<p>Evaluation of the Cesarean Scar Niche In Women With Secondary Infertility Undergoing ICSI Using 2D Sonohysterography Versus 3D Sonohysterography and Setting a Standard Criteria; Alalfy Simple Rules for Scar Assessment by Ultrasound To Prevent Health Problems for Women</p>

Abstract

Background Many expressions were used to define the defect that is seen by ultrasound after cesarean section (CS) namely scar defect, niche, isthmocele, uterine pouch or diverticula. Objective To compare the accuracy of 2 dimensional sonohysterography (2D SHG) to 3 dimensional sonohysterography (3D SHG) in evaluating cesarean section uterine scar depth (D), base width (BW), width (W) and residual myometrial thickness (RMT) in women with secondary infertility and establishment of a standard criteria; Alalfy simple rules for scar assessment. Patients and Methods This was an observational cross-sectional comparative study that was conducted on women who presented with secondary infertility and were candidates for intracytoplasmic sperm injection (ICSI) and giving a history of a previous cesarean section. Assessment of uterine scar in each woman was performed using 2D transvaginal ultrasound with sonohysterography (SHG) followed by 3D transvaginal with SHG with evaluation of niche depth, width, RMT, niche BW and RMT/depth ratio. The study was conducted at Algezeera hospital, Egypt. Results The present study revealed that 3D ultrasound with SHG is superior in evaluation of the RMT and niche width prior to ICSI providing better characterization of the scar niche. Conclusion Scar niche should be assessed by a combined integrated 2D SHG and 3D SHG scan with the specific geometrical and anatomical considerations, Alalfy simple rules for scar niche assessment that involvemeasurement of niche depth, (Base width) BW, width, RMT and RMT/depth ratio in sagittal plane, RMT in coronal plane / niche width in coronal plane ratio (ratio less than 1 denotes scar weakness with more liability for dehiscence). Trial Registration Clinical Trials.gov Id NCT04076904.

Uterine niche after cesarean section: a review of diagnostic methods

“…The study by M. Alalfy showed that 3D sonohysterography is as accurate in assessing the uterine niche after cesarean section as 2D sonohysterography. However, the use of 3D sonography provide better characterization of the cesarean scar niche, because of superior evaluation of the RMT and niche width before the Intracytoplasmic Sperm Injection [20].…”

“…According to some authors, the best time to perform an ultrasound examination is when the endometrial thickness is the smallest, it means immediately after the menstruation [33]. In another publication, the best time is during/after a few days after the menstruation [20]. According to the modified Delphi protocol, the ultrasound niche evaluation between 7.-14. cycle day may prevent the need for additional infusion fluid due to its natural intrauterine occurrence in the midfollicular phase [3].…”

Scar Tissue after a Cesarean Section—The Management of Different Complications in Pregnant Women

“…It is proved that the US scan is the most valuable, repeatable, and cost-effective technique [18,19]. Scar niche can be assessed by a combined integrated 2D and 3D US scan with new specific geometrical and anatomical considerations [20].…”

The impact of Cesarean section on female fertility: a narrative review

“…Three-dimensional sonohysterography gives the examiner a more detailed image of the niche with regard to base width and scar depth. More precise data leads to a better prediction of the outcome in future pregnancies and is important to guide follow-up niche management [24,25].…”