Uterine niche

Uterine niche refers to a small indentation or defect at the site of a previous cesarean section scar in the uterus. This condition is also known as a cesarean scar defect or niche. It is identified through imaging techniques such as ultrasound or magnetic resonance imaging (MRI). Uterine niches are of clinical importance due to their association with postmenstrual spotting, pelvic pain, and potential complications in subsequent pregnancies.

Causes

The primary cause of a uterine niche is the healing process following a cesarean section (C-section). Not all women who undergo a C-section will develop a niche; the risk may be influenced by surgical techniques, the healing capacity of the individual, and other factors such as infection.

Symptoms

Many women with a uterine niche may not experience any symptoms. However, when symptoms do occur, they can include:

• Postmenstrual spotting or bleeding
• Pelvic pain
• Infertility (in some cases)

Diagnosis

Diagnosis of a uterine niche typically involves imaging studies. The most common methods include:

• Transvaginal ultrasound: A high-resolution ultrasound probe is inserted into the vagina to get a close view of the uterus and the scar area.
• Saline infusion sonohysterography (SIS): This technique involves the injection of saline into the uterus during ultrasound imaging to enhance the visualization of the uterine cavity and the niche.
• Magnetic resonance imaging (MRI): MRI may be used when a more detailed image of the uterine structure is required.

Treatment

Treatment options for a uterine niche depend on the severity of symptoms and the patient's reproductive plans. Options may include:

• Expectant management for asymptomatic women or those with mild symptoms.
• Hormonal therapy to reduce bleeding and pain.
• Surgical intervention, such as laparoscopic or hysteroscopic repair, may be considered for symptomatic niches, especially in women desiring future pregnancies.

Complications

Complications related to uterine niches primarily concern future pregnancies. These can include:

• Difficulty in conceiving
• Increased risk of uterine rupture during pregnancy
• Placental abnormalities such as placenta previa or placenta accreta

Prevention

Preventive strategies focus on minimizing the risk of niche formation after a C-section. These include:

• Optimal surgical techniques during cesarean delivery
• Consideration of vaginal delivery if appropriate in subsequent pregnancies

See Also

• Cesarean section
• Ultrasound
• Magnetic resonance imaging (MRI)
• Saline infusion sonohysterography (SIS)
• Placenta previa
• Placenta accreta

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