Background: Cesarean section (CS) scars can develop into niches, which are triangular anechoic areas at the site of the CS incision indicating defective tissue healing and usually associated with various gynecological symptoms. However, the prevalence and clinical significance of niches remain debated.
Objectives: This study aimed to investigate the prevalence of niches in women with previous CS, and to correlate their presence with the clinical symptoms.
Methods: A cross-sectional study was conducted on 100 women with previous one or two CS evaluated within 6 months after delivery. Trans-vaginal ultrasound (TVUS) was used to identify the niche and to measure its length, depth, width in addition to the residual myometrial thickness (RMT). Patients were then classified as symptomatic or asymptomatic based on the niche related gynecological symptoms.
Results: From women attending the Ob&Gyn clinic within 6 months post CS uterine niche was detected in 100 women during routine TVUS examination. 68 women (68%) were symptomatic and 32(32%) were asymptomatic. Symptoms included menstrual irregularity (35.0%), Dysmenorrhea (36%) Chronic pelvic pain (27%). The most common symptom was Postmenstrual spotting reported in in all symptomatic group (68%) followed by dyspareunia that was reported only in (52.0%) of the patients. Comparing the symptomatic and asymptomatic groups showed that: Age and BMI were significantly higher in symptomatic group (P value is 0.002 and 0.016) respectively. The depth and the width of the niche were significantly higher in symptomatic group (P value 0.027 and |
