Gynecological outcomes of uterine niche after cesarean section: A descriptive study

Abstract

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.

Prevalence of Caesarean Section Niche in Women With Previous Caesarean Section and Its Effect on Reproductive Health

“…Regarding gynaecological symptoms, this study shows that more than half of women with CSN were symptomatic, which was also reported by Abdelfattah et al and the other studies mentioned below (7) .…”

“…In this study, niche was present in 44% of cases, which goes with the study done by Gozzi et al, who detected a prevalence of niche of 44.4% (8) . It is near to a systematic review done by Bij de Vaat et al, who found a prevalence of 24-70% when detected by TVU and between 56% and 84% when detected by SHG from twenty-one paper s (4) , and studies done by Abd (,9,10,13,14) , but does not agree with Osser et al which showed 70% detection by TVU and 84% detection by SHG (11) , and a study done by Abdelfattah et al which shows niche in 14.7% of cases detected by TVU, these may be related to the different procedure of CS, different study population, different criteria, and detection of niche by different personnel (7) .…”

“…In some studies, assessment is done 6-12 weeks after CS. However, other studies recommend assessment for cesarean niche at least six months after CS as remanent myometrial tissue (RMT) over the niche decreases with time, and most authors recommend assessment of niche in the follicular phase of the menstrual cycle, especially a few days after menstruation (7) .…”

Correlation between Blood Glucose Levels on Niche Incidence after Cesarean Section

“…Based on parity, 194 (64.67%) patients had parity 1-2, 102 (34.00%) patients had parity 3-4, and 4 (1.33%) patients had parity >5. For history of CS, 115 (38.33%) patients had only one history of previous CS, 116 (38.67%) patients had history of two previous CS, 67 (23.33%) patients had history of three previous CS, and 2 (0.67%) patients had history of four previous CS [22].…”