. https://doi.org/10.1002/ijgo.14509.
  9. Kremer TG, Ghiorzi IB, Dibi RP. Isthmocele: an overview of diagnosis and treatment. Rev Assoc Medica Bras 1992. 2019;65:714–21. https://doi.org/10.1590/1806-9282.65.5.714.
  10. Lee Y-L, Bai Y-S, Chang C-C, High-grade endometrial stromal sarcoma in cesarean section scar isth-mocele - case report. Taiwan J Obstet Gynecol. 2022;61:388–90. https://doi.org/10.1016/j.tjog.2022.02.036.
  11. van der Voet LF, Bij de Vaate AM, Veersema S, Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG Int J Obstet Gynaecol. 2014;121:236–44. https://doi.org/10.1111/1471-0528.12542.
  12. Bij de Vaate AJM, van der Voet LF, Naji O, Witmer M, Veersema S, Brölmann H a. M, et al. Reply: Niche risk factor for uterine rupture? Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2014;44:371–2. https://doi.org/10.1002/uog.14632.
  13. Hemminki E. Effects of cesarean section on fertility and abortions. J Reprod Med. 1986;31:620–4.
  14. Hemminki E. Impact of caesarean section on future pregnancy--a review of cohort studies. Paediatr Perinat Epidemiol. 1996;10:366–79. https://doi.org/10.1111/j.1365-3016.1996.tb00062.x.
  15. Naji O, Wynants L, Smith A, Abdallah Y, Saso S, Stalder C, et al. Does the presence of a Caesarean section scar affect implantation site and early pregnancy outcome in women attending an early pregnancy assessment unit? Hum Reprod Oxf Engl. 2013;28:1489–96. https://doi.org/10.1093/humrep/det110.
  16. Chen HY, Chen SJ, Hsieh FJ. Observation of cesarean section scar by transvaginal ultrasonography. Ultrasound Med Biol. 1990;16:443–7. https://doi.org/10.1016/0301-5629(90)90166-a.
  17. Monteagudo A, Carreno C, Timor-Tritsch IE. Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the “niche” in the scar. J Ultrasound Med Off J Am Inst Ultrasound Med. 2001;20:1105–15. https://doi.org/10.7863/jum.2001.20.10.1105.
  18. Jordans IPM, de Leeuw RA, Stegwee SI, Amso NN, Barri-Soldevila PN, van den Bosch T, et al. Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2019;53:107–15. https://doi.org/10.1002/uog.19049.
  19. Dominguez JA, Pacheco LA, Moratalla E, Carugno JA, Carrera M, Perez-Milan F, et al. Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2023;62:336–44. https://doi.org/10.1002/uog.26171.
  20. Agarwal P, Agarwal RK, Purohit A. Sonographic Assessment of Isthmocele and Its Obstetric Complications in Subsequent Pregnancies: A Pictorial Review. Indian J Radiol Imaging. 2025;35:159–68. https://doi.org/10.1055/s-0044-1788588.
  21. Leonardo-Pinto JP, Brito LGO, Belluomini RTP, Benetti-Pinto CL, Yela DA. Factors Associated to the Presence of Isthmocele Diagnosed by Pelvic Ultrasound, Magnetic Resonance Imaging or Diagnostic Hysteroscopy: A Cross-Sectional Study. Reprod Sci Thousand Oaks Calif. 2024;31:3908–12. https://doi.org/10.1007/s43032-024-01711-8.
  22. Pinto JL, Brito LO, Belluomini RP, Bennetti-Pinto CL, Yela D. 11666 Accuracy of Hysteroscopy, Pelvic Ultrasound and Magnetic Resonance Imaging for the Diagnosis of Isthmocele: A Cross-Sectional Study. J Minim Invasive Gynecol. 2024;31:S101. https://doi.org/10.1016/j.jmig.2024.09.808.
  23. Sipahi S, Sasaki K, Miller CE. The minimally invasive approach to the symptomatic isthmocele - what does the literature say? A step-by-step primer on laparoscopic isthmocele - excision and repair. Curr Opin Obstet Gynecol. 2017;29:257–65. https://doi.org/10.1097/GCO.0000000000000380.
