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Cesarean scar niche: An evolving concern in clinical practice
Fionnvola Armstrong1, Karen Mulligan1,2, Roisin Mac Dermott3
1National Maternity Hospital, Dublin, Ireland.
Summary
Cesarean scar niche, an indentation after C-section, has unclear prevalence but multifactorial causes. Treatment focuses on symptomatic relief for conditions like abnormal bleeding and subfertility.
Area of Science:
- Reproductive Medicine
- Gynecologic Surgery
Background:
- Rising cesarean section rates increase awareness of complications.
- Cesarean scar niche is defined as a uterine scar indentation ≥2mm, diagnosed via imaging.
- Its precise prevalence remains undetermined.
Purpose of the Study:
- To review current literature on cesarean scar niche.
- To summarize causes, prevalence, diagnosis, and symptoms.
- To provide management recommendations for this condition.
Main Methods:
- Literature review of existing studies on cesarean scar niche.
- Synthesis of data regarding etiology, diagnosis, and clinical presentation.
- Analysis of treatment strategies, including hormonal and surgical options.
Main Results:
- Causes appear multifactorial: technical, anatomical, and patient-related factors.
- Common symptoms include postmenstrual bleeding, pelvic pain, and subfertility.
- Pregnancy complications associated with niches include placenta accreta spectrum disorder and uterine rupture.
Conclusions:
- Cesarean scar niche is a recognized complication with diverse contributing factors.
- Management should target symptomatic relief, with hormonal therapy as a first-line option.
- Surgical intervention is reserved for refractory cases or contraindications to hormonal treatment.
