Gynaecological morbidity associated with caesarean niche: increasing awareness, prevention and management

Brook, Adam; Bhatia, Kalsang

doi:10.1111/tog.12642

Cited by 4 publications

(10 citation statements)

References 31 publications

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“…Transvaginal ultrasonography (TV/US), being noninvasive and widely available, is the primary tool for assessing women with abnormal uterine bleeding (AUB) and a history of CS delivery. TV/US can detect uterine niche in 50% of cases, but its effectiveness depends on operator skill and hormonal influences [21]. Before the European Niche Taskforce's 2019 recommendations, there were no standardized criteria for assessing CS niche.…”

Section: A) Imagingmentioning

confidence: 99%

“…A landmark article by the Taskforce established a standardized method for identifying and assessing uterine niche using ultrasonography in non-pregnant women. Gel instillation sonography remains the standard method, but ultrasonography, performed during specific cycle days (7)(8)(9)(10)(11)(12)(13)(14), may provide sufficient information without the need for gel instillation [21].…”

Section: A) Imagingmentioning

confidence: 99%

“…Table 4 summarizes the international guidelines for ultrasound evaluation of the niche [21,24] (Appendix A). (2) Other imaging ➢HSG Hysterosalpingography (HSG) was among the initial modalities used to diagnose uterine niche (Fig.…”

Section: • Tips For the Visualization Of Nichesmentioning

confidence: 99%

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Navigating uterine niche 360 degree: a narrative review

Zakherah,

Mohamed,

Rageh

et al. 2024

Middle East Fertil Soc J

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Background The increasing prevalence of cesarean section (CS) deliveries globally has sparked apprehension regarding potential long-term complications, notably the emergence of uterine niches. CS results in a scar that in certain patients, inadequate healing of that scar results in the development of a uterine niche. While most small niches show no symptoms, large cesarean scar niches in nonpregnant women can give rise to cesarean scar disorder syndrome. This syndrome is characterized by abnormal uterine bleeding, dysmenorrhea, and secondary infertility. In pregnant women, the presence of substantial niches may be linked to potentially life-threatening complications, including cesarean scar dehiscence, uterine rupture, placenta accreta spectrum disorders, placenta previa, and cesarean scar ectopic pregnancy. Main body Given the potential dangers associated with uterine niche occurrence, numerous studies in recent years have delved into the concept of cesarean scar niche, exploring its risk factors, diagnostic approaches, and treatment options. Various diagnostic modalities, such as two- or three-dimensional transvaginal ultrasonography, two- and three-dimensional sono-hysterography, hysterosalpingography, hysteroscopy, or magnetic resonance imaging, can be employed to detect uterine niches. However, none of these diagnostic methods is universally accepted as the “gold standard,” and there remains a lack of unequivocal guidelines on certain aspects related to the diagnosis of cesarean scar niche. These niches, characterized by hypoechoic regions within the myometrium at the site of a previous CS scar, pose diagnostic complexities and provoke inquiries into their prevalence, factors influencing their development, clinical presentations, and appropriate therapeutic approaches. Conclusion As CS rates rise, this review aims to understand and address uterine niches and mitigate their impact on maternal health and reproductive outcomes.

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Section: A) Imagingmentioning

confidence: 99%

Section: A) Imagingmentioning

confidence: 99%

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Navigating uterine niche 360 degree: a narrative review

Zakherah,

Mohamed,

Rageh

et al. 2024

Middle East Fertil Soc J

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“…Infection wound disruption, venous thromboembolism as well as hemorrhage are some of the short-term consequences of caesarean delivery (1) . Although caesarean delivery's obstetric consequences are widely known; potential long-term gynecological diseases have received less attention (2) .…”

Section: Introductionmentioning

confidence: 99%

Assessment of Cesarean Section Uterine Scar by Transvaginal Ultrasound after Single Versus Double Layer Closure Techniques

Mousa¹,

Abdelhamed²,

Sadek³

et al. 2022

The Egyptian Journal of Hospital Medicine

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Background: The best way to show a caesarean section (CS) scar is using transvaginal ultrasound, which has better detection rates. The objective of the current study is to detect sonographic features of CS scar after single layer and double layer closure techniques and determine those of better healing and niche development. Patients and methods: A clinical trial was conducted on 74 pregnant at 39 weeks with single-tone pregnancies. Participants were divided into 2 equal groups. Group SL included 39 primigravidae who underwent single layer closure of the uterine incision during CS, and Group DL included 37 primigravidae who underwent double layer closure of the uterine incision during CS. Participant women were subjected to thorough medical and obstetrical examination, and ultrasound check 3 months following their operations. Results: Niche features revealed that patients in the double layer group had a significantly larger niche depth than those in the single layer group. Additionally, they had significantly greater residual myometrial thickness as compared to the single-layer group. No statistically significant difference in niche length, breadth, or neighboring myometrial thickness existed between the two groups. The residual myometrium thickness (RMT)/ adjacent myometrium thickness (AMT) ratio was utilized as a marker of uterine scar healing, and our findings indicated that patients in the double layer group had considerably higher healing "RMT/AMT" ratios than those in the single layer group. Conclusion:With closure of CS incision by double layer, better outcomes have occurred, including incidence of niche development, residual myometrial thickness and healing ratio than the single layer closure.

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“…While the overall expert consensus is expectant management for asymptomatic niche s detected incidentally on pelvic imaging, laparoscopic repair is a commonly used surgical treatment modality that will be discussed further in this article ( Nezhat et al, 2017 ; Brook et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic management of a full-thickness uterine niche with subsequent pregnancy outcome

Kasapoglu¹,

Tang²,

Kadir³

et al. 2021

Facts Views Vis ObGyn

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Background: Uterine niche is the consequence of impaired healing of the myometrium following a lower segment transverse caesarean section (CS). Although there is conflicting evidence on the management of these cases, laparoscopic repair is a commonly used surgical treatment modality. Objectives: To demonstrate the management and laparoscopic repair of the niche with subsequent pregnancy outcome. Materials and Methods: We report a case of a 33-year-old patient who had a significant haematoma in the niche. The haematoma resolved after conservative management however, she remained symptomatic. Therefore, she had a laparoscopic repair. The narrated surgical video article demonstrates the dissection of the uterovesical fold overlying the niche, followed by the excision of the scar tissue and its repair with laparoscopic suturing. Ultrasound and magnetic resonance imaging images of the uterus demonstrating the haematoma at the caesarean section site, the niche after resolution of the haematoma and post-repair imaging are also provided. Main outcome measures: Repair of the niche, symptomatic relief of abnormal uterine bleeding, spontaneous conception and live birth. Ultrasonographic images also demonstrate uterine wall continuity post laparoscopic repair. Results: The patient recovered uneventfully. Full-thickness of myometrium was demonstrated with post-operative imaging and confirmed at the subsequent caesarean section. Gynaecological symptoms resolved following the repair. The patient conceived spontaneously after surgery and delivered at term by caesarean section without any complications. Conclusion: Laparoscopic management of the niche should be considered where there is a complete myometrial defect or significant thinning of the myometrium, especially in symptomatic women who desire future pregnancy.

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Gynaecological morbidity associated with caesarean niche: increasing awareness, prevention and management

Cited by 4 publications

References 31 publications

Navigating uterine niche 360 degree: a narrative review

Navigating uterine niche 360 degree: a narrative review

Assessment of Cesarean Section Uterine Scar by Transvaginal Ultrasound after Single Versus Double Layer Closure Techniques

Laparoscopic management of a full-thickness uterine niche with subsequent pregnancy outcome

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