  24. Tulandi T, Cohen A. Emerging Manifestations of Cesarean Scar Defect in Reproductive-aged Women. J Minim Invasive Gynecol. 2016;23:893–902. https://doi.org/10.1016/j.jmig.2016.06.020.
  25. Wang C-B, Chiu W-W-C, Lee C-Y, Sun Y-L, Lin Y-H, Tseng C-J. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2009;34:85–9. https://doi.org/10.1002/uog.6405.
  26. Bij de Vaate AJM, van der Voet LF, Naji O, Witmer M, Veersema S, Brölmann H a. M, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2014;43:372–82. https://doi.org/10.1002/uog.13199.
  27. Veritas Feritlity.
  28. Vervoort AJMW, Uittenbogaard LB, Hehenkamp WJK, Brölmann H a. M, Mol BWJ, Huirne J a. F. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod Oxf Engl. 2015;30:2695–702. https://doi.org/10.1093/humrep/dev240.
  29. Florio P, Filippeschi M, Moncini I, Marra E, Franchini M, Gubbini G. Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility. Curr Opin Obstet Gynecol. 2012;24:180–6. https://doi.org/10.1097/GCO.0b013e3283521202.
  30. Futyma K, Gałczyński K, Romanek K, Filipczak A, Rechberger T. When and how should we treat cesarean scar defect - isthmocoele? Ginekol Pol. 2016;87:664–8. https://doi.org/10.5603/GP.2016.0063.
  31. Liu S, Liu X, Chen Q, Zhao M, Tang Y. Potential Risk Factors for Developing Cesarean Scar Pregnancy in Women With a History of Cesarean Section. J Ultrasound Med Off J Am Inst Ultrasound Med. 2025;44:231–7. https://doi.org/10.1002/jum.16599.
  32. Gan Y, Jiang H, Zhou Y, Chen Z. Evaluation Effectiveness of Pre-Treatment Combined with Ultrasound-Guided Suction Curettage in Cesarean Scar Pregnancy: A Retrospective Cohort Study. Clin Exp Obstet Gynecol. 2024;51:213. https://doi.org/10.31083/j.ceog5109213.
  33. Abdullah NA. Outcome and treatment of cesarean scar ectopic pregnancy under ultrasound-guided vacuum aspiration. J Int Med Res. 2024;52:3000605241281692. https://doi.org/10.1177/03000605241281692.
  34. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2003;21:220–7. https://doi.org/10.1002/uog.56.
  35. Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207:44.e1–13. https://doi. org/10.1016/j.ajog.2012.04.018.
  36. Seow K-M, Huang L-W, Lin Y-H, Lin MY-S, Tsai Y-L, Hwang J-L. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2004;23:247–53. https://doi.org/10.1002/uog.974.
  37. Jurkovic D, Knez J, Appiah A, Farahani L, Mavrelos D, Ross JA. Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound-guided suction curettage. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2016;47:511–7. https://doi.org/10.1002/uog.15857.
  38. Kaelin Agten A, Jurkovic D, Timor-Tritsch I, Jones N, Johnson S, Monteagudo A, et al. First-trimester cesarean scar pregnancy: a comparative analysis of treatment options from the international registry. Am J Obstet Gynecol. 2024;230:669.e1–669.e19. https://doi.org/10.1016/j.ajog.2023.10.028.
  39. Pirtea L, Balint O, Secoşan C, Grigoraş D, Pirtea P. Case Report: Laparoscopic Isthmocele Repair on an 8 Weeks Pregnant Uterus. Front Med. 2022;9:831588. https://doi.org/10.3389/fmed.2022.831588.
  40. Harjee R, Khinda J, Bedaiwy MA. Reproductive Outcomes Following Surgical Management for Isthmoceles: A Systematic Review. J Minim Invasive Gynecol. 2021;28:1291-1302.e2. https://doi.org/10.1016/j. jmig.2021.03.012.
