Evaluation Of The Caesarean Scar Niche In Women With Previous Caesarean Section 2D Saline Sonohystrography Versus 3D Saline Sonohystrography

Abstract

A niche is defined as any uterine dimpling measuring 2mm or more at the site of cesarean scar and could be visualized by ultrasound. the cesarean-induced isthmocele may lead to the occurrence of gynecologic symptoms such as abnormal uterine bleeding(AUB) secondary to intermittent passage of retained  menstrual blood  within the cesarean scar defect (CSD), pelvic pain, and sterility. The worldwide prevalence of post-cesarean scar niche out of all cesarean sections ranges from 19% to 84%,  but this may be underrated because of asymptomatic patients and a lack of clinician awareness. Sonohysterography (SHG) identified a higher number of patients with isthmoceles (56%–78%) than transvaginal ultrasound (24%–69%) . There is an increasing tendency for cesarean delivery worldwide so  several obstetric complications such as placenta accreta, scar dehiscence, rupture uterus especially in trial of birth after cesarean section and ectopic scar pregnancy due to inappropriate healing. Niche with total score between 0 and 2 is probably clinically irrelevant and other specific features should be investigated but total score>2 indicates potentially clinically relevant features of uterine niche and future pregnancies should be monitored closely.