caesarean scar niche, caesarean section, CS defect, descent scar, rupture uterus, caesarean scar pregnancy, ectopic pregnancy, postmenstrual spotting, abnormal uterine bleeding, dysparonea, dysmenorrhea, 2nd infertility, adherent placenta, placenta previa.

1. CS SCAR NICHE
(DEFECT)
BY
MAGDY ABDELRAHMAN MOHAMED
LECTURER OF OB/GYN
2017

2. NOMENCLATURE
•Niche.
•Defect.
•Diverticulum.
•Pouch.

3. •Increase rate of CS lead to:
•Dehiscent scar & rupture uterus.
•Morbidly adherent placenta.
•CS scar niche.

4. DEFINITION
• No consensus.
• Indentations of the
myometrium of at least 2
mm.

5. DEFINITION
• Large niche was defined as
depth at least 50% of the
anterior myometrium, or the
remaining myometrial thickness
≤2.2 mm by TVS or ≤2.5 mm by
sonohysterography.
• Van Der Voet et al., 2014.

6. ETIOLOGY
• Low (cervical) location of the uterine incision
during a CS.
• Incomplete closure of the uterine wall, due to
single-layer, endometrial saving closure
technique.
• Surgical activities that may induce adhesion
formation (i.e. nonclosure of peritoneum,
inadequate haemostasis.)
• Patient related factor. (poor healing)

7. GYNECOLOGICAL SYMPTOMS
•Postmenstrual spotting.
•Dysmenorrhea.
•Chronic pelvic pain.
•Dyspareunia.

8. REPRODUCTIVE EFFECT
• Subfertility.?
Retained menstrual blood within niche may lead to:
• Chronic inflammatory state.
• Impair sperm motility.
• Impair implantation.
• CS scar pregnancy.
• Scar dehiscence in future pregnancy.

9. DIAGNOSIS
No consensus for accurate diagnosis.
•TVS…. Better during menses or
bleeding.
•Saline infusion sonohysterography.
•HSG.
•Hysteroscopy.

12. TREATMENT OPTIONS
•Medical therapy (symptomatic ttt).
• Analgesic, COCs.
•Surgical correction.
• Hysteroscopic niche resection.
• Laparoscopic repair.
• Vaginal repair.