Post caesarean section niche and female subfertility

Abstract

Background: Caesarean delivery is one of the most common surgical procedures in females. "CS niche" refers to a hypoechoic region with myometrial disruption at the site of prior CS within the isthmus (lower uterine segment) myometrium (defect). A myometrial depression of at least 2 millimetres is considered a niche. A scar defect forms on the anterior wall of the uterine isthmus after hysterotomy or Caesarean delivery. Several pregnancy-and patient-related hypotheses explain why a niche develops. Caesarean scar defect patients had many symptoms. Delayed cervix menstruation causes abnormal uterine bleeding, pelvic pain, vaginal discharge, dysmenorrhea, dyspareunia, and infertility. A niche may cause future obstetric problems. Aim: To assess the relationship between post Caesarean section niche and female subfertility. Subject and Methods: This study was an observational prospective cohort study. The study was carried out at the Department of Obstetrics and Gynecology. Tanta University Hospitals. Results: Intermenstrual bleeding, dysmenorrhea, dysparunea, pelvic pain were statistically significant higher in niche group than no niche group. There is statistically significant lower pregnancy rate in CS with Niche group than CS without niche group. As regard the relation between intramenestrual spotting and ultrasound findings in CS with niche patients; there is statistically significant higher IU fluid collection, niche depth, endometrial thickness and lower RMT in patients with AUB. Conclusion:With increasing cesarean section rates worldwide, it is inevitable that sequelae associated with such surgery is also increasing. It is clear that cesarean scar niche formation is a common complication, the formation of which appears to be multifactorial in nature but associated with poor wound healing, cesarean section technique, and possibly retroflexion of the uterus.