  41. Ma R, Zheng Y, Zhang L, Zhao R, Chen J. Pregnancy outcomes and recurrence following surgical treatment of cesarean scar pregnancy: a retrospective analysis. Front Med. 2025;12:1650262. https://doi. org/10.3389/fmed.2025.1650262.
  42. Baldini GM, Lot D, Malvasi A, Di Nanni D, Laganà AS, Angelucci C, et al. Isthmocele and Infertility. J Clin Med. 2024;13:2192. https://doi.org/10.3390/jcm13082192.
  43. Tsuji S, Takahashi A, Higuchi A, Yamanaka A, Amano T, Kimura F, et al. Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome. PloS One. 2020;15:e0243421. https://doi.org/10.1371/journal.pone.0243421.
  44. Vidal A, Geiger J, Vinayahalingam V, Pape J, Gulz M, Karrer T, et al. High live birth rates after laparoscopic isthmocele repair in infertility: a systematic review and meta-analysis. Front Endocrinol. 2025;16:1507482. https://doi.org/10.3389/fendo.2025.1507482.
  45. Einerson BD, Comstock J, Silver RM, Branch DW, Woodward PJ, Kennedy A. Placenta Accreta Spectrum Disorder: Uterine Dehiscence, Not Placental Invasion. Obstet Gynecol. 2020;135:1104–11. https://doi.org/10.1097/AOG.0000000000003793.
  46. Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Cahill AG, Beigi R, Heine RP, Silver RM, et al. Placenta Accreta Spectrum. Am J Obstet Gynecol. 2018;219:B2–16. https://doi.org/10.1016/j.ajog.2018.09.042.
  47. Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132:e259–75. https://doi.org/10.1097/AOG.0000000000002983.
  48. Morlando M, Sarno L, Napolitano R, Capone A, Tessitore G, Maruotti GM, et al. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet Gynecol Scand. 2013;92:457–60. https://doi.org/10.1111/aogs.12080.
  49. Mohamed Siraj SH, Tan KH, Wright AM. Conservative surgical approach towards placenta accreta spectrum disorders for uterine preservation. BMC Pregnancy Childbirth. 2023;23:28. https://doi.org/10.1186/s12884-023-05370-6.
  50. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries: Obstet Gynecol. 2006;107:1226–32. https://doi.org/10.1097/01.AOG.0000219750.79480.84.
  51. Jauniaux E, Jurkovic D, Hussein AM, Burton GJ. New insights into the etiopathology of placenta accreta spectrum. Am J Obstet Gynecol. 2022;227:384–91. https://doi.org/10.1016/j.ajog.2022.02.038.
  52. Abdel Fattah AT, Mowafy HE-SM, Moussa NA, Mohamed AI. Diagnosis and Management of Caesarian Section Scar Niche:Review Article. Egypt J Hosp Med. 2023;91:5219–23. https://doi.org/10.21608/ejhm.2023.304052.
  53. Kulshrestha V, Agarwal N, Kachhawa G. Post-caesarean Niche (Isthmocele) in Uterine Scar: An Update. J Obstet Gynaecol India. 2020;70:440–6. https://doi.org/10.1007/s13224-020-01370-0.
  54. Jacob S, B. S. L, S. S. Chronic abscess in isthmocele: a rare entity. Int J Reprod Contracept Obstet Gynecol. 2023;12:2867–71. https://doi.org/10.18203/2320-1770.ijrcog20232756.
  55. Iannone P, Nencini G, Bonaccorsi G, Martinello R, Pontrelli G, Scioscia M, et al. Isthmocele: From Risk Factors to Management. Rev Bras Ginecol E Obstet Rev Fed Bras Soc Ginecol E Obstet. 2019;41:44–52. https://doi.org/10.1055/s-0038-1676109.
  56. Murji A, Sanders AP, Monteiro I, Haiderbhai S, Matelski J, Walsh C, et al. Cesarean scar defects and abnormal uterine bleeding: a systematic review and meta-analysis. Fertil Steril. 2022;118:758–66. https://doi.org/10.1016/j.fertnstert.2022.06.031.
