Objectives: Our aim was to study the prevalence of isthmocele in cases with previous cesarean section scar presented to El Shatby maternity university hospital and its association with gynecological complications. Material and Methods: After approval of the ethics committee of Alexandria faculty of medicine, a sample of 300 patients delivered by cesarean section since 6 months or more presented by one or more of the following symptoms: Abnormal uterine bleeding (AUB) dysmenorrhea, secondary infertility, and lower abdominal pain were selected from the gynecology clinic of El Shatby maternity university hospital. All patients were subjected to history taking, clinical, and gynecological examination. Post-menstrual 2D transvaginal ultrasonography was done. Where the niche or isthmocele was seen as triangular or dome- shaped echo-free space. Data were collected and entered to the computer using Statistical Package for the Social Science program for statistical analysis. Results: Niche was found in 44 cases. Most of them were symptomatic. Duration from the last (CS) was statistically significant. Symptoms were related to number of previous cesarean sections. Conclusion: The incidence of post-cesarean section niche in El Shatby Maternity hospital was 14.67%. Most common symptoms were AUB and dyspareunia.

Background: caesarean section is the most performed major operation around the world. In this study we aim to compare in situ repair of caesarean section uterine incision to repair with uterine exteriorization.Methods: The study was conducted on 200 patients at El-Shatby maternity university hospital during the period from June 2019 to June 2020 and after ethical committee approval and obtaining an informed consent. All cases were 37 weeks gestation or more with singleton fetus prepared to have caesarean section. They were randomly allocated into 2 groups each of 100 participants: group A: with exteriorization repair of the uterus, group B: with in situ repair. After history taking, examination and laboratory investigations, elective caesarean section was done under spinal anesthesia. After delivery of the fetus and placenta, the uterus was repaired either in situ or after exteriorization followed by closure of the abdomen in layers. We assessed: primary outcome: blood loss. secondary outcome: nausea or vomiting, hypotension, operative time and duration of uterine repair, tachycardia, uterine contractility and hematoma formation. Post-operative pain, febrile illness, time of ambulation, time of return of bowel function were also assessed. Data were collected and submitted to statistical analysis. Results: In situ repair had a statistically significant decrease in intra operative nausea, vomiting and tachycardia. Exteriorization resulted in significantly shorter duration of uterine repair; unlikely duration of the whole surgery was not statistically significant. Return of intestinal sounds was statistically significant in favour of in situ repair.Conclusions: There is no definite or absolute privilege of in-situ repair versus exteriorization.