Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review
A J M Bij de Vaate, L F van der Voet, O Naji, M Witmer, S Veersema, H A M Brölmann, T Bourne, J A F Huirne, A J M Bij de Vaate, L F van der Voet, O Naji, M Witmer, S Veersema, H A M Brölmann, T Bourne, J A F Huirne
Abstract
Objective: To review systematically the medical literature reporting on the prevalence of a niche at the site of a Cesarean section (CS) scar using various diagnostic methods, on potential risk factors for the development of a niche and on niche-related gynecological symptoms in non-pregnant women.
Methods: The PubMed and EMBASE databases were searched. All types of clinical study reporting on the prevalence, risk factors and/or symptoms of a niche in non-pregnant women with a history of CS were included, apart from case reports and case series.
Results: Twenty-one papers were selected for inclusion in the review. A wide range in the prevalence of a niche was found. Using contrast-enhanced sonohysterography in a random population of women with a history of CS, the prevalence was found to vary between 56% and 84%. Nine studies reported on risk factors and each study evaluated different factors, which made it difficult to compare studies. Risk factors could be classified into four categories: those related to closure technique, to development of the lower uterine segment or location of the incision or to wound healing, and miscellaneous factors. Probable risk factors are single-layer myometrium closure, multiple CSs and uterine retroflexion. Six out of eight studies that evaluated niche-related symptoms described an association between the presence of a niche and postmenstrual spotting.
Conclusions: The reported prevalence of a niche in non-pregnant women varies depending on the method of detection, the criteria used to define a niche and the study population. Potential risk factors can be categorized into four main categories, which may be useful for future research and meta-analyses. The predominant symptom associated with a niche is postmenstrual spotting.
Keywords: Cesarean scar; isthmocele; postmenstrual spotting; scar defect; sonohysterography; transvaginal ultrasound; wound dehiscence.
Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
Source: PubMed