  57. Al-Ghotani B, Martini N, Alabdallah E, Alawad I, Hussien K. A large post-caesarean Niche (Isthmocele) with amenorrhea, a symptom that was not reported in the medical literature: A rare case report. Int J Surg Case Rep. 2023;109:108528. https://doi.org/10.1016/j.ijscr.2023.108528.
  58. Vidal A, Pape J, Vinayahalingam V, Gulz M, Karrer T, von Wolff M. High Risk of Chronic Endometritis in Isthmocele-A Systematic Review and Meta-Analysis. J Clin Med. 2025;14:3628. https://doi.org/10.3390/jcm14113628.
  59. Atalay Mert Ş, Kınay T, Erbey S, Kindan SE, Keskin HL. A Rare Complication of Hysteroscopic Isthmocele Surgery: Uterine Subserosal Abscess Formation. Akdeniz Med J. 2025;11:136–9. https://doi.org/10.53394/akd.1386554.
  60. Whittington JR, Slaton KB, Rhomberg ME, Ghahremani T, Thomas SL, Magann EF. Uterine Dehiscence and Subsequent Pregnancy Management: A Review of the Literature. Obstet Gynecol Surv. 2021;76:48–54. https://doi.org/10.1097/OGX.0000000000000856.
  61. Togioka BM, Tonismae T. Uterine Rupture. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Oct 21]. http://www.ncbi.nlm.nih.gov/books/NBK559209/. Accessed 21 Oct 2025.
  62. Alper E, Aksakal E, Usta I, Urman B. The Novel Parallel Closure Technique Compared to Single-Layer Closure of the Uterus After Primary Cesarean Section Decreases the Incidence of Isthmocele Formation and Increases Residual Myometrial Thickness. Cureus. 2024;16:e60932. https://doi.org/10.7759/cureus.60932.
  63. Zakherah M, Mohamed AA, Rageh AM, Abdel-aleem M. Navigating uterine niche 360 degree: a narrative review. Middle East Fertil Soc J. 2024;29:29. https://doi.org/10.1186/s43043-024-00185-7.
  64. Cohen N, Arush L, Younes G, Lavie O, Goldberg Y. Cesarean scar niche, fertility and uterine rupture during labor - A retrospective study. Eur J Obstet Gynecol Reprod Biol. 2023;286:107–11. https://doi.org/10.1016/j.ejogrb.2023.05.011.
  65. Zheng X, Yan J, Liu Z, Wang X, Xu R, Li L, et al. Safety and feasibility of trial of labor in pregnant women with cesarean scar diverticulum. J Int Med Res. 2020;48:300060520954993. https://doi.org/10.1177/0300060520954993.
  66. Savukyne E, Machtejeviene E, Paskauskas S, Ramoniene G, Nadisauskiene RJ. Transvaginal Sonographic Evaluation of Cesarean Section Scar Niche in Pregnancy: A Prospective Longitudinal Study. Medicina (Mex). 2021;57:1091. https://doi.org/10.3390/medicina57101091.
  67. Barnea ER, Ramasauskaite D, Ubom AE, Di Simone N, Mueller M, Borovac-Pinheiro A, et al. FIGO good practice recommendations for vaginal birth after cesarean section. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2025;171:17–31. https://doi.org/10.1002/ijgo.70406.
  68. Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2017;130:e217–33. https://doi.org/10.1097/AOG.0000000000002398.
  69. Surico D, Vigone A, Monateri C, Tortora M, Aquino CI. Minimally Invasive Surgery for the Excision and Repair of Cesarean Scar Defect: A Scoping Review of the Literature. Medicina (Mex). 2025;61:1123. https://doi.org/10.3390/medicina61071123.
  70. Donnez O, Donnez J, Orellana R, Dolmans M-M. Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women. Fertil Steril. 2017;107:289-296.e2. https://doi.org/10.1016/j.fertnstert.2016.09.033.
