Ultrasonographic criteria of cesarean scar defect evaluation

Abstract

Cesarean sections account for approximately 20% of all deliveries worldwide. In Poland, the percentage of women delivering by cesarean section amounts to over 43%. According to studies, the prevalence of cesarean scar defects ranges from 24–70%. Due to the overall cesarean section rate, this is a medical problem affecting a large population of women. In such cases, ultrasonographic evaluation of a cesarean scar reveals a hypoechoic space filled with postmenstrual blood, representing a myometrial tear at the wound site. Such an ultrasound appearance is referred to as a niche, and it forms after a cesarean section at the site of the hysterotomy of the anterior uterine wall, most commonly within the uterine isthmus. Currently, the exact cause of niche formation remains unexplained, yet the risk factors for its development are universally acknowledged. They include the site of hysterotomy, multiple previous cesarean section deliveries, suturing technique and maternal diabetes or smoking. Ultrasound evaluation of the cesarean section scar is an important element of obstetric and gynecologic practice, especially in the case of further pregnancies. It facilitates an early diagnosis of a cesarean scar ectopic pregnancy, and the prediction of the risk for perinatal dehiscence in the case of a vaginal birth after a cesarean section.

Uterine niche after cesarean section: a review of diagnostic methods

“…There are no clear guidelines regarding the phase of the menstrual cycle in which a cesarean scar should be assessed [3]. According to some authors, the best time to perform an ultrasound examination is when the endometrial thickness is the smallest, it means immediately after the menstruation [33]. In another publication, the best time is during/after a few days after the menstruation [20].…”

Diagnosis of caesarean section scar niche causing chronic pelvic pain

“…There can be infertility due to impact of the collected blood on the cervical mucus as well as on sperm motility. 1 All these symptoms were present in the current lady. Her main complaint at present was constant back pain and pain during defecation There was no fissure-in-ano or haemorrhoids and no mass on per rectal examination as these are the main causes for rectalgia or proctalgia.…”

The Role of Ultrasound in Preventing the Life-Threatening Emergencies Associated With Repeated Cesarean Section

“…The measurement of the hysterography scar since the first trimester represents a prognostic factor for the evolution of the pregnancy regarding the risk of uterine rupture. A scar thickness value <2.5 mm is associated with an increased risk of uterine dehiscence [3]. A recent study exposes the sonographic characteristics of the lower uterine segment in labour in patients with cesarean section.…”