  71. Abacjew-Chmylko A, Wydra DG, Olszewska H, Sawicki S, Stefanska K. Laparoscopic repair of the caesarean section scar niche: A prospective cohort study. PloS One. 2025;20:e0318592. https://doi.org/10.1371/journal.pone.0318592.
  72. Nezhat C, Zaghi B, Baek K, et al. Outcomes of Laparoscopic Cesarean Scar Defect Repair: Retrospective and Observational Study. J Clin Med. 2023;12:3720. https://doi.org/10.3390/jcm12113720.
  73. Shapira M, Mashiach R, Meller N, Watad H, Baron A, Bouaziz J, et al. Clinical Success Rate of Extensive Hysteroscopic Cesarean Scar Defect Excision and Correlation to Histologic Findings. J Minim Invasive Gynecol. 2020;27:129–34. https://doi.org/10.1016/j.jmig.2019.03.001.
  74. Backer S, Khanna D, Sadr S, Khatibi A. Intra-operative Guidelines for the Prevention of Uterine Niche Formation in Cesarean Sections: A Review. Cureus. 2023;15:e44521. https://doi.org/10.7759/cureus.44521.
  75. Kalem Z, Kaya AE, Bakırarar B, Basbug A, Kalem MN. An Optimal Uterine Closure Technique for Better Scar Healing and Avoiding Isthmocele in Cesarean Section: A Randomized Controlled Study. J.Investig Surg Off J Acad Surg Res. 2021;34:148–56. https://doi.org/10.1080/08941939.2019.1610530.
  76. Ramezani Z, Goodarzi S, Rashidian P, Mohammadian S, Rastad H, Esmi M, et al. A comparison between laparoscopy and hysteroscopy approaches in the treatment of symptomatic isthmocele: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X. 2025;27:100405. https://doi.org/10.1016/j. eurox.2025.100405.
  77. Vitale SG, Ludwin A, Vilos GA, Török P, Tesarik J, Vitagliano A, et al. From hysteroscopy to laparoendoscopic surgery: what is the best surgical approach for symptomatic isthmocele? A systematic review and meta-analysis. Arch Gynecol Obstet. 2020;301:33–52. https://doi.org/10.1007/s00404-020-05438-0.
  78. Karampelas S, Salem Wehbe G, de Landsheere L, Badr DA, Tebache L, Nisolle M. Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section. J Clin Med. 2021;10:5785. https://doi.org/10.3390/jcm10245785.
  79. Akay E, Donbaloğlu GŞ, Bayıcı N, Aslancan R. Clinical Outcomes of Isthmocele Repair Methods: A Comparison of Transvaginal, Hysteroscopic, and Laparoscopic Approaches. Anatol J Obstet Gynecol Res. 2025;1:109–17. https://doi.org/10.4274/anajog.galenos.2024.96168.
  80. Mc Gowan S, Goumalatsou C, Kent A. Fantastic niches and where to find them: the current diagnosis and management of uterine niche. Facts Views Vis ObGyn. 2022;14:37–47. https://doi.org/10.52054/FVVO.14.1.003.
  81. Seaman SJ, Advincula AP, Parra NS, Laifer-Narin S, Arora C. Uterine isthmocele: obstetric outcomes after robotic-assisted laparoscopic repair. J Robot Surg. 2025;19:293. https://doi.org/10.1007/s11701-025-02459-2.
DOI: https://doi.org/10.2478/bgbl-2025-0018 | Journal eISSN: 2956-6851 | Journal ISSN: 0373-174X
Language: English
Page range: 71 - 94
Accepted on: Nov 17, 2025
Published on: Dec 10, 2025
Published by: The Medical Library named after S. Konopka in Warsaw
In partnership with: Paradigm Publishing Services
Publication frequency: 2 issues per year

© 2025 Magdalena Gąsior, Kinga Bojdo, Zofia Dąbrowska, Hanna Frankenstein, Katarzyna Kazimierczuk, Agata Mikołajczyk, Julia Piotrowska, Amelia Wardak, published by The Medical Library named after S. Konopka